Tests for myeloma

Most people go to the GP when they first suspect they have a health problem. Your family doctor will examine you and ask about your general health and medical history. The doctor will also ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor may give you a physical examination to look for things such as bruising, bleeding or signs of infection. You will probably be asked to have some simple blood tests. You may also have a urine test if your doctor suspects myeloma.

If your doctor suspects that you may have multiple myeloma, they will arrange for you to see a haematologist at your local hospital. A haematologist is a medical doctor who specialises in diseases of the blood.

At the hospital, the haematologist will ask about your medical history and symptoms. He or she will examine you and arrange some more tests. You may have any or all of the following tests.

There are a variety of blood tests that help to diagnose myeloma. One of the first blood tests your GP may have done is a blood test called an ESR. This stands for erythrocyte sedimentation rate (ESR). This test shows the doctor whether the red cells (erythrocytes) are sticking together, forming clumps. An abnormal ESR can be a sign of many illnesses or conditions, such as arthritis, infections and inflammation. But it can also be raised in myeloma, so an abnormal ESR may prompt your doctor to do further tests, particularly if there's no obvious reason for it to be raised.

The main blood test to diagnose and monitor myeloma measures the type and amount of abnormal antibodies (paraprotein) produced by the plasma cells. This blood test is called serum protein electrophoresis or immunofixation because of the way the blood is tested in the lab.

Your specialist will do a full blood count to check the levels of the different types of blood cells. Your GP may have already done this blood test, but it's likely to be repeated. If any of the blood cells are abnormal, this will be noted and reported back to your doctor. The doctor will be looking out for low red blood cell or platelet counts. Sometimes there are low counts of the different types of white blood cells as well, although these can be normal. You will have other blood tests to check that your liver and kidneys are working properly. Your doctor may also ask for your blood calcium level. This can be raised in myeloma, if it is affecting the bones.

There is a new test which is useful for diagnosing and monitoring the small group of patients who don't produce the paraprotein that can be picked up on the standard blood and urine tests for myeloma. You may hear it called the 'serum free light chain test' or Freelite. Serum means the liquid part of the blood, and the 'free' just means the protein is floating unattached in the bloodstream. The 'light chain' is part of the abnormal protein made by myeloma cells that we call Bence Jones protein when it gets into the urine. This test can pick up tiny amounts of free light chains in the blood.

This is sometimes called a bone marrow aspirate and biopsy. For this test, the doctor must remove a sample of bone marrow cells (aspirate) with or without a sample of bone (biopsy) to look at under the microscope. There is more information about having a bone marrow test in the about cancer tests section of CancerHelp UK.

In the laboratory, a scientist will test the cells from the bone marrow aspirate to see if there are any abnormal chromosomes. This is called cytogenetics. About 7 out of 10 (70%) people with myeloma have chromosome changes. Various research studies are looking into this. A few chromosome changes have been found that can have an effect on how quickly the myeloma develops and how well treatment may work. Doctors may be able to use this information in the future to help decide which patients need more intensive treatment.

The large numbers of plasma cells being made in the bone marrow can cause damage to the bones. It will help your doctor to find this damage if you mention any bones that are painful. Then, your doctor will ask you to have X-rays of all your long bones, spine, pelvis and skull to find any areas of damage that are not causing symptoms. This is called a skeletal survey. You may also be asked to have a chest X-ray to check your general health.

The specialist will ask you for a urine sample. Your sample will go off to the lab, where the pathologist will check for the abnormal antibodies made by the cancerous plasma cells in multiple myeloma. Antibodies are proteins. You may hear the antibody called monoclonal immunoglobulin or paraprotein. Different paraproteins are made in different types of myeloma. Bence Jones protein is part of the abnormal paraprotein made by the plasma cells. The body gets rid of this protein in your urine. So it may be picked up in your urine sample if you have multiple myeloma. About 3 out of 4 people (75%) with malignant myeloma have Bence Jones protein in their urine.

These protein molecules can damage the kidneys as they pass through them from the blood to the urine. Your doctor will check the levels of creatinine in your blood. Creatinine is another chemical that is removed from the body by your kidneys. If the levels of creatinine in your blood are high, this may mean your kidneys are not working properly.

You will probably be asked to collect all the urine you pass for 24 hours. This is the best way of finding out how much Bence Jones protein you are producing and also how well your kidneys are working.