Other Tests For Myeloma
You will also have blood tests to show how the myeloma is affecting you. The tests measure the following:
- Blood cells levels this test measures the number of red blood cells, white blood cells and platelets in your blood. These can be low in people with myeloma.
- Urea and electrolytes and creatinine levels this test shows how well your kidneys are working.
- Calcium levels this test measures the level of calcium in the blood. The level can be raised if the myeloma is affecting your bones.
- Albumin levels this test measures the level of a protein called albumin in the blood. The level can be low in people who have myeloma. This test is used to help stage the myeloma.
- Lactate dehydrogenase levels this test measures the amount of a substance called LDH in the blood. This can be higher in patients with myeloma. The level of LDH is also used to help find out the stage of the myeloma.
How Multiple Myeloma Is Diagnosed
There are many tests used for diagnosing multiple myeloma. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests
The following tests may be used to diagnose multiple myeloma:
Blood and urine tests. Blood and urine tests play a key role in diagnosing myeloma.
These test results are important for determining the stage of the myeloma. Blood tests are also used to measure kidney function, calcium levels, and blood cell counts for possible anemia and other low blood counts.
X-ray. An x-ray is a way to create a picture of the structures inside of your body, using a small amount of radiation. X-rays taken as part of the doctors evaluation of the patients skeletal system are typically the first step in evaluating bones when myeloma is suspected or diagnosed. A x-ray skeletal survey may not find myeloma as early as the more advanced tests described below.
Fat pad aspirate. If certain M proteins that are misfolded in a particular way are deposited in body tissues, it can cause organs to stop functioning normally. This condition is called amyloidosis. If your doctor suspects you may have amyloidosis, then it may be necessary to take a sample of the abdominal fat pad to be examined under a microscope, called a biopsy.
How Is Multiple Myeloma Treated
Theres no cure for multiple myeloma. However, there are treatments that can help ease the pain, reduce complications, and slow the progression of the disease. Treatments are only used if the disease is getting worse.
Your doctor is unlikely to suggest treatment if you arent experiencing any symptoms. Instead, your doctor will closely monitor your condition for signs that the disease is progressing. This often involves regular blood and urine tests.
If you need treatment, common options include the following:
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How Multiple Myeloma Is Treated
There is currently no cure for multiple myeloma, but treatment can often help control it for several years.
Treatment will often involve:
- a combination of anti-myeloma medications to destroy the myeloma cells
- medicines and procedures to prevent and treat problems caused by myeloma, such as bone pain, fractures and anaemia
- anti-myeloma medicines to control the cancer when it comes back
As part of your treatment, you may be asked if you want to take part in a clinical trial to help researchers develop better treatments for multiple myeloma.
Read more about treating multiple myeloma
Bringing Myeloma Under Control
The initial treatment for multiple myeloma may be either:
- non-intensive for older or less fit patients
- intensive for younger or fitter patients
The decision about which treatment is appropriate for you is usually based on your biological age or fitness.
As a general rule, people younger than 65 are more likely to be candidates for intensive therapy. For those over 70, non-intensive treatment is more likely to be recommended.
Those aged in between will be given careful consideration as to what treatment group they fall into.
Both non-intensive and intensive treatments involve taking a combination of anti-myeloma medicines. Intensive treatment involves much higher doses and is followed by a stem cell transplant.
The medicines usually include a chemotherapy medicine, a steroid medicine, and either thalidomide or bortezomib.
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When The Diagnosis Isnt Multiple Myeloma Yet
Physicians sometimes diagnose a condition called monoclonal gammopathy of unknown significance, or MGUS, after blood samples taken during a routine medical checkup reveal unusually high levels of protein.
For people with MGUS, abnormal plasma cells make up less than 10 percent of the cells in bone marrow.
MGUS occurs in about 3 percent of people age 50 and older. The condition is asymptomatic and doesnt require treatment but puts doctors on alert, because over time MGUS can develop into multiple myeloma or another plasma cell or lymph disorder.
A long-term study at the Mayo Clinic in Rochester, Minnesota, published in the New England Journal of Medicine in January 2018, followed more than 1,300 patients with MGUS over a median period of 34 years. The researchers found that MGUS progressed in 11 percent of patients a rate that was almost seven times higher than in the general population.
Staging Of Multiple Myeloma
If multiple myeloma is found during diagnosis, doctors will then use certain tests to determine how far its progressed. This is known as staging the cancer. Tests look at:
- blood cell counts
- protein levels in blood and urine
- calcium levels in blood
There are two ways to stage multiple myeloma:
Both systems divide the condition into three stages, with the third stage being the most severe. Staging helps your doctor determine your outlook and treatment options.
