Abdominal masses

What is an abdominal mass?

An abdominal mass is a lump in the tummy (abdomen). The abdomen contains many different structures including the:

• Stomach and gut (bowel).

• Liver.

• Spleen.

• Pancreas.

• Kidneys and bladder.

• Womb (uterus) and ovaries in women.

• Major blood vessels - for example, the aorta.

The position of the mass will help to determine which structure the mass is arising from.

The abdomen is traditionally divided into nine areas:

• Just below the ribs on the right side (right upper quadrant/hypogastrium).

• Just below the ribs in the middle (epigastrium).

• Just below the ribs on the left side (left upper quadrant/hypogastrium).

• Right side of the middle abdomen (right loin/lumbar region).

• Around the tummy button (periumbilical).

• Left side of the middle abdomen (left loin/lumbar region).

• Right side of the lower abdomen (right lower quadrant/inguinal or iliac region).

• Middle of the lower abdomen (suprapubic and pelvis).

• Left side of the lower abdomen (left lower quadrant/inguinal or iliac region).

Abdominopelvic regions

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Often nowadays, the abdomen is described in quadrants rather than using the nine areas. These are described as the right upper, right lower, left upper and left lower quadrants.

Abdominal mass symptoms

It is possible to feel a lump in the stomach (the mass in your own abdomen) before any other symptom but, much more frequently, it is first felt by a doctor examining the abdomen because of a different symptom, such as abdominal pain.

Therefore, it is more usual to become aware of a mass in the abdomen because of other symptoms such as:

• Abdominal pain.

• Diarrhoea.

• Constipation.

• Rectal bleeding.

• Weight loss.

A mass in the kidney may also cause blood in the urine. Other symptoms will depend on the cause of the mass.

Abdominal mass causes

The possible cause of the abdominal mass will depend on where it is in the abdomen. The following lists are examples of the more common causes of an abdominal mass in each area. A lump (swelling) that can be seen and felt over the front of the abdomen (abdominal wall) may also be a skin lump, a lipoma (fatty lump) or a hernia.

Right upper quadrant

• Liver: enlarged liver (hepatomegaly), liver cancer. There are many causes of an enlarged liver, including infection, heart failure, liver cancer, alcoholic liver disease and fatty liver disease.

• Gallbladder: cholecystitis, cancer of the bile duct in the liver (cholangiocarcinoma).

Epigastrium

• Stomach: for example, stomach cancer.

• Pancreas: for example, a pancreatic abscess or cancer of the pancreas.

• Ribcage: at the very bottom of the rib cage in the centre of the body, there is a small bone called the xiphisternum. In some people this bone sticks out and can feel like a lump. This is entirely normal and can be easily diagnosed by a doctor on clinical examination.

Left upper quadrant

• Spleen: enlarged spleen (splenomegaly). There are many causes of an enlarged spleen, including leukaemia, lymphoma, thalassaemia, sickle cell disease, malaria and glandular fever.

• Stomach: for example, stomach cancer.

• Pancreas: for example, an abscess or cancer of the pancreas.

• Gut (bowel): for example, colon cancer.

• Kidney: for example, kidney cancer.

Right loin

• Kidney: for example, kidney cancer.

Periumbilical

• Enlarged part of the major blood vessel (aorta): aortic aneurysm.

Left loin

• Kidney: for example, kidney cancer.

Right lower quadrant

• Bowel: for example, colon cancer.

• Kidney: for example, kidney cancer.

• Ovary: for example, cancer of the ovary.

Suprapubic and pelvis

• Bladder: for example, a distended bladder caused by a blockage preventing you from emptying the bladder - such as in prostate gland enlargement in men.

• Womb (uterus): for example, pregnancy, fibroids.

• Ovary: for example, ovarian cyst, ovarian cancer.

• Abdominal aorta: for example, a pulsatile mass due to an abdominal aortic aneurysm.

Left lower quadrant

• Bowel: for example, constipation, colon cancer, diverticular disease.

• Kidney: for example, kidney cancer.

• Ovary: for example, cancer of the ovary.

Diagnosing an abdominal mass

What tests are needed?

There are lots of different causes of an abdominal mass. Doctors will ask about various other symptoms and do a physical examination of the abdomen. Further tests depend on what they find, and what they think the cause might be.

Examples of tests that might be needed include:

• Blood tests - for example, a CA-125 test to look for ovarian cancer.

• Urine tests - to look for hidden blood in the urine which can be a sign of kidney cancer or bladder cancer.

• Stool tests - a qFIT test is a test to look for hidden blood in the stool which can be a sign of bowel cancer.

• Scans or other imaging, such as:

  • Ultrasound scans; abdominal ultrasound and sometimes transvaginal ultrasound scans.

  • CT scans.

  • MRI scans.

• Depending on the scan results, sometimes a biopsy (sample) of the mass is needed. This would be done in hospital. It might require an operation, depending on where the mass is.

Blood, stool and urine tests can be done by a GP; others need to be done by a hospital team.

If the GP suspects that the mass might be due to cancer, they are likely to make an urgent referral to the hospital - suspected cancer pathways mean that patients should have been seen and investigated within 28 days of referral. Often particular tests are needed before the hospital referral can be sent (for example, a qFIT result may be needed in advance).

Cancer is one cause of an abdominal mass, but there are many others. Most people referred to hospital for suspected cancer end up with normal or reassuring test results. For instance, fibroids are a common cause of a pelvic mass in women, but are not cancerous.

Abdominal mass treatment

Treatment options will depend on the cause of the abdominal mass. If the mass isn't cancer, and isn't causing any problems, no treatment may be needed. Treatment for cancer depends on the type of cancer and how advanced it is. Depending on what the mass is, an operation to remove it may be possible.

Complications of an abdominal mass

There are lots of different causes of an abdominal mass. Complications differ depending on the cause.

In general, masses can cause:

• Pressure symptoms. A large mass in the abdomen can press on other organs. This might cause bloating, abdominal swelling, a reduced appetite, leg swelling and pain.

Other complications depend on the cause of the mass. For example:

• Uterine (womb) fibroids can cause heavy menstrual bleeding and anaemia.

• People with polycystic kidney disease, which causes enlarged kidneys with multiple fluid-filled cysts in them, can develop high blood pressure and kidney problems.

• Cancer can spread to other organs.