Diagnosis of Multiple Myeloma

Medical practitioners could find it challenging to identify and diagnose cancer. They also conduct tests and scans to learn and understand if the tumor has spread to other parts of the body from where it matured. In other words, metastasis. For instance, medical practitioners know how much cancer has spread and developed through imaging tests. These imaging tests show or give them visuals from inside the body. For most types of cancer, a biopsy is the only well-known way for medical practitioners to know if any area of the body has cancer. Medical practitioners also perform scans and tests to understand the most suitable and effective treatment for a specific type of cancer. In a biopsy procedure, a medical practitioner takes a small tissue sample to undergo testing in a laboratory. If the biopsy is not possible, the medical practitioner could recommend other tests to help diagnose. 

How to diagnose multiple myeloma?

The medical practitioner will also think or suspect multiple myeloma if the patient’s blood test shows anything different.

  • Hypercalcemia or excess of calcium in the blood.
  • Anaemia or lack of red blood cells
  • Issues with the kidney
  • High total protein levels in your blood, but low levels of one called albumin, known as globulin gap by your medical practitioner.

The diagnosis of the disease is confirm when the blood tests show the following:

  • CBC, in other words, complete blood count as it measures the different kinds of cells in your blood levels. 
  • BUN, in other words, blood urea nitrogen and also creatinine as it checks how effectively the kidneys are operating
  • Other blood and urine tests also check if the body is producing unusual proteins and, if yes, the types and how much they are producing. 
  • Once the results have come in, the medical practitioner will perform a biopsy for the bone marrow. They will insert a needle into the bone, and generally to the hip and take a sample to check the number of plasma cells. 
  • Imaging tests are also a possibility. X rays are efficient and can show visuals of a spot damaged in the bone by multiple myeloma. If this isn’t sufficient, the medical practitioner will suggest a CT Scan, MRI Scan, or PET Scan. 

There are many different tests and scans used to diagnose multiple myeloma. Not all the tests described below will act as usable for every patient. The medical practitioner may examine these factors when choosing a diagnostic test. 

  • The type of cancer that is suspected 
  • The signs and symptoms 
  • The age of the patient and the general health
  • The results of earlier medical tests and scans

To diagnose multiple myeloma, use the following steps:

Blood and urine tests –

Blood and urine tests play a significant role in the process of analyzing the disease 

Myeloma cells often produce the monoclonal antibody immunoglobulin, called M protein. The M protein levels found in a patient’s blood and urine are useful in determining the proportions of the disease and help track how well the treatment and medication procedures are panning out and whether the condition is progressing or may be coming back. The myeloma cells produce only a part of the antibody known as the light chain in some patients. The serum protein electrophoresis (SPE or SPEP) or urine protein electrophoresis (UPE or UPEP) calculates the amount of M protein levels in the blood or urine.

Immunoglobulin –

The doctors calculate the immunoglobulin levels to understand and help check the number of antibody levels in the blood. Immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) are the names of the antibodies that are under the scanner. In multiple myeloma, when the protein levels are up, the antibody levels in the blood automatically go down. 

Light chains –

The doctors can find the number of free light chains in the blood before the kidneys filter and purify the blood. In other words, serum-free light assay. Measuring M protein in the urine is a very sensitive and delicate process, but it is crucial to measure both. When the urine contains a light chain, it is Bence Jones protein. 

Serum albumin and serum beta-2 microglobulin (β2-M) –

The blood tests help measure serum albumin and serum β2-M levels. Serum albumin is a blood protein put together by the liver that is critical for maintaining proper blood volume and tracking general health. β2-M is also a protein that plays a significant role in the body’s response to the immune system. 

Lactate dehydrogenase (LDH) –

Lactate dehydrogenase is an enzyme that is also a type of protein. One can find it in almost all the tissues of the body. The bloodstream is filled with LDH that is released by the damaged tissues. So the LDH is signified that the body has taken a beating or shows signs of the disease. In myeloma, LDH levels can help determine the prognosis, which is the chance of recovery and its stage. The scans and tests are critical for identifying the stage of the disease. Doctors also use the blood tests to measure how the kidneys are functioning, the calcium levels, and the blood counts for potential anaemia and other low blood counts.

Multiple Myeloma Complications

Multiple myeloma can cause issues that include:

  • Bone problems –  The bones become drastically weak, potentially leading to bone ache or fractures. 
  •  Blood problems –  When there aren’t a sufficient amount of red blood cells in the body, you might have chances of getting anaemia. This can cause weakness, make you pale, and make way for heart issues. It can complicate for your blood to clot as there isn’t enough platelet count. 
  • Infections – When you get a myeloma diagnosis, the body gives out a lot of weak antibodies that outnumber the healthy ones, which eventually makes it harder for it to fight against infection. The immune system also becomes ineffective when there is a lack of white blood cells in the body.
  • Kidney damage –  Kidney failures are a possibility as myeloma can congest your kidneys, so they stop filtering in the process they should. 

X-Ray –

An X-ray is a technique that uses a small amount of radiation to create a picture or visuals of the structures inside of the body. When myeloma is suspected, identified or diagnosed, X-rays taken as a part of the medical practitioner’s evaluation of the patient’s skeletal system are typically the first step in evaluating the bones. A skeletal survey with x rays may not detect myeloma as early as the more advanced tests.

