Tests after a multiple myeloma diagnosis

At the hospital you will have blood and urine tests to see if you have myeloma. If myeloma is diagnosed, you will have other tests to find out:

1. The type of myeloma you have
2. How it might affect you
3. How best to treat you
4. If you have any other conditions

Some tests may also be used to see how well you are responding to treatment. 

Blood and urine tests 

Blood tests can help to confirm if you have myeloma. If you’re diagnosed with myeloma you will have regular blood tests to check the levels of different blood cells and certain proteins in your blood. This can show how the myeloma is affecting you. For example how well your kidneys are working. Blood tests can also show how well your treatment is working. Some substances can be found in your urine, so your urine will be checked too. 

• Full blood count (FBC) – checks the level of blood cells in your blood
• Kidney function – checks for signs of damage by measuring substances like urea, electrolytes and creatinine 
• Calcium – to see if hypercalcaemia might be causing symptoms
• Normal proteins – normal proteins like albumin can be reduced if you have multiple myeloma. Blood and urine tests can measure this.
• Immunoglobulins (antibodies) – myeloma can reduce the number of normal immunoglobulins 
• Paraproteins (abnormal antibodies) – myeloma can produce abnormal immunoglobulins, which can be detected in the blood and urine
• Tumour markers – substances in your blood that can give information about the cancer
• Protein electrophoresis – to find out the type of paraprotein made by the multiple myeloma cells. Blood and urine tests can be used.
• Levels of beta-2 microglobulin – this is known as a tumour marker and can help to stage the myeloma
• Serum free light chain test – this is a way to measure abnormal antibodies (paraproteins) if you don’t make full immunoglobulins. A light chain is one part of an immunoglobulin which can be detected in the blood. 
• Bence Jones paraprotein – found in about 1 in 10 patients with myeloma. You may need to collect urine over a 24-hour period for this test. 

Bone tests

• Bone marrow aspirate / bone marrow biopsy. This test is done if there are paraproteins in your blood or urine. A sample of your bone marrow (aspirate) or solid bone (biopsy) is examined under a microscope to see the number and type of cells in it. You may have this test to see how you are responding to treatment. It may also be used to diagnose myeloma.
• Chromosome studies (cytogenetics) / FISH test. Examines the bone marrow samples for any genetic changes in your cells. About 7 in 10 people with myeloma have gene changes. These tests are not to see if the cancer runs in the family, but to examine any changes in the genes (chromosomes/DNA) of the affected cancer cells.

  A test called FISH analysis (fluorescence in situ hybridisation) makes abnormal genes glow (fluoresce) so that the doctor can identify the particular type of genetic abnormality. A FISH test can help your doctor to predict how your myeloma might respond to a particular treatment, so they can recommend the best option for you.

• Bone X-ray / skeletal survey. Using high-energy rays to take pictures inside your body to check for any bone damage. Your skull, chest, spine, pelvis and the long bones in your arms and legs will all be X-rayed. You may have this test every year or so to see how your illness is progressing. 
• CT scan. This is a special type of X-ray that can show bone damage more clearly than a regular X-ray.
• CT / PET scan. A radioactive injection that will show up any cancer spread to other parts of your body on a CT scan picture. 

Other tests

• MRI scan. A scan that uses magnetic energy to build up a picture of the tissues inside your body to see if the cancer has spread. During the scan you will lie inside a tunnel-like machine.