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Making a diagnosis of myeloma depends on finding abnormal plasma cells or their products somewhere in the body. Plasma cells are cells of the immune system that make antibodies when they are functioning normally. In myeloma, these cells begin to grow and divide abnormally. They make abnormal amounts of antibody-like proteins.
The growth of these plasma cells in the bone marrow can reduce the normal function of the bone marrow. It can also result in thinned, weakened bones that are likely to break. The abnormal antibody-like protein collects in the blood. It can cause problems with blood flow to the kidney and other parts of the body. Usually, symptoms related to these changes bring a patient to the doctor or raise a question of myeloma.
The diagnosis and prognosis of multiple myeloma include the following:
Diagnosis begins with a visit to the doctor. Sometimes, multiple myeloma is noted when blood tests are ordered for an unrelated reason. A biopsy will be needed to confirm the presence of myeloma cells.
The doctor will ask about your symptoms and medical history. You may be asked how your symptoms have progressed. You may also be asked about anything that may increase your risk of multiple myeloma, such as exposure to radiation or toxic chemicals.
The doctor will perform a complete physical exam. This will focus on uncovering evidence of bone damage, anemia , or impaired circulation, each of which might be the result of myeloma.
To help with the diagnosis, your doctor may need to order tests.
Your doctor may need pictures of your bones. This can be done with:
Your doctor may need to test your bodily fluids. This can be done with:
Cytology is the study of cells. The cytology of cancer cells differs from normal cells. Doctors use the unique cellular features seen on biopsy samples to diagnose and assess cancer.
To diagnose myeloma, the doctor will look for abnormal plasma cells. A plasma cell labeling index, which measures the percentage of dividing plasma cells, is available in some labs. This test gives an idea of how fast the cancer cells are growing. A higher labeling index is associated with a worse prognosis. It means that there are more, faster reproducing plasma cells than there should be.
Staging is the process used to determine the prognosis of a cancer that has already been diagnosed. Staging is needed to make treatment decisions (such as surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification. The most common features are the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0-1) imply a favorable prognosis. High staging classifications (4-5) imply an unfavorable prognosis.
The Durie-Salmon staging system is used to stage multiple myeloma. The amount of tumor in the body is estimated based on the following factors:
The more myeloma cells and/or their products present in the body, the higher the stage and the worse the outcome. Patients with higher stage disease also tend to have more symptoms from their disease. Based on the Durie-Salmon system, staging of multiple myeloma is as follows:
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is an inexact process. Predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed. But, it is the only method available. A prognosis may or may not reflect your unique situation.
The five-year survival rates for multiple myeloma based on stage are as follows:
Stage I: 50%
Stage II: 40%
Stage III: 10%-25%
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Treating multiple myeloma: bisphosphonates for multiple myeloma. Available at: http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-treating-bisphosphonates . Updated July 24, 2012. Accessed December 27, 2012.
Treating multiple myeloma: chemotherapy and other drugs for multiple myeloma. Available at: http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-treating-chemotherapy . Updated July 24, 2012. Accessed December 27, 2012.
Treating multiple myeloma: plasmapheresis for multiple myeloma. Available at: http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-treating-plasmapheresis . Updated July 24, 2012. Accessed December 27, 2012.
Treating multiple myeloma: radiation therapy for multiple myeloma. Available at: http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-treating-radiation . Updated July 24, 2012. Accessed December 27, 2012.
Treating multiple myeloma: stem cell transplant. Available at: http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-treating-stem-cell-transplant . Updated July 24, 2012. Accessed December 27, 2012.
Multiple myeloma. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated September 13, 2012. Accessed December 27, 2012.
Last reviewed September 2013 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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