Multiple myeloma causes damage to bones throughout the body. An X-ray can find this damage, but it can’t prove that the damage was caused by multiple myeloma. You’ll need further testing to confirm a diagnosis.
Multiple myeloma is cancer that affects the plasma cells inside your bone marrow. It can cause damage to your bones, such as bone lesions, fractures, and thinning.
Typically, damage occurs in the limbs, spine, pelvis, ribs, and skull. If a doctor suspects you have multiple myeloma, they’ll often ask you to get an X-ray.
An X-ray can identify bone damage and point toward a myeloma diagnosis. However, an X-ray on its own isn’t enough to fully make a diagnosis. You’ll need additional imaging tests, blood tests, and a biopsy to confirm a diagnosis of multiple myeloma.
Multiple myeloma causes bone damage by creating an imbalance in the usual behavior of bone remodeling. It increases the mechanism of destruction (osteoclasts) and suppresses the mechanism of bone-building (osteoblasts).
To diagnose multiple myeloma, you might have X-ray images taken of your entire body. This is called a skeletal survey. It can help doctors find signs of bone damage from myeloma.
Bone damage that can be detected on an X-ray includes:
- holes in the bone (lytic lesions)
- bone loss
- bone fractures
However, an X-ray can’t pinpoint where this bone damage came from or how old it is. This means that although an X-ray can help point to symptoms and complications of multiple myeloma, it can’t determine their cause.
Additional testing will be needed to confirm a multiple myeloma diagnosis.
Additional imaging tests can help doctors get clearer images of bones and can help confirm a diagnosis. This might include tests such as:
- Computed tomography (CT) scans: A CT scan can provide more detailed information than an X-ray. For example, a CT scan can create clear images of lytic lesions. It can also show any damage, atypical structures, and tumors inside bones.
- Magnetic resonance imaging (MRI) scan: An MRI scan can help find early stage bone lesions by creating 3D images that can show bone damage as well as tumors located in the bone marrow and plasma cells. Tumors in plasma cells are called plasmacytomas, and they can progress and become multiple myeloma.
- Positron emission tomography (PET) scans: A PET scan uses a special sugar solution that, when injected, makes cancer cells show up on diagnostic images. This can help highlight multiple myeloma cells.
Imaging alone isn’t enough to confirm a diagnosis of multiple myeloma. You’ll also need additional testing, such as:
- A complete blood count (CBC): A CBC shows doctors what blood cells, chemicals, and proteins make up your blood. Results that show the presence of atypical proteins or a low red blood cell count can point to multiple myeloma.
- Antibody tests: Blood tests to determine the type and number of myeloma-related antibodies you have can help diagnose multiple myeloma.
- Serum free light chain test: This test looks for linked-up immunoglobulin proteins in your blood. Certain chain types can be a sign of multiple myeloma.
- Serum protein electrophoresis (SPEP) test: This test can detect the atypical monoclonal (M) protein. High amounts of this protein are found in people with multiple myeloma.
- Urine protein electrophoresis (UPEP) test: This test checks for the presence of the monoclonal (M) protein in urine that has been collected over a 24-hour time period.
- Immunoglobulin level test: This test measures the amount of different immunoglobulins (antibodies) in the blood. There are five types of immunoglobulins, and a high level in one of these types is a common marker of myeloma.
- Urine testing: A urinalysis can look for atypical proteins in your urine. These proteins can indicate myeloma.
- Bone marrow biopsy: During a bone marrow biopsy, a sample of bone marrow fluid and bone are removed, typically from the hip bone. These samples are tested for the presence of multiple myeloma cells in a lab. A biopsy can confirm a diagnosis.
Once a diagnosis of multiple myeloma has been confirmed, doctors use the following tests to help stage the cancer and determine its type:
- Beta-2 microglobulin test: This blood test looks for a specific protein called beta-2 microglobulin. High levels of this protein can point toward a multiple myeloma diagnosis.
- Genome sequencing: Genome sequencing can help find the genetic markers and mutations that are linked to different substyles of multiple myeloma. Finding out which of these mutations and markers you have can help doctors determine the subtype of multiple myeloma and plan the best treatment for your condition.
- Lactic dehydrogenase (LDH) test: An LDH test is a blood test that measures the level of an enzyme called lactic acid in your blood. The levels of this protein increase as myeloma becomes more advanced.
Multiple myeloma is cancer that develops in the plasma cells of your bone marrow. As multiple myeloma progresses, it can cause bone damage. This damage can include bone lesions and bone fractures.
An X-ray can create images of your bones that will show this damage. That’s why it’s a standard part of the multiple myeloma diagnostic process. However, an X-ray has limits, and it cannot confirm a diagnosis.
You’ll likely need additional testing, such as further imaging, blood work, a urinalysis, and a biopsy. Once your diagnosis is confirmed, a test called genome sequencing can help doctors determine the type and stage of myeloma you have.