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Treating Symptoms And Complications Of Myeloma
As well as the main treatments for multiple myeloma, you may also need treatment to help relieve some of the problems caused by the condition.
- painkillers may be given to reduce pain
- radiotherapy may be used to relieve bone pain or help healing after a bone is surgically repaired
- bisphosphonate medication either given as tablets or by injection, this may help prevent bone damage and reduce the levels of calcium in your blood
- blood transfusions or erythropoietin medication may be used to increase your red blood cell count and treat anaemia
- surgery may be carried out to repair or strengthen damaged bones, or treat compression of the spinal cord
- dialysis may be required if you develop kidney failure
- plasma exchange treatment to remove and replace a blood component called plasma may be carried out if you have unusually thick blood
These treatments can each cause side effects and complications, so make sure you discuss the potential risks and benefits with your treatment team beforehand.
Blood And Urine Tests: Go
If a doctor suspects that a patient has multiple myeloma, blood and urine tests can help confirm the diagnosis.
- Blood counts A test called the complete blood count measures levels of red cells, white cells, and platelets in a blood sample. Myeloma cells can crowd out other cells in bone marrow, causing levels to drop.
- Blood chemistry tests These tests focus on creatinine the blood protein albumin and calcium . Doctors may also run additional tests to measure the enzyme lactate dehydrogenase because elevated levels reveal that the disease has already reached an advanced stage.
- Urine tests Myeloma cells produce something called a monoclonal protein an abnormal type. This goes by a number of names, including M protein. The kidneys filter some of it out of the blood and pass it out of the body in urine.
- Quantitative immunoglobulins This test measures the levels of different kinds of antibodies in the blood. Multiple myeloma can raise or lower levels of certain antibodies. This is the umbrella term for a variety of tests that can detect monoclonal antibodies in a blood or urine sample.
- Serum-free light chains Antibodies are made up of light and heavy protein chains. This test looks for changes in light-chain levels, which can signify multiple myeloma.
- Beta-2 microglobulin This is another protein produced by myeloma cells high levels suggest the cancer is at an advanced stage.
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What Are Multiple Myeloma Treatments
Healthcare providers treat multiple myeloma based on your symptoms and the extent of your disease. For example, people who have MGUS usually dont need treatment, but their healthcare provider will closely monitor their overall health. They may also develop a treatment plan so they can move quickly if symptoms do develop.
Some treatments healthcare providers may use if you have symptoms caused by multiple myeloma include:
- Pain medications:People often have significant bone pain.
- Antibiotics:A weakened immune system can lead to more infections. Your doctor may prescribe antibiotics to clear up these infections.
- Steroids: High doses of steroids can kill cancer cells and reduce inflammation.
- Chemotherapy: Healthcare providers use chemotherapy to reduce the number of abnormal plasma cells.
- Immunotherapy:This treatment stimulates your immune system so it develops more cancer-fighting cells.
- Radiation therapy: This treatment kills cancer cells and reduces bone tumors.
- Stem cell transplants: Stem cells are specialized cells in your bone marrow or blood that can help produce healthy new plasma cells. Healthcare providers typically recommend autologous stem cell transplants. This treatment replaces damaged or unhealthy stem cells with healthy stem cells from your body. Rarely, you may receive healthy plasma stem cells from a donor. This is an allogenic stem cell transplant.
Possible Risks Of Having A Blood Test
Blood sampling is a safe test. There is a possibility of:
- bleeding and bruising – pressing hard when the needle is removed can help to stop it
- pain – this is normally mild and can last for a few minutes
- swelling – ask your nurse, doctor or phlebotomist to avoid an arm that is swollen or has a risk of swelling
- feeling faint or fainting – tell the person doing your blood test if you’re feeling lightheaded or dizzy at any time
- infection – this is very rare
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Blood Tests For Myeloma
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Blood tests are an important way to diagnose the type of myeloma and to monitor myeloma. They can also check how well the myeloma is responding to treatment.
These tests include the following:
- Serum protein electrophoresis this is a test to find out if a paraprotein is in the blood and what type it is. If it is present, a second test may be done to find out the type.
- Paraprotein level this is a test to measure the amount of paraproteins in the blood.
- Light chains this is a test to measure the amount of light chains in the blood and the amount of kappa and lambda light chains there are.
- Beta-2 microglobulin level this is a test to see how active the myeloma is and to find out the stage of the myeloma. B2M is a protein that is on the surface of most cells in the body. In people with myeloma, the level of B2M is often higher.
Diagnosis Of Multiple Myeloma
Diagnosing multiple myeloma usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for multiple myeloma or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as multiple myeloma. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of multiple myeloma.
