How is multiple myeloma diagnosed?
If you have signs or symptoms of blood cancer, you need tests to find the specific condition. An accurate and timely multiple myeloma diagnosis is the first step to the best possible treatment.
Testing also helps your care team classify and stage the cancer. This information guides treatment decisions and gives you a clearer understanding of your outlook. At Penn Medicine, specialists use advanced testing and a team-based approach to provide a precise diagnosis as quickly as possible.
During a physical exam, our nurses and hematologists ask about:
- Symptoms
- How long they've been happening
- Personal and family history of cancer
Blood tests are essential to accurate diagnosis of this complex disease. They can help your hematologist identify and measure many things to indicate type and stage of disease, including:
- Albumin, a protein in the blood which, when low, can identify more aggressive disease
- Beta-2-microglobulin, a protein made by myeloma cells
- Calcium, which is in higher levels in the blood when bone is breaking down
- Complete blood count, levels of red cells, white cells and platelets
- Genetic abnormalities of the cancer, which helps guide treatment decisions
- Lactate dehydrogenase (LDH), which indicates tissue damage and active myeloma
- Kidney function tests
- M protein in the blood, a hallmark of multiple myeloma
Your team may order a bone marrow biopsy to check the cells in the bone marrow, where multiple myeloma starts. For a bone marrow biopsy, a specialist uses a long, thin need to take a small sample of bone marrow. The sample usually comes from the hip bone. Most patients receive local anesthesia to prevent pain at the needle site, sometimes with a sedative to help them relax.
Our pathologists examine the cells under a microscope to identify myeloma cells and determine how many are present. Our pathologists also perform tests to identify certain characteristics in cells to help determine the best treatment options.
Your hematologist may order imaging tests to look for cancer in the body or to identify damage to bones or organs. Imaging tests include X-rays, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and positron emission tomography (PET).
Tests for multiple myeloma diagnosis
Our specialists use a variety of tools to gather information for an accurate diagnosis. This includes a physical exam, blood tests, and kidney function tests. Your care team may also order a bone marrow biopsy to check the cells where multiple myeloma starts. Imaging tests can look for cancer in the body or identify damage to bones or organs.
Understanding your diagnostic results
After testing, our multiple myeloma team which consists of hematologists, oncologists and pathologists meet to discuss your results. This meeting ensures that we have all of the information we need for an accurate diagnosis.
Then our physicians and nurse practitioners meet with you, taking time to educate you about the diagnosis, including:
- Test results
- Classification and stage of multiple myeloma
- Next steps for treatment
- Prognosis
- Questions you or your loved ones have
What is multiple myeloma staging?
If tests indicate you have multiple myeloma, our hematologists (blood cancer experts) determine the stage of cancer. The stage ranges from stage I to III.
Test results could indicate that you have a condition that has not yet developed into multiple myeloma but could progress:
- Monoclonal gammopathy of undetermined significance (MGUS): There is a small amount of M protein (an antibody released by multiple myeloma cells) in the blood. But there are no other signs of multiple myeloma diagnosis (for example, a tumor or symptoms).
- Solitary (isolated) plasmacytoma: There is a single myeloma tumor somewhere in the body. But there are no signs of anemia, kidney damage or further disease.
- Smoldering (asymptomatic) multiple myeloma: Low levels of M protein are present in the blood, but there are few to no symptoms.
Depending on classification and stage, your team may suggest multiple myeloma treatment. Or they may recommend active surveillance, a "watch and wait" strategy to monitor you closely until symptoms appear or change.
Getting a second opinion on your diagnosis
If you already have a blood cancer diagnosis, you may want to meet with a specialist for a second opinion.
Penn Medicine has hematologists, pathologists, and nurses who specialize only in multiple myeloma. We can confirm your diagnosis, clarify the stage, and provide more information to guide your care. We review your existing medical records and determine if you need any additional, advanced testing. Talking with our team can help you feel confident that you’re choosing the most effective treatments for your unique case.
Why experience matters for your diagnosis
The Multiple Myeloma Research Foundation (MMRF) recommends finding specialists who diagnose and treat a high number of people with this disease. This volume of experience helps you get the most accurate understanding of your situation and leads to better results.
Because our blood cancer care experts see this condition every day, we have a deep understanding of how multiple myeloma behaves. At Penn Medicine, you’ll find:
- Specialized expertise: Our hematologists, pathologists, and nurses focus on multiple myeloma and use advanced tools to diagnose and stage the disease.
- Guidance throughout the process: You’ll work closely with a nurse navigator who helps coordinate testing and appointments and supports you as you learn about your results.
- On-site testing: Many tests are performed in our labs, helping you get results faster and begin care sooner.
- Active research efforts: Our teams are involved in clinical trials aimed at improving how multiple myeloma is detected and treated.