How Does My Doctor Know I Have Multiple Myeloma?

Your doctor may find myeloma, based on a blood or urine test during a routine visit, even if you don't have symptoms. If you have symptoms that might be due to multiple myeloma, your doctor will ask you about the following:

  • Your current symptoms

  • Your health history

  • Your family's history of cancer

  • Your other risk factors

Your doctor may also perform certain tests to check if you have multiple myeloma. You may need more than one of these tests. Your doctor may give you the tests in the order in which they are listed, or in a different order.

Blood tests. Blood tests help your doctor check your immunoglobulin (antibody) levels. These are the proteins that your plasma cells make. Multiple myeloma causes an increase in M protein (immunoglobulin) levels. Your doctor will also take a small sample of your blood for a complete blood count (CBC). This will let your doctor check for anemia and other problems that may result from multiple myeloma.

Urine tests. Urine tests can help your doctor check for M protein and other protein levels. You may need to collect your urine for 24 hours for these tests. They may also show how well your kidneys function. Myeloma can harm your kidneys.

X-rays. X-rays help your doctor see if any of your bones are broken or affected, which is a sign of multiple myeloma. The series of x-rays often performed in the workup of myeloma is called a “skeletal survey” or “myeloma bone survey.”

Bone marrow aspiration and biopsy. These tests look for cancer cells in the bone marrow, usually in the hip bone. They are often done at the same time. Your doctor numbs the area over your hip with a local anesthetic. For the bone marrow aspiration, your doctor places a thin, hollow needle attached to a syringe into your hip bone to suck out (aspirate) a sample of blood and cells from your bone marrow. This is usually followed by the bone marrow biopsy. For the biopsy, your doctor uses a larger needle to remove a small piece of bone and bone marrow from your hip bone. A pathologist then checks the cell samples for cancer. A pathologist is a doctor who specializes in looking at cells under a microscope to check for problems, including cancer. A biopsy is the only way for your doctor to know for sure if you have cancer.

Magnetic resonance imaging (MRI). This imaging test may be helpful on occasion, but it is not always necessary in evaluating for myeloma. MRIs use radio waves and magnets to create detailed images of the inside of your body. The energy from the radio waves creates patterns formed by different types of tissue and diseases. These patterns make cross-sectional pictures that look like slices of the body. If you are having a lot of pain at a certain spot, your doctor may order an MRI of your spine or a particular area of your bone, such as your hip bone. Your doctor may also use this test to find out if a damaged area of your spine or bones is at risk for more damage from the myeloma.

For this test, you lie still on a table as it passes through a tubelike scanner. The scanner directs a continuous beam of radio waves at the area being examined. A computer uses data from the radio waves to create pictures of the inside of your body. You may need more than one set of images. Each one may take two to 15 minutes. This test may last an hour or more. You may want to ask for earplugs if they aren't offered, since there is a loud thumping noise during the scan. If you are claustrophobic, your health care provider may give you a sedative before having this test. If you do take a sedative, you will need to have someone drive you home afterwards.

Computerized tomography (CT scan). A CT scanner takes many X-rays, as you slide through it on a table. A computer combines these images to create detailed pictures that your doctor can view. CT scans can show early stages of bone involvement with multiple myeloma, but they are not considered a necessary part of testing for multiple myeloma..