Usually you begin by seeing your family doctor (GP), who will examine you and arrange for you to have any tests or x-rays that may be necessary. Your GP will refer you to hospital for these tests and for specialist advice and treatment.

At the hospital, the specialist will ask you about your general health and any previous medical problems, before examining you.

Samples of your blood and urine will be taken and examined to check your general health and how well your kidneys are working. These tests will also show whether there are any paraproteins (the abnormal proteins that are produced by myeloma cells) in your blood and urine.

If the blood test shows that a paraprotein is present, your doctor will want to take a bone marrow sample and do some further tests. These are done so that the doctor can plan the best treatment for your situation.

A sample of bone marrow is usually taken from the back of your hipbone (pelvis) or, sometimes, the breast bone. It will be examined to see if it contains any myeloma cells.

The bone marrow sample is taken under a local anaesthetic. You will be given a small injection to numb the area and the doctor will gently pass a needle through the skin into the bone. The doctor will draw a small sample of liquid marrow into a syringe to be looked at later under the microscope (bone marrow aspirate). The doctor will then take a small core of marrow from the bone (a trephine biopsy).

The test can be done on the ward or in the outpatients department. The whole procedure takes about 15–20 minutes. It may feel uncomfortable while the marrow is drawn into the syringe but this should only last for a few seconds. You may be offered a short-acting sedative to reduce any pain or discomfort during the test. You may feel bruised after the test and have an ache for a few days. This can be eased with mild painkillers.

Each cell in the body contains chromosomes, which are made up of genes. The genes control all activities of the cell. In myeloma there may be changes in the structure of the chromosomes within the myeloma cells, but not the normal cells of the body. The tests on the blood and bone marrow samples will often include a chromosome analysis to look for any particular changes in the chromosomes. These tests, known as cytogenetic tests, may help to decide on the best treatment and predict how well the myeloma may respond to that treatment.

These will be taken to check for any damage that may have been done to your bones by the myeloma cells. You will usually have x-rays taken of your whole body, which is known as a skeletal survey.

If the tests show that you have myeloma, your doctor will want to do regular blood tests to measure the level of paraprotein in your blood, to check for anaemia and hypercalcaemia (a raised level of calcium in the blood), and to make sure that your kidneys are working properly.

Samples of your urine will be taken to test for a particular paraprotein known as the Bence Jones protein. This may involve taking a container home and collecting your urine for 24 hours.

In a few people with myeloma, standard blood and urine tests are unable to measure the level of paraprotein. A new test which detects very small amounts of paraprotein, called the Freelite test, may be used.