Q. My mother has multiple myeloma. How to find out the stage of her cancer?

Hi doctor,

My 97-year-old mother, who is in a nursing home, is more tired and feeling unwell. A blood test has shown she has likely got multiple myeloma. She had left-sided paralysis from a stroke six years ago. She cannot speak, and she is slow in understanding and writing, but she has no dementia. She also has had atrial fibrillation for 12 years. Usually, she is alert and enjoys life with what she has. A bone marrow biopsy would be too nasty and cruel for her, so our physician and I have ruled it out. The physician can only offer palliative care, and maybe a blood transfusion if she gets anemic. I have been researching other alternative supplements to help her.

The physician is reluctant to refer her to a hematologist, but I think she should be referred just to get an expert assessment and possibly other tests, even though she cannot have a bone marrow biopsy. Could more be done to help with diagnosis and determining what stage of cancer she is at, or if she has MGUS or smoldering multiple myeloma through a hematologist referral? What do you think? Do you have a particular view of the blood results? Are there any more interpretations to be had? Weirdly, the physician also says you have to do a bone marrow biopsy to refer her to the hematologist. But my understanding is the physician refers to the hematologist, who then orders a bone marrow biopsy, right? I think they are just fobbing me off because she is old.

Her blood report shows, that total serum protein is 83, serum albumin is 27, serum globulin is 56, IgA is 1.12, IgM is 0.56, serum protein electrophoresis discrete band in gamma region, serum immunofixation monoclonal band of IgG lambda paraprotein band is 26.1, the serum TSH level is 1.46, serum free T4 level 12.9, serum ferritin is 30, basophil count is 0.02, eosinophil count is 0, monocyte count is 0.4, lymphocyte count is 4.46, and the neutrophil count is 2.71. Her platelet count is 166, MCH is 31.5, mean corpuscular volume (MCV) is 95.1, hematocrit is 0.37, and the red blood cell count is 3.93.