Aesthetics are the name of the game when it comes to self-care, at least according to my misinformed friends. I always think it's better to subscribe to the notion of self-love, where one's full acceptance of one's body is the ultimate goal of self-care. However, one issue cropped up recently when we were discussing about our bodies (nothing creepy, just a very manly discussion of how to look more attractive). My friend brought up that he had a 'blob' over his belly button. Normally, I would just dismiss it as a mere incidental lesion (or incidentaloma, the courteous medical term for things that we see in imaging and examination that are just not important; one example is the angiokeratomas on the scrotum - numerous brown spots across the organ which pose no identifiable health risk). However, given the description 'red blob' and location of the lesion, I've decided to have a look.
It confirmed my worst fears and I got him to see a specialist right away after asking him some key questions. He came back and was diagnosed Stage 4 Pancreatic Cancer, which already metastasised to the liver, stomach and brain.
What is a red blob over the belly button anyway? In medical jargon, we describe a mass in the following way so as to be precise (a patient might have more than one lesion and it's hard to keep track if we don't have an accurate description of each): [1]
Observed Characteristics: Colour, Size, Location, Number, Distribution, Lymph Node involvement, symmetry (whether the other side is affected), Base and Edge;
Felt Characteristics (upon 'touching', or palpating the mass): pain/tenderness, attachment to underlying tissue, Contours (well-defined or jagged?), Texture (hard vs firm vs soft), Temperature and Pulsatility (whether it moves like a blood vessel).
These are by no means the only parameters that we look for in examination. In fact, there are many more things, such as scars and changes in the skin elsewhere. Nor does it follow that all characteristics are relevant. For example, pulsatility is only relevant if the mass is in any way vessel-related. So, upon examining for breast cancer, this is probably not too relevant. However, the above characteristics still serve as a general framework.
The red blob over the belly button my friend looks similar to this:
[2] 'Sister Mary Joseph Nodule', a photograph included in a case report published on Canadian Medical Association Journal.
This is a worrying sign. Named after Sister Mary Joseph (hence the name Sister Mary Joseph Nodule), it is rare but classical as a sign of metastasis in the tummy (or as medical circles like to call: peritoneal metastases) (the word 'peritoneal' is the adjectivised form of 'peritoneum', which refers to the tummy space). It is postulated that the metastasis comes from cancer of the pancreas, stomach, or gynaecological structures (e.g. endometrial and ovarian cancers), through the remnant structures of the umbilicus. [3] The word 'remnant' means 'leftover' - there are things we don't need anymore from the moment when we were born. These usually get 'fibrosed' - thickened and hardened into ligaments.
Of course, with such a red blob, there are also other signs we can look for before it's too late. It must be stated that these do not replace advice given during a consultation with a licensed medical professional. This is meant to be, and solely, a general guide - take it as a list of warning signs that prompt you to seek medical help. Moreover, the first two signs are usually only related to tummy and gynaecological cancers:
Swollen Tummy (might be indicative of malignant ascites, a condition which comes from the increase in inflammation in the abdomen; cancer loves chaos!)
Constipation (might be due to a condition called Blumer's Shelf, with a hard mass compressing over the rectum, leading to difficulty in excretion);
Feeling tired all the time;
Unexplained, significant weight loss (over 3 months) (medical professionals like to quantify this as >10% of total body weight; in my opinion, this is quite funny because it's rare that a patient comes in and tells the doctor how much he/she has lost);
Poor appetite;
Night sweats;
Nausea and Vomiting.
Items 3-8 are very general and can be applicable to a wide range of conditions. However, if many of them are present and you get tummy-related symptoms, such as pain or a fixed, hard mass in the area, then you probably should get it checked by a licensed medical professional. [4, 5]
If you have a red blob over the belly button but don't have the symptoms listed, or are not feeling particularly unwell, don't panic! This is just a red flag that all medical professionals should know. As with all things medical, it's just a possibility, rather than a certainty. Many things may also present as a red blob, but Sister Mary Joseph Nodule is a crucial sign that must be ruled out before we explore other possibilities (or differential diagnoses, in use of a more medically accurate term).
[1] Dhir T. (2020). Examination of a Lump - OSCE Guide | Geeky Medics. Geeky Medics. Retrieved 9 November 2020, from https://geekymedics.com/examination-of-a-lump-osce-guide/.
Geeky Medics is what I've always used, but of course, there are loads of different resources out there. If interested, also consult the following book: Macleod J, Munro JF, and Edwards CRW. (1990). Macleod's Clinical Examination. Edinburgh: Churchill Livingstone.
[2] Fairchild A, Janoski M, & Dundas G. (2007). Sister Mary Joseph's nodule. Canadian Medical Association Journal, 176(7), 929-930. https://doi.org/10.1503/cmaj.060847.
This image is posted purely for educational purposes.
[3] Miller T, Ashworth J, & Richards S. (2015). Sister Mary Joseph nodule. BMJ, h5224. https://doi.org/10.1136/bmj.h5224.
Do note that there are three different types of umbilical remnants - lateral umbilical fold, median umbilical ligament and medial umbilical ligaments.
[4] Halkia E, Spiliotis J, & Sugarbaker P. (2012). Diagnosis and Management of Peritoneal Metastases from Ovarian Cancer. Gastroenterology Research And Practice, 2012, 1-12. https://doi.org/10.1155/2012/541842.
[5] Weigt J, & Malfertheiner P. (2015). Metastatic Disease in the Stomach. Gastrointestinal Tumors, 2(2), 61-64. https://doi.org/10.1159/000431304
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