Multiple Myeloma Diagnosis and Staging
Multiple myeloma is a complex and often challenging cancer to diagnose. However, the success of treatment is usually determined by the accuracy of the diagnosis. The diagnostic process includes a combination of laboratory tests, imaging techniques and bone marrow testing.
Blood tests play a crucial role in diagnosing multiple myeloma. Following are the most commonly used.
- A complete blood count (CBC) assesses red and white cell counts, often revealing anemia. Blood chemistry tests measure creatinine, albumin and calcium levels, indicating kidney function and possible hypercalcemia.
- Lactic dehydrogenase (LDH) levels provide prognostic insights, with higher levels suggesting an advanced disease.
- Quantitative immunoglobulin testing determines the levels of various antibodies, essential in detecting imbalances characteristic of myeloma.
- Electrophoresis tests, including serum protein electrophoresis (SPEP) and immunofixation, identify abnormal monoclonal antibodies.
- Serum free light chain tests measure specific light chain proteins, offering valuable diagnostic information, especially in cases where the SPEP is inconclusive.
Urine tests are a significant component in diagnosing multiple myeloma. These tests primarily focus on detecting myeloma proteins that have been filtered through the kidneys and excreted in the urine. There are two main urine tests:
- Urine protein electrophoresis (UPEP): This test determines the presence and quantifies the amount of protein in the urine. It’s particularly relevant when conditions like multiple myeloma or amyloidosis are suspected, which can lead to elevated protein levels in urine. UPEP is also used to monitor treatment efficacy or disease progression, especially if initial tests indicate protein presence in the urine.
- Urine Immunofixation: This test specifically tests for monoclonal proteins (M-proteins) in the urine, which are typically absent in healthy individuals. The presence of M-proteins can indicate disorders like multiple myeloma or primary amyloidosis. Urine immunofixation is vital for diagnosing these conditions and understanding more about the patient’s specific disease profile.
Bone Marrow Aspiration and Biopsy
Bone marrow aspiration and biopsy involve collecting samples from the bone marrow to examine myeloma cells directly.
This can include sampling both the liquid and solid parts of the bone marrow. Aspiration uses a syringe to draw out the liquid marrow, while a core biopsy involves a special needle to capture a sample of the spongy bone in the marrow. The procedure might be uncomfortable or painful, but is essential for accurate diagnosis. The pathologist then examines the cells, determining the presence and appearance of abnormal plasma cells.
Imaging tests offer visual insights that complement laboratory findings, helping to form a complete picture of the disease. They range from traditional X-rays to advanced techniques like CT, MRI and PET scans, each providing unique and crucial information. Understanding the specific contributions of these imaging modalities is key in determining the extent of multiple myeloma and guiding appropriate treatment strategies.
Computed Tomography (CT) Scan
A computed tomography (CT) scan, also known as a CAT scan, is a sophisticated imaging technique used in the diagnosis of multiple myeloma. It utilizes X-ray technology to create detailed three-dimensional images of the body's internal structures.
During a CT scan, the patient lies on a table inside a large, doughnut-shaped machine. As the table moves through the scanner, several X-ray beams rotate around the body, capturing multiple cross-sectional images from different angles. These images are then digitally processed to generate a comprehensive view of the bones and tissues, helping to detect bone lesions and assess the extent of myeloma-related damage.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) is an extensively used imaging technique in the diagnosis of multiple myeloma. It employs powerful magnets and radio waves to create detailed images of the body's organs and structures.
For this procedure, the patient lies inside a large tube-like machine, where magnetic fields and radio waves are used to align hydrogen atoms in the body. These aligned atoms emit signals when returning to their original positions, which are then captured by the scanner and transformed into detailed images. An MRI is particularly effective at visualizing soft tissues and the bone marrow, making it highly useful for detecting myeloma lesions, including those in the spine and pelvis.
Positron Emission Tomography (PET) Scan
A Positron Emission Tomography (PET) scan is a sophisticated imaging tool used for the analysis of multiple myeloma. This scan involves injecting a small amount of radioactive tracer, typically a sugar molecule like fluorodeoxyglucose (FDG), into the body. The tracer accumulates in areas with high metabolic activity, such as rapidly growing cancer cells.
During the scan, the patient lies on a table that slides into a PET scanner, which detects the radiation emitted by the tracer. This creates images highlighting areas of significant activity, allowing for the detection of myeloma cells and providing valuable insights into the extent and activity of the disease.
An X-ray scan is a basic yet essential imaging technique used in diagnosing multiple myeloma. It involves exposing a part of the body to a small dose of ionizing radiation to produce images of the inside of the body. X-rays are particularly effective in visualizing bone structures. In the context of multiple myeloma, X-ray scans can reveal bone damage such as thinning (osteopenia), bone loss (osteoporosis), lytic lesions (holes in the bone) and fractures.
While less sensitive than other advanced imaging methods, X-rays are widely used for their availability and simplicity, helping detect significant bone changes associated with multiple myeloma.
Multiple Myeloma Staging
The staging of multiple myeloma is conducted using the Revised International Staging System (RISS), which considers four key factors: the amount of albumin and beta-2-microglobulin in the blood, the level of lactic dehydrogenase (LDH) and specific gene abnormalities (cytogenetics) of the cancer.
Stage I Multiple Myeloma: Characterized by a serum beta-2 microglobulin level less than 3.5 mg/L, an albumin level of 3.5 g/dL or greater, cytogenetics not considered high risk, and normal LDH levels.
Stage II Multiple Myeloma: Defined as neither stage I nor III.
Stage III Multiple Myeloma: Indicated by a serum beta-2 microglobulin level of 5.5 mg/L or greater, high risk cytogenetics and/or high LDH levels.
High risk cytogenetics may include changes like loss of a piece of chromosome 17 or translocations involving chromosomes 4 and 14, or 14 and 16, all associated with a poorer prognosis.
Diagnosing and stage multiple myeloma is a multifaceted and meticulous process. Through a combination of blood tests, urine tests, bone marrow examinations, and advanced imaging technologies, healthcare professionals gain invaluable insights into the disease's presence and severity.
At Sheba, we are proud to stand at the forefront of advancing these diagnostic and staging methods, continually improving the effectiveness of treatment strategies and leading to better outcomes.
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