The following tests are commonly used to rule out or diagnose multiple myeloma. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.
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Learn More About Multiple Myeloma
Educate yourself by learning about multiple myeloma so you can make informed decisions about your treatment. Talk with your doctor about your treatment options and the side effects of treatment.
The and International Myeloma Foundation can also provide you with more information about multiple myeloma.
What Are Multiple Myeloma Symptoms
Multiple myeloma causes many symptoms, but bone pain often is the first symptom people notice. Other symptoms include:
- Weakness in your arms and legs and/or a sensation of numbness in your arms and legs. Multiple myeloma can affect the bones in your spine, causing them to collapse and press on your spinal cord.
- Having fatigue feeling so tired you cant manage daily activities and feeling weak. These are signs of anemia.
- Nausea and vomiting. This may be a sign of hypercalcemia.
- Not having an appetite and/or feeling thirstier than usual. These may be signs of hypercalcemia.
- Unexplained weight loss.
- Unexplained fever. This may be a symptom of a bacterial infection.
- Bruising or bleeding more easily. This may be a sign abnormal plasma cells prevent your body from producing enough platelets. Platelets help your blood to clot.
- Feeling confused or foggy.
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Types Of Multiple Myeloma
There are two main types of multiple myeloma:
- Indolent myeloma. This type usually develops slowly without noticeable symptoms. It doesnt cause bone tumors, only small increases in M protein and M plasma cells.
- Solitary plasmacytoma. This type causes a tumor to form, typically in the bone. It usually responds well to treatment, but it needs close monitoring.
The symptoms of multiple myeloma vary depending on the person. Initially, symptoms may not be noticeable. However, as the disease progresses, most people will experience at least one of four major types of symptoms.
These symptoms are generally referred to by the acronym CRAB, which stands for:
- exposed to radiation
- employed in the petroleum industry
Another risk factor for multiple myeloma is a history of monoclonal gammopathy of undetermined significance . This is a condition that causes plasma cells to produce M proteins. It usually doesnt cause any problems.
However, MGUS can sometimes develop into multiple myeloma over time.
When To Speak To Your Gp
Speak to your GP if you have any of these symptoms. While they’re unlikely to be caused by cancer, it’s best to get a proper diagnosis.
Your GP will examine you to check for bone tenderness, bleeding, signs of infection, and any other symptoms that suggest you may have myeloma.
They may also arrange blood and urine tests that can detect abnormal proteins produced by myeloma cells.
If myeloma is suspected, you will be referred to a consultant haematologist for further tests and treatment.
Read more about diagnosing multiple myeloma
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Tests To Assess Proteins And Other Substances In The Blood
Many tests are used to assess proteins and other substances in the blood of multiple myeloma patients. These tests measure levels of blood calcium, total protein, serum beta-2 microglobulin, LDH, C-reactive protein, and blood glucose. They are used to monitor the disease and its potential complications.
These tests are part of a basic medical exam and are also very useful in diagnosing and monitoring myeloma.
Serum Free Light Chains
This blood test can measure the light chain levels in the blood and is done when looking for myeloma or light chain amyloidosis.
This is most helpful in the rare cases of myeloma in which no M protein is found by SPEP. Since the SPEP measures the levels of intact antibodies, it cannot measure the amount of light chains only.
This test also calculates thelight chain ratio which is used to see if there is one type of light chain more than the other. There are 2 kinds of light chains: kappa and lambda. Normally, they are present in equal amounts in the blood, giving a ratio of 1 to 1. If there is more of one type of light chain than the other, the ratio will be different, which can be a sign of myeloma.
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Fine Needle Aspiration Biopsy
Fine needle aspiration uses a very thin needle and a syringe to withdraw a small amount of tissue from a tumor or lymph node. The doctor can aim the needle while feeling an enlarged lymph node near the surface of the body. If the abnormal area is deep in the body, the needle can be guided while its watched on a computed tomography scan . The main advantage of FNA is that it doesnt require surgery. The disadvantage is that in some cases the thin needle cannot remove enough tissue for a definite diagnosis.
An Accurate Multiple Myeloma Diagnosis
Results of any single test are not enough to make a diagnosis of multiple myeloma. Diagnosis is based on a combination of factors, including the patients description of symptoms, the doctors physical examination and the results of a variety of tests. The diagnosis of multiple myeloma requires either:
- A plasma cell tumor OR
- At least 10% of the cells in the bone marrow be plasma cells.AND one of the following:
- M protein over a certain level in the blood OR
- M protein in the urine over a certain level OR
- Holes in bones due to tumor growth are found on imaging studies.
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