How Is Multiple Myeloma Diagnosed?

This content has been reviewed and approved by

Kenneth C. Anderson, MD
Chief, Division of Hematologic Neoplasia

Dana-Farber Cancer Institute

A doctor may suspect multiple myeloma based on the results of a routine blood test. Sometimes, an x-ray for a broken bone shows evidence of the disease. In other cases, a person may be complaining about some of the symptoms associated with multiple myeloma. Because these symptoms can be signs of many other medical conditions, a careful work-up is needed.

Most people with multiple myeloma have increased levels of the white blood cells called plasma cells in their bone marrow. They also have evidence of M protein, the abnormal antibody made by myeloma cells—the plasma cells that have become cancerous—in their blood or urine. Many also have thinning of the bones, or osteoporosis, or holes in the bones (technically called “osteolytic lesions”). Some people have high levels of calcium in the blood and evidence of poor kidney function.

To diagnose multiple myeloma, your doctor will take your complete medical history and do a physical examination. He or she also may order some or all of the following tests:

• X-ray - This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissue, bones, and organs onto film. X-rays can detect thinness (osteoporosis) or “holes” (lytic lesions) in bone.
• Blood tests - These can detect the abnormal proteins made by myeloma cells, such as M protein and beta-2-microglobulin. They also may show high levels of plasma cells and calcium, as well as low levels of hemoglobin (the substance in red blood cells than transports oxygen). Blood tests may also reveal lower-than-normal counts of red blood cells, white blood cells, and platelets. All of these can be signs of multiple myeloma.
  
• Urine tests – These are used to measure the presence of Bence Jones protein, a type of M protein, in the urine. The urine is collected over a 24-hour period. This protein can clog the kidneys and damage them. 
  
• Bone marrow aspiration and/or biopsy - This procedure involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy)—usually from the hip bones or another large bone. It is done under local anesthetic (numbing of the area) using a long needle. The sample is then examined to determine whether myeloma cells are present and to define any genetic abnormalities in tumor cells.
• Magnetic resonance imaging (MRI) - An MRI test involves lying inside a tunnel-like tube that uses radio waves and a powerful magnetic field to create detailed images of the inside of the body. The test doesn’t hurt, although some people do not like feeling enclosed in the tube. Some medical centers now have open MRI machines that allow patients to avoid this. MRI can show evidence of multiple myeloma in the bones and bone marrow.

Other imaging tests that may be used include CT and PET/CT. A CT (computed tomography) scan uses a large machine to take multiple x-rays of the body. A computer then turns these into images. A PET (positron emission tomography)/CT scan is used to create images of tissues as they function. First, the person is injected with a substance made up of sugar and a small amount of radioactive material. The scan makes images of the cancer cells as they absorb the radioactive substance.

Although these are some of the tests most frequently used to diagnose multiple myeloma, your doctor may order other tests as well. Ask your doctor what he or she recommends.