Multiple myeloma - Diagnosing multiple myeloma

Multiple myeloma is a rare type of cancer that initially has few or no symptoms. This means that a diagnosis can often be delayed.

Your GP will examine you and ask about your symptoms, medical history and overall health.

During the examination, your GP will look for things such as bleeding, signs of infection and specific areas of bone tenderness.

They may ask you to have blood tests and a urine test (see below) to check for the presence of certain types of antibodies (proteins).

After looking at your blood test results, if your GP suspects multiple myeloma, they will refer you to a haematologist (medical doctor who specialises in conditions affecting the blood).

The haematologist will carry out further blood and urine tests, scans, X-rays and a bone marrow test.

Blood tests

A number of blood tests are used to help diagnose multiple myeloma.

An erythrocyte sedimentation rate (ESR) test, or plasma viscosity (PV) test, is a type of blood test that shows whether there are unusually high levels of proteins in your blood that make it more viscous (thick). If you have myeloma, your ESR or PV will usually be raised.

You will also have blood tests to measure the type and number of abnormal antibodies produced by the cancerous plasma cells. The test can be used to help both diagnose and manage myeloma.

You will also have a full blood count (FBC) to check your levels of the different types of blood cells. In particular, your doctor will be looking for a low number of red blood cells and platelets (tiny cell fragments that cause the blood to clot).

Other blood tests may also be used to check the functioning of your liver and kidneys. Your blood calcium level may also be checked. In myeloma, the calcium level can be high. Many of these tests will be repeated on more than one occasion.

Urine tests

A urine sample will be checked for the abnormal proteins produced by the cancerous plasma cells. The abnormal proteins are known as ‘monoclonal light chains’ and are sometimes referred to as Bence Jones protein.

These proteins can damage your kidneys as they pass through them from the blood to the urine. You may be asked to collect all of the urine you pass over a 24-hour period. This sample can be used to check the quantity of proteins being produced and how well your kidneys are functioning.

X-rays and other scans

Large quantities of plasma cells produced in your bone marrow can damage the hard outer layer of your bones. You should tell your specialist if you have bone pain in certain parts of your body.

You will have X-rays taken of your long bones, skull, spine and pelvis to help identify any damage. You may also have a chest X-ray.

Other scans, such as computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans may also be carried out. 

Bone marrow test

A bone marrow test is usually used to confirm a diagnosis of multiple myeloma.

A needle will be used to take a small sample of bone marrow (biopsy) from one of your bones, usually the pelvis. A sample of bone may also be removed. The biopsy will be carried out using a local anaesthetic.

The sample of bone marrow (and bone) will be examined in a laboratory to check for the presence of cancerous plasma cells.