Lump underneath rib cage

Adult primary liver cancer: A tumor in which the cancer starts during adulthood in cells in the liver. Also called hepatocellular carcinoma or hepatoma.

Primary liver cancer is different from cancer that has metastasized (spread) from another place in the body to the liver.

The signs and symptoms may include a hard lump just below the rib cage on the right side (from swelling of the liver), discomfort in the upper abdomen on the right side, pain around the right shoulder blade, or yellowing of the skin (jaundice).

There is often an increase in the blood levels of alpha-fetoprotein (AFP) and alkaline phosphatase. A rapid deterioration of liver function may be the only clue to the presence of the tumor.

Hepatocellular carcinoma is potentially curable by surgery, but surgery is the treatment of choice for only a small fraction of patients who have localized disease. Laparoscopy may detect metastatic disease, tumor in both lobes of the liver, or an inadequate liver remnant, and avoid the need for open surgery to explore the liver. Liver transplantation is also potentially curative, but is appropriate for only 5% of patients presenting with a hepatoma.

Therapy other than surgery is best as part of a clinical trial. Such trials evaluate the efficacy of systemic or infusional chemotherapy, hepatic artery ligation or embolization, percutaneous ethanol (alcohol) injection, radiofrequency ablation, cryotherapy (freezing the tumor), and radiolabeled antibodies, often in conjunction with surgical resection (removal) and/or radiation therapy.

The prognosis (outlook) depends on the degree of local tumor replacement and the extent of liver function impairment.

Primary liver cancer (hepatocellular carcinoma) is the most common cancer in some parts of the world. It is still relatively uncommon in the US but its incidence is rising, principally in relation to the spread of hepatitis B and hepatitis C. People who have a disease of the liver called cirrhosis are also more likely to get adult primary liver cancer. People with the iron-storage disease called hemochromatosis are also at increased risk for hepatoma.

Hepatitis B and C appear to be the most significant causes of hepatocellular carcinoma worldwide. People who have both hepatitis B and hepatitis C may be at even higher risk if they consume more than 3 oz. (80 grams) of alcohol a day. A history of a first-degree relative with hepatocellular carcinoma also increases the risk.

Hepatocellular carcinoma is associated with cirrhosis in 50% to 80% of patients; 5% of cirrhotic patients eventually develop hepatocellular cancer.

Aflatoxin has also been implicated as a factor in the etiology (causation) of primary liver cancer in parts of the world where this mycotoxin- that is a toxic substance which comes from a mold- occurs in high levels in food.

Workers exposed to vinyl chloride before controls on vinyl chloride dust were instituted developed sarcomas in the liver, most commonly angiosarcomas. These are different from hepatomas

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Abdominal mass

Several conditions can cause an abdominal mass:

  • Abdominal aortic aneurysm can cause a pulsating mass around the navel.
  • Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones. In extreme cases, it can reach as far up as the navel.
  • Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).
  • Colon cancer can cause a mass almost anywhere in the abdomen.
  • Crohn disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen.
  • Diverticulitis can cause a mass that is usually located in the left-lower quadrant.
  • Gallbladder tumor can cause a tender, irregularly shaped mass in the right-upper quadrant.
  • Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).
  • Kidney cancer can sometimes cause a mass in the abdomen.
  • Liver cancer can cause a firm, lumpy mass in the right upper quadrant.
  • Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage, or on the left side in the stomach area.
  • Neuroblastoma, a cancerous tumor often found in the lower abdomen can cause a mass (this cancer mainly occurs in children and infants).
  • Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.
  • Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.
  • Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.
  • Renal cell carcinoma can cause a smooth, firm, but not tender mass near the kidney (usually only affects one kidney).
  • Spleen enlargement (splenomegaly) can sometimes be felt in the left-upper quadrant.
  • Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.
  • Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (sometimes can be felt if the fibroids are large).
  • Volvulus can cause a mass anywhere in the abdomen.
  • Ureteropelvic junction obstruction can cause a mass in the lower abdomen.

It’s the rare person who hasn’t self-diagnosed various aches and pains. It turns out one of the most popular internet searches is something along the lines of: “I have a pain under my right rib. OMG, am I dying?”

Luckily, that pain in the few inches of space right below your right ribs isn’t necessarily an indicator something is seriously wrong.

“Sometimes a pain under the rib is nothing more than you slept wrong, or you exercised too hard,” said Dr. Gregory Cooper, a gastroenterologist at the University Hospitals Cleveland Medical Center. But if the pain is severe enough — or you are stressing yourself out enough — that you’re actually spending time online self-diagnosing, it may be time to get checked out, he noted.

The pain could potentially be something more serious like gallbladder issues. Or it could be “referred” pain from another area of the body. The key is to look at other symptoms you may be experiencing, the severity of the pain, whether it is intermittent or constant, or whether it goes away only to return at a later date, he added.

After months of stomach problems, young woman is diagnosed with colon cancer

March 30, 201801:02

Here’s a brief rundown of some causes of what that right-under-the-right-rib ache could mean:

1. Gallbladder gone rogue

Your gallbladder (located on the right side of your body, beneath the liver) may be the cause of your misery. There’s a host of conditions plaguing this pear-shaped organ and you might be experiencing one of them.

