Diagnosis and Staging of multiple myeloma
-Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.
-To find out whether such problems are from multiple myeloma or some other condition, doctor may ask about personal and family medical history of patient.
-The lab does several blood tests:
-Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
-Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
-The lab also checks for high levels of calcium.
-To see how well the kidneys are working, the lab tests for creatinine.
-The lab checks for Bence Jones protein, a type of M protein, in urine.
-The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period.
-If the lab finds a high level of Bence Jones protein in urine sample, doctors will monitor the kidneys. Bence Jones protein can clog the kidneys and damage them.
-X-rays to check for broken or thinning bones.
-An x-ray of the whole body can be done to see how many bones could be damaged by the myeloma.
-Doctor removes tissue to look for cancer cells.
-A biopsy is the only sure way to know whether myeloma cells are in the bone marrow.
Doctor removes some bone marrow from the hip bone or another large bone.
-A pathologist uses a microscope to check the tissue for myeloma cells.
-There are two ways to obtain bone marrow. Some people will have both procedures during the same visit:
-Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
-Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
If the biopsy shows that the patient has multiple myeloma, doctor needs to learn the extent (stage) of the disease to plan the best treatment.
Staging may involve having more tests:
-Blood tests
-CT scan
-MRI
-Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.
-CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of bones.
-MRI: A powerful magnet linked to a computer is used to make detailed pictures of bones
Stages of multiple myeloma
-Doctors may describe multiple myeloma as smoldering, Stage I, Stage II, or Stage III.
-The stage takes into account whether the cancer is causing problems with bones or kidneys.
-Smoldering multiple myeloma is early disease without any symptoms.
-Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.
In stage I multiple myeloma, the blood levels are as follows:
-beta-2-microglobulin level is lower than 3.5 mg/L; and
-albumin level is 3.5 g/dL or higher.
Stage II multiple myeloma
In stage II multiple myeloma, the blood levels are as follows:
-beta-2-microglobulin level is lower than 3.5 mg/L and the albumin level is lower than 3.5 g/dL; or
-beta-2-microglobulin level is between 3.5 mg/L and 5.4 mg/L.
Stage III multiple myeloma
-In stage III multiple myeloma, the blood level of beta-2-microglobulin is 5.5 mg/L or higher.
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