You might have some of these further tests to either confirm the diagnosis, or to see how much the myeloma has developed and how much it’s affecting your body.
These tests can also help you and your healthcare team decide which type of treatment would be best for you. For many people this can be an anxious time, especially if you need to wait for the results. You might like to get extra support from family and friends, your healthcare team or talk to other people who’ve been affected.
Free light chain assay – Freelite™
This test is done to confirm the diagnosis of light chain myeloma. You’ll have this test if no paraprotein is found in your blood or urine. This sensitive test can detect even very small amounts of light chain proteins present.
Plasma viscosity test
This test is done to measure how thick the plasma is in the blood. This can show how active the myeloma is because thicker plasma is associated with more paraprotein in the blood.
This is a series of X-rays looking at your skull, spine, pelvis and long bones to see if there’s any myeloma-related damage to your skeleton.
Bone marrow biopsy (aspirate and trephine)
If there’s paraprotein in your blood or urine, a biopsy will usually be taken from the bone marrow – normally from your hip bone – to confirm your diagnosis. It’s then studied under a microscope to see if there are any myeloma cells in it.
You don’t need to stay overnight in hospital for a bone marrow biopsy – you can have it as an outpatient using local anaesthetic or mild sedation. It’s usually quite quick but will be uncomfortable while the sample is being taken from the marrow; you can take painkillers if you need to.
Bone marrow aspirate
A special needle is inserted into the hip bone after local anaesthetic has been administered. A small sample of bone marrow is aspirated (removed) into a syringe and sent for analysis.
Bone marrow trephine
You’ll usually have a trephine biopsy at the same time. This is where a ‘core’ of bone and bone marrow from the hip bone is taken. This gives information about the structure of your bone marrow and the number and distribution of the different blood cell types – and cancer cells, if there are any there.
Cytogenetics and FISH
Your bone marrow sample is sent for cytogenics and FISH (flourescence in situ hybridisation) testing. All kinds of cancer, including blood cancer, involve changes in genes in the affected cells. This isn’t the same as an inherited genetic cause.
Understanding the exact changes in your myeloma cells can help doctors to diagnose your illness, to decide how likely it is that your condition will respond to standard treatment, and to help monitor how well you respond to treatment. The study of these changes is called cytogenetics. FISH testing is a more sophisticated test that can give additional genetic information.
β2M and albumin levels
The stage of a person’s cancer (how far it’s spread), can be measured against the amounts of two proteins in the blood called albumin and β2-microglobulin.
In myeloma, albumin levels can be low and β2M levels (a protein found on the surface of the abnormal cells) can be raised. Based on this, your doctor will take your blood sample and stage the myeloma from stages I to III:
- Stage I Both albumin and β2M levels are normal or near normal.
- Stage II Either albumin is low with normal β2M, or β2M is moderately raised.
- Stage III β2M levels are much higher than normal, albumin is low.
You may have a scan if your doctor needs further clarification of your diagnosis.
CT or CAT scan
A CT scan is a type of X-ray that will show up any areas where the myeloma could be affecting your bones. The procedure won’t cause any pain. You’ll lie on a table that moves into a cylindrical tunnel while the pictures are taken. Your body is never completely enclosed and you’ll be able to talk to the person who takes and assesses the images (the radiographer) all the time. You might need to have a dye injected into one of your veins to help get a better image.
Magnetic resonance imaging (MRI) scan
This scan shows up soft tissues (non-bony parts) and uses radio waves rather than X-rays. It can help your team to find out if the myeloma is affecting your spine or spinal cord. You’ll be asked to lie on a table which will move you through the scanner. It isn’t painful but it can take up to an hour to complete and some people find it claustrophobic. The MRI machine is also noisy, so you may be given headphones so you can listen to music during the procedure. As with a CT scan, you might need to have a dye injected into one of your veins to get a better image.