Diagnosing Myeloma

Support Throughout the Diagnostic Process

Our physicians, nurses and support staff are here to advise you, listen to you and calm your fears. Your physicians will explain your diagnosis and compassionately offer suggestions for treatment and care. Their job is to help you.

Also available for counsel, support and guidance are nurse coordinators, oncology social workers and a pastoral team. They’ll help you navigate through the system and provide additional assistance, including:

  • Social support
  • Spiritual guidance
  • Emotional support
  • Practical advice
  • Tips on coping

Call on them. They’re here for you.

The truth about myeloma is that it’s sometimes a difficult diagnosis to make because it tends to be a little of this and a little of that, and there’s no one of those things that immediately makes you say, ‘Aha! That’s multiple myeloma.’ Sometimes it’s putting together a little bit of this and a little bit of that to actually make the diagnosis.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Myeloma is a complex disease of the antibody-making plasma cells in your blood. Its detection, diagnosis and evaluation require a team of highly knowledgeable and skilled specialists of the blood, called hematologists.

We have some of the best hematologists in the nation right here.

Our nationally recognized hematologist/oncologists are renowned for their work in hematologic malignancies, histochemotherapy and blood-count abnormalities. Your blood is their specialty.

Because myeloma is a difficult disease to diagnose — one where your physicians first have to rule out a wide variety of other diseases — it takes a team of highly specialized doctors to make this diagnosis.

Your team of hematologist/oncologists, hepatopathologists and cytogeneticists employ the most advanced diagnostic procedures available to diagnose and classify your myeloma with meticulous precision.

To me the team care of the patient has to begin with who the most important team member is — and that’s the patient. We are truly centered around the patient.

Christian T. Cable, MD, Medical Oncology; Director, Blood & Marrow Transplant Program

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Diagnostic Excellence and Precision

Our blood disorder specialists have unparalleled knowledge and experience in diagnosing myeloma. They're first-rate in identifying and isolating its many subtypes.

Of special note are our hematopathologists, physicians who specialize in diagnosing diseases of the blood, bone marrow and plasma system. Our pathology team is superb at analyzing:

  • Bone marrow biopsies
  • Blood smears
  • Lymph node biopsies

They provide necessary information regarding the progression and prognosis of your myeloma for your treatment team.

Our cytogeneticists are unparalleled at studying chromosomes and chromosomal abnormalities in order to diagnose myeloma and determine subtype. Like hematopathologists, they’re key members of your Integrated Care Team, providing vital information for treatment planning.

Our hepatopathologists and cytogenetics group are invaluable to us in helping us figure out what specific features are there in this leukemic cell that can predict for how you’re going to do.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Once the team has determined your subtype of myeloma, your physician will discuss with you:

  • What kind of myeloma you have
  • How your myeloma will likely progress
  • What your chances of remission or cure are
  • What your treatment will be like
  • The side effects of your treatment
  • The emotional aspects of dealing with myeloma

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Myeloma Diagnostic Services

A confirmed diagnosis of myeloma includes:

  • Increased levels of antibody-making cells found in your bone marrow
  • Intact monoclonal immunoglobulins or immunoglobulin light chains found in your blood or urine
  • Bone thinning, holes or fractures

If your physician suspects you may have myeloma, he or she may recommend one or more of the following tests.

Physical Exam

Physical exam and history. Your physician will begin with a thorough physical exam and medical history.

Biopsy

A biopsy is generally the best way to confirm the presence of myeloma. Your physician may order a biopsy if myeloma is suspected based on the results of other diagnostic tests.

A biopsy is the surgical removal of a small sample of tissue. This tissue sample is sent to the laboratory for evaluation by a pathologist

  • Fine needle aspiration. In this procedure, your surgeon will insert a very thin needle through your skin and into your lymph node. With the needle, your surgeon will remove a small sample of fluid containing tiny bits of tissue.
  • Bone marrow aspiration. Bone marrow aspiration is the removal of a small amount of tissue in liquid form for examination. Bone marrow is found in the hollow part of most bones. It helps form blood cells.    
  • Bone marrow biopsy. A bone marrow biopsy is the surgical removal of a small sample of soft tissue, called marrow, from inside bone. Bone marrow is found in the hollow part of most bones. It helps form blood cells.

The antibody-making cells themselves live in the bone marrow so one usually has to have a bone marrow biopsy to show the cells and confirm a diagnosis.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Laboratory Tests

Your physician may order one or more of the following tests. An abnormal amount of a substance may be a sign of disease.

  • Quantitative nephelometry. This test measures the specific levels of immunoglobulins in your blood.  Elevated levels of monoclonal immunoglobulin (M protein) may indicate disease.  This test is also used to:
    • Determine which type of myeloma you may have
    • The extent of your disease
    • The effectiveness of treatment
  • Bence Jones protein.This test measures the specific level of abnormal proteins in your urine. Proteins link together in heavy (long) and short (light) chains. The presence of small light chains (Bence Jones protein; named for the physician who studied them) in urine may indicate disease.
  • Serum protein electrophoresis.This test identifies the presence of specific immunoglobulins. It’s helpful in monitoring the effectiveness of treatment or monitoring the course of your disease.
  • Beta 2-microglobulin. Elevated levels may indicate advanced disease.
  • Abdominal wall fat pad biopsy.Your physician may order this test if proteins begin to accumulate in your body tissues, causing organ dysfunction, in a condition called amyloidosis.

Blood Tests & Chemistry Tests

Your physician may order one or more of the following tests. An abnormal amount of a substance may be a sign of disease.

  • Complete blood count.This test determines the number of red blood cells, white blood cells and platelets you have.
  • Total protein. This test helps determine size and growth rate of tumors.
  • Calcium. Elevated levels, called hypercalcemia, may indicate calcium has entered bloodstream, possibly affecting kidneys.
  • Blood urea nitrogen (BUN)andcreatinine levels. Evaluate kidney function.
  • Albumin. Decreased levels can be signs of advanced myeloma.
  • Sodium and potassium. Abnormal levels may indicate disease.

Most of the time the cells continue to make their antibody and that helps us to detect the disease and to monitor the disease. If we shrink the antibody-making cells, we shrink the antibody level, and the antibody level we can measure in the bloodstream fairly easily.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Pathology Tests

Your pathology team will use samples procured at biopsy to determine:

  • Whether you have myeloma
  • The subtype of myeloma you have
  • Your treatment plan

Your pathologist team may conduct one or more of the following laboratory tests:

  • G-banding karotyping. This highly specialized test uses a distinctive dye to highlight chromosome patterns.
  • Immunohistochemistry. This test is useful in locating myeloma cells.
  • Cytogenetics. Your physician may order this highly specialized test to help detect genetic abnormalities in your chromosomes that often happen in some cases of myeloma. Cytogenetics can help predict prognosis.
  • Fluorescent in site hybridization (FISH). This highly specialized genetic analysis is used to identify specific changes within chromosomes. Your physician may order this test to help identify whether you carry a particular gene change.

Imaging Tests

If you have a positive diagnosis of myeloma, your physician team may order one or more of the following imaging studies to check for signs of disease and to determine whether your myelomahas spread to other areas of your body.

  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan
  • Chest X-ray
  • Bone scan

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