Abdominal masses

What is an abdominal mass?

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

• Stomach and gut (bowel).

• Liver.

• Spleen.

• Pancreas.

• Kidneys and bladder.

• Womb (uterus) and ovaries in women.

• Major blood vessels - for example, the aorta.

The exact position of the mass will help to determine what structure the mass is coming from. See the section 'What are the causes of an abdominal mass?' below.

The abdomen can be divided into nine areas:

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

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

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

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

• Around your tummy button (periumbilical).

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

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

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

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

Abdominal mass symptoms

You might feel the lump in your tummy before any other symptom, but more usually it is first felt by a doctor examining your abdomen because of a different symptom, such as abdominal pain.

Therefore, you are more likely to be aware of a mass in your abdomen because of other symptoms such as:

• Abdominal pain.

• Diarrhoea.

• Constipation.

• Rectal bleeding.

• Weight loss.

A mass in your kidney may also cause blood in your urine. Any other symptoms you get will depend on exactly where the mass is and the cause of the mass.

Abdominal mass causes

The possible cause of the lump (mass) in your tummy (abdomen) will depend on where it is in your 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 be a skin 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 feels 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 your bladder - such as in prostate gland enlargement in men.

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

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

Left lower quadrant

• Bowel: for example, 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 examine the mass and ask about your medical history. 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.

• Scans, 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. This would be done in hospital. It might require an operation, depending on where the mass is.

Some tests can be done by a GP; others need to be done by a hospital team.

If your GP suspects that the mass might be due to cancer, they may refer you urgently to hospital under the NHS's 'two week wait' system. Sometimes, GPs can arrange urgent tests themselves.

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. However, it is very important that tests be done to exclude cancer as soon as possible.

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, 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.