Understanding Multiple Myeloma: Stages
If the biopsy shows that you have multiple myeloma, your doctor needs to learn the stage of the disease to plan the best treatment.
Blood tests: For staging, the doctor considers the results of blood tests, including albumin, beta-2-microglobulin, and also lactate dehydrogenase (LDH).
Bone marrow sample testing: The bone marrow sample taken during the biopsy is also used for staging. Genetic testing such as conventional metaphase cytogenetic (karyotyping) and FISH studies is done to see if the myeloma has high-risk features which would lend to a higher stage.
CT scan (CAT scan or computed tomography): The CT scan is an X-ray test that produces detailed pictures of your body. Instead of taking one picture, like a regular X-ray does, a CT scanner takes many pictures. It does this by rotating around you while you lie on a table. Then a computer combines all these images. That produces 3-dimensional pictures. CT scans can help find tumors in your bladder, kidneys, and other organs. It can also show any swollen lymph nodes that might have cancer.
Before any pictures are taken, you may have to drink 1 to 2 pints of a liquid. It is called oral contrast. This fluid helps outline your intestine. This helps the doctor see the differences between your normal body and any potential tumors.
A CT scan can also be used to guide a biopsy needle in a tumor. This procedure is called a CT-guided needle biopsy. In this procedure, the radiologist puts a biopsy needle through your skin and into the mass. Then a tissue sample is removed and examined under a microscope.
MRI scan (magnetic resonance imaging): MRIs are similar to CT scans. An MRI scan provides detailed pictures like CT scans. The difference is that MRI scans use radio waves and strong magnets instead of X-rays. The energy from the radio waves produces patterns. A computer takes these and turns them into detailed images of specific parts of your body.
MRI scans are often a little more uncomfortable than CT scans. For one thing, an MRI takes up to an hour. You may be placed inside a narrow tube. This can feel confining. Again, you must lie completely still. There are newer, open MRI machines in many hospitals and clinics around the country.
Using the lab tests, doctors classify multiple myeloma as either:
- Smoldering: early disease without any symptoms
- Stage I: early disease with symptoms (such as bone damage)
- Stage II: a moderate number of myeloma cells are present.
- Stage III: A large number of myeloma cells are present