Tests for myeloma

You usually have a number of tests to diagnose myeloma and plan treatment. These include:

• blood and urine tests
• bone marrow test
• x-rays and scans

Tests your GP might do

Most people start by seeing their GP. Your GP can do some tests to help them decide whether you need to see a specialist (haematologist). Your GP might arrange:

Blood tests

Your GP can arrange blood tests to check:

• your blood cell levels (full blood count)
• how well your liver and kidneys are working 
• your calcium level
• how thick your blood is (plasma viscosity) 

Blood tests also look for abnormal types of antibodies (immunoglobulins) called paraproteins . Myeloma makes paraproteins. These blood tests include: 

• serum protein electrophoresis - this checks for paraproteins 
• serum free light chain assay (sFLC) - this looks for small proteins called light chains in your blood 
• total immunoglobulin levels - this test measures the level of normal antibodies in your blood 

Urine tests

Your doctor might ask for a urine sample to check for:

• problems with your kidneys (urinalysis)
• abnormal antibodies (paraproteins) made by myeloma cells (Bence Jones protein)

You might:

• give a sample of your urine in a pot to your doctor or nurse
• collect your urine over 24 hours - you take a container home to collect all of the urine you pass in the 24 hours 

It is now more common to have a blood test instead of a 24 hour urine collection. The blood test is called a serum free light chain (sFLC) assay.

Bence Jones protein

Tests can detect paraproteins in the blood and urine if you have myeloma. One part of the paraprotein is called the light chain. This is also known as the Bence Jones protein. The body gets rid of the light chain in the urine. Urine tests are a way of detecting these light chains to diagnose and monitor myeloma.

Tests at the hospital

If your GP thinks your symptoms could be due to myeloma, you will have more tests at the hospital. Tests might include:

• further blood tests
• a bone marrow test
• an x-ray
• an MRI scan
• a PET-CT scan
• a CT scan

Further blood tests

Further blood tests can help the doctor understand more about your myeloma. The results can show how myeloma is affecting you and how it might develop (the stage). Blood tests include:

• beta 2 microglobulin (β2M) - this protein level is raised in myeloma 
• immunofixation electrophoresis (IFE) - this shows which type of immunoglobulin the myeloma is making (for example, IgA or IgG)
• albumin level - this protein can be low if you have myeloma 
• LDH (lactic dehydrogenase) levels 

Bone marrow test

This test checks for myeloma cells in your bone marrow .  A doctor or specialist nurse removes a sample of bone marrow, usually from your hip. Doctors then look at this under a microscope. 

You have the test in the outpatient department. Or you may have this on the ward if you are in hospital. You're usually awake and have a local anaesthetic  to numb the area. Some people have medicine to make them drowsy (sedation).

X-rays

You might have x-rays to investigate bone symptoms and to help diagnose myeloma.

Doctors can do a series of x-rays. This includes x-rays of your skull, spine and long bones. They call this a skeletal survey.

Doctors don't tend to use skeletal surveys any more. Instead, you are more likely to have scans such as a PET-CT, MRI or CT scan. 

MRI scan

MRI stands for magnetic resonance imaging. It is a type of scan that uses magnetism and radio waves to take pictures of inside the body. It produces pictures from angles all around the body.

You might have an MRI scan if you are diagnosed with myeloma. Doctors use MRI scans of your whole body to see how myeloma is affecting your bones. They also use MRI scans if they suspect that myeloma is causing spinal cord compression . 

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan into one. This type of scan can give detailed information about your myeloma.

The CT scan takes a series of pictures from all around your body. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. 

You might have a PET-CT scan if the results of other scans are unclear. It can also help doctors diagnose a condition similar to myeloma called plasmacytoma .

CT scan

CT (or CAT) stands for computed (axial) tomography. It uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures from different angles. The computer puts them together to make a 3 dimensional (3D) image.  

You usually have a whole body MRI scan to assess bone damage in myeloma. But your doctor might suggest a CT scan if MRI is not an option. They might do a whole body low dose CT scan. This uses a lower dose of radiation.

Your doctor might do a CT scan of one part of your body to get more information about painful areas of bone.  

Genetic tests on your myeloma cells

Your doctors do tests on your blood and bone marrow to look for changes in certain genes . This helps them understand how your myeloma might behave. You might hear these tests called cytogenetic tests or molecular analysis.

Most body cells contain chromosomes . Chromosomes are made up of thousands of genes. Genes carry the instructions cells need to work properly. Sometimes a change happens in the genes when a cell divides. 

The doctors do cytogenetic tests to look for changes in genes and chromosomes in the myeloma cells. This is different to testing you to see if you have an inherited faulty gene that increases your risk of getting myeloma in the first place. 

Types of genetic changes

There are many gene changes (mutations) that can happen in myeloma. The doctors give mutations names which are codes for the specific change.

They refer to these genetic mutations as either high risk or low risk. They use this information, along with other factors, to decide what stage your myeloma is. This helps them understand how your myeloma might develop.

Types of genetic tests

FISH tests

FISH stands for fluorescence in situ hybridisation. The FISH technique uses a special fluorescent dye. This makes it easier to see particular gene and chromosome changes.

The doctors don’t need to grow the cells first, so it is a quicker test than some other types of gene tests.

Treatment for myeloma

All the tests you have help your doctor find out about more about the myeloma.

This is important because doctors recommend your treatment depending on:

• your symptoms
• results of blood tests, bone marrow tests and scans
• general health and levels of fitness 
• personal wishes

Coping with myeloma

Coping with a diagnosis of myeloma can be difficult. There is help and support available to you and your family.