Magnetic resonance imaging ( MRI ) –

An MRI produces detailed and comprehensive body images using magnetic fields rather than the X rays. Through an MRI, one can reveal whether normal bone marrow has been replaced by the myeloma cells or plasmacytoma, particularly in the skull, the spine, and pelvis. A plasmacytoma is a plasma cell tumor that develops in the bone or soft tissues. 

Computed tomography (CT or CAT) scan –

A CT scan also produces detailed and comprehensive cross-sectional images of the soft tissues, revealing any abnormalities or tumors. A computer then combines the images to create a three-dimensional image of the inside of the body. It is important to note that the doctors often avoid intravenous contrast dye, commonly used in the Computed tomography scan for other types of cancer, in people with multiple myeloma. Before receiving a dye injection into the vein, it is essential to inform the radiologist as this can cause damage to the kidneys in people with myeloma. 

Positron emission tomography (PET) or PET-CT scan –

PET scan, in other words, as a PET – CT scan is a type of positron emission tomography scan. Doctors frequently combine a PET Scan with a CT scan explained above, resulting in a PET-CT scan. However, the medical practitioner may refer to this procedure or phase simply as a PET scan. A PET scan is a technique for creating images of organs and tissues within the body. The doctors insert a radioactive sugar substance into the patient’s body in small amounts. Cells, then absorb this sugar substance that consume the most energy. Cancer absorbs more radioactive substances because it actively uses energy. However, the amount of radiation in a substance is too low to be harmful. The scanner then detects the substance, which then produces images of the inside of the body. 

Bone marrow aspiration and biopsy –

These two procedures are very similar and doctors frequently perform them concurrently to examine the bone marrow. The bone marrow contains both a solid and also a liquid substance. He or she uses a needle to extract a sample of the bone marrow fluid during a bone marrow aspiration. A bone marrow biopsy is the process of removing a small amount of solid tissue through a needle.

This is very critical in making a diagnosis of myeloma. A pathologist or several pathologists then examine the sample. A pathologist is a medical professional specializing in interpreting laboratory tests and evaluating the cells, tissues, and organs to diagnose the disease. Cytogenetics and a particular test called fluorescence in situ hybridization are used to examine the genes in myeloma. These tests determine whether the myeloma has a standard or high-risk genetic makeup. Samples can also be analyzed using genomic sequencing to determine precisely what changes have occurred in the DNA of the cancer cells.

The pelvic bone, located in the lower back of the hip, is a common site for bone marrow aspiration and biopsy. Before the procedure, the doctor numbs the skin in that area with medication. In other words, anaesthesia. One can also use other types of anaesthesia to reduce pain awareness.

Fat pad aspirate –

Certain M proteins that have misfolded in a specific way cause organs to stop generally functioning if deposited in body tissues. In other words, amyloidosis. Suppose your medical practitioner suspects you have amyloidosis. In that case, they may recommend a biopsy, which is a sample of the abdominal fat pad or the collection of fat around a person’s abdomen, examined under a microscope. 

Biomarker testing of the tumor –

The medical practitioner may advise or recommend you to run a few laboratory tests on the tumor and the bone marrow sample to identify specific chromosomes that are cytogenetics, genes, proteins, and other factors that are tumour-specific. In other words, tumor molecular testing. The results of these tests can aid in deciding on a suitable treatment plan. 

Cytogenetics –

Cytogenetics determines how aggressive the cancer is. In other words, the study of genetic changes in cell structures. Researchers can perform molecular studies on a tissue sample obtained during a biopsy. The fluorescence in situ hybridization test, also known as the FISH test, is often used in myeloma to identify the standard and high-risk disease by studying the genes in the plasma cells. This could help in the process of planning the treatment. More genetic tests are being developed, most often as a part of the ongoing research studies and experiments. 

Fluorescence in situ hybridization (FISH) –

The fluorescence in situ hybridization test is a cytogenetic test that uses a fluorescent dye to detect changes in a person’s chromosomes. FISH informs the medical practitioner about whether the myeloma is aggressive and at high risk, as well as its prognosis. The FISH test will be used for the majority of myeloma patients. 

Minimal residual disease (MRD) tests –

As treatments for myeloma have become more effective, new approaches for measuring how well a treatment works, including Minimal residual disease, have been developed. The general rule is that the more difficult it is to detect the disease, the better. If a minimal amount of disorder is discovered after treatment, which is referred to as MRD positive by this testing, Additional treatment to suppress the condition may be offered. 

After completing diagnostic tests, the medical practitioner will go over the results with you. If myeloma is the diagnosis, these results will also help the medical practitioner describe cancer and its stage. In other words, referred is staging. 

The Diagnostic criteria

The components that assist medical practitioners in examining and diagnosing disease are called diagnostic criteria. The diagnostic criteria for multiple myeloma are based on the diagnostic tests done on blood, urine, bone, and bone marrow specimens.

Diagnostic criteria are used to determine if multiple myeloma is present and the extent of the disease. They are very cruicial for both classifying and staging various myeloma.

The diagnostic criteria for multiple myeloma need confirmation of (a) one primary criterion and one minor criterion or (b) three minor criteria in an individual with signs or symptoms of multiple myeloma.

Major criteria:

  •  Plasmacytoma as displayed on the evaluation of the biopsy sample
  • The bone marrow sample consists of more than 30% of plasma cells
  • Blood and urine has high levels of M protein

Minor criteria:

  • The bone marrow sample consists of 10% to 30% of plasma cells
  • Low levels of antibodies in the blood
  • Minor elevations as displayed on the imaging studies