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Diagnosing myeloma starts with a suspicion

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Dr Caroline Donoghue

Senior Scientific Knowledge and Communications Officer, Myeloma UK

Myeloma patients experience some of the longest delays to diagnosis of all cancer patients, with a third of patients being diagnosed via an emergency route.

Myeloma is an incurable blood cancer which, as it advances, becomes more difficult to treat and more likely to cause life-limiting complications. An early diagnosis of myeloma means patients are treated sooner to help prevent permanent damage, lengthen survival and preserve quality of life. 

There is no single symptom

Myeloma arises from plasma cells found in the bone marrow. As it grows, it spreads throughout the bone marrow, weakening the bones, reducing blood cell production and suppresses the immune system. As a result, the signs and symptoms of myeloma – such as bone pain, fatigue, anaemia, kidney damage and recurring infections – are vague and outwardly unconnected.

With no lump, no single place to screen or scan and no single symptom to raise concern myeloma is consistently difficult to detect.

Sometimes we need to suspect the worst

The challenge is not that it is a rare cancer, but that the most frequent symptoms are common and often linked to general ageing or benign conditions. Consequently, one of the main challenges to diagnosis is for patients and GPs to suspect that these seemingly ordinary symptoms could be something more serious.

With no lump, no single place to screen or scan and no single symptom to raise concern myeloma is consistently difficult to detect.

Other early signs of myeloma can go undetected because they are happening under the surface. For example, changes in the blood: the presence of paraprotein, the increases in blood calcium levels and blood thickness and the reduction in blood cells.

Making diagnosis as simple as possible

Without screening methods or an identifiable symptom, diagnosis relies on someone piecing everything together.

Most GPs will only see one or two cases of myeloma throughout their career and it is naïve to expect every GP to remember every sign, symptom and test for myeloma. To improve diagnosis, we need the right tools and infrastructure to support them.

Rapid diagnostic centres are helping. Having one referral route for patients with vague but worrying symptoms reduces the risk of delay caused by incorrect referrals. Tools like the Myeloma GP Diagnostic Tool, developed by the Myeloma UK Early Diagnosis Programme, also help by providing simple guidance and instructions to suspect and diagnose myeloma.

Without challenging current practice around early diagnosis, we cannot achieve the change in patient outcomes that we wish to see. 

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