Myeloma - diagnosis

What are cancer staging systems? 

Staging systems are tools that are used by doctors to help describe the extent or spread of a malignancy. They normally come in the form of a combination of Roman numerals and letters (e.g. stage Ia or IIIb), with higher numbers indicating more advanced cancer. Staging systems are specific to each particular type of cancer.

Why is myeloma staged?

Myeloma is staged to help determine the level of myeloma and whether or not it has caused any complications.

There are two main staging systems: the Durie Salmon Staging System, which takes into account a range of different blood and urine test results, and the presence or absence of bone lesions; and the International Staging System (ISS), which uses the levels of beta 2 microglobulin and albumin in the blood. The Durie Salmon staging system has been superseded by the ISS and is now less commonly used.

The ISS has 3 stages:

Stage 1 - the level of beta 2 microglobulin is less than 3.5 mg per litre and the level of albumin in the blood is more than 3.5 grams per decilitre.

Stage 2 - the levels of beta 2 microglobulin and albumin fall between those in stages 1 and 3.

Stage 3 - the level of the protein beta 2 microglobulin is more than 5.5 mg per litre.

How is myeloma diagnosed?

Myeloma is a complex cancer and its diagnosis can involve a number of different tests including blood and urine tests, a bone marrow biopsy and a series of X-rays. These tests are done to determine if there is evidence of myeloma-related organ or tissue impairment, e.g. kidney problems, bone lesions, high calcium levels in the blood and anaemia.

Anyone suspected of having myeloma will be referred to a haematologist who will order further tests and investigations. If a myeloma diagnosis is confirmed, these tests can be used to determine the stage of their myeloma and to plan the most appropriate treatment.

Why does a delay in diagnosis often happen?

Some people do not have any symptoms, or, if they do have symptoms, they can be quite vague, e.g. general tiredness, lower back pain and a cough or cold. These are all very common in the majority of adults and this is why myeloma can be quite difficult to diagnose. Sometimes it is picked up during routine blood tests or by chance, but rarely is myeloma suspected when people first present to their GP.