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The most likely culprit may be biliary colic. Pain is sudden and often gets worse. You usually feel that pain in the abdomen, right under the right ribs or the center of your abdomen. Pain may be “referred” or felt in the right shoulder blade. It might be fleeting, lasting just a few minutes, or it can last a few hours. You might feel nauseous and your abdomen may be tender for a day or so.

Another issue could be acute cholecystitis, or the gallbladder attack. Basically, your gallbladder has become inflamed — most likely due to a gallstone blocking the cystic duct. Symptoms include pain, fever, chills, nausea and vomiting. The pain is usually severe and steady.

You might also be suffering from acute pancreatitis, which is sometimes linked to gallstones.

2. Liver issues

An isolated ouch under your right ribs probably doesn’t mean your liver is diseased.

But this football-shaped organ is located on the right side of the body and is prone to numerous problems. Aside from pain, which can be dull or very severe, liver problems usually include some combination of jaundice, itchy skin, darkened urine, changes in stool color (including pale or tar-colored stool), fatigue, and appetite loss, among others.

3. Gas problems

Gas in the intestines can cause real-deal pain for some folks. If you have a pain under your ribs from gas, you’re not alone. Your large intestine has two points under the rib cage where it bends. The right-sided bend is called the hepatic flexure. Gas can accumulate in this area, causing pain and tenderness, especially if you have IBS. Gas can accumulate on the left side, too. That’s called splenic flexure syndrome. Right-sided gas pain is often confused with gallstones.

4. Bruises, breaks and strains

Musculoskeletal issues can cause pain on your right side under your ribs. That pain can be caused by something as simple as lousy posture and sitting at your desk for too long. But if you’ve taken a fall or got hit during a sporting event, you could have a bruised rib, maybe even a fracture. For bruising or breaks, symptoms include pain when breathing in or coughing. The area may be tender or swollen. The rib cage contains intercostal muscles that allow it to move. If you’ve twisted your body forcefully or played 18-holes of golf without a warm-up, you could have strained an intercostal muscle.

The best time to schedule a doctor’s appointment is…

Feb. 13, 201703:50

Don’t be a hero

Searching the internet for answers on pain can make you more miserable and scared. So heed this advice: “If the pain is keeping you from working or just enjoying your day, then see your doctor,” says gastroenterologist Dr. Amit Bhan of the Henry Ford Health System in Detroit.

Don’t be embarrassed if that pain can be fixed by buying a new mattress, stretching before exercise — or eating more fiber.

“There’s nothing we like more than telling someone that everything is OK or finding something more serious in the earliest stages so treatment is most effective” he adds.

Related:

  • How to get your liver back in shape
  • Best home cures for your aches and pains
  • What your leg pain really means and when it’s time to see a doctor

Pain under the right rib cage can be minor or severe depending on the cause, and sharp pain under the right rib cage can be frightening. If you experience pain on the right under the rib cage, there could be a simple explanation such as an injury. It could also be related to a serious medical issue.

There are many vital organs protected by the right rib cage, so you shouldn’t ignore the pain. Getting a thorough physical exam is important to help determine the exact cause. Understanding pain right under the rib cage can give you a sense of relief as opposed to panic. For example, some people may simply be experiencing pain under the right rib cage due to postural changes. When some people have pain on the right side under the rib cage, they fear they are having a heart attack. While this is not entirely out of the question, it is rare that pain in this location is heart-related.

Being aware of the type of pain, when the pain occurs, and whether the pain is associated with movement, eating, or a certain food item can assist the doctor during their assessment and might help identify the cause.

Pain under the right side of the rib cage can feel like an aching, stabbing, or burning sensation. Some individuals have described it as feeling like something is squeezing their chest, while others say they experience a sharp pain under the right rib cage when breathing in. While not all pain under the right rib cage is life-threatening, it is a good idea to get it checked out, especially if it just won’t go away.

Causes of pain under the right rib cage

The cause of pain under the right rib cage can be the same as pain on the left. Many people jump to conclusions based on where the pain is situated, but they could be way off base. Here we look at the many different causes of pain under the right rib cage.

Injury: Injuries to the ribs are common and can cause chest pain. This pain can be mild or severe depending on the extent of the injury. Some injuries to the rib cage can lead to serious problems such as a collapsed lung or kidney damage.

Liver pain related causes:

  • Liver trauma: During surgical or diagnostic procedures, sharp force can injure the abdominal wall.
  • Viral hepatitis: This is an infection of the liver.
  • Alcoholic liver disease: A broad term used to describe many stages of liver disease caused by excessive alcohol consumption. The end stages of cirrhosis of the liver normally do not include pain.
  • Fatty liver disease: The accumulation of fat in the liver can be linked to obesity, high blood cholesterol, hypertension, and diabetes mellitus.
  • Liver abscess: This is a buildup of puss in the liver and can be accompanied by other infections in the abdomen.
  • Liver cancer: Liver cancer or hepatocellular carcinoma is a malignant tumor. It can occur due to the spread of cancer from elsewhere in the body. Liver cysts or hepatic cysts, which are fluid filled sacs in the liver, have also been linked to pain under the right rib cage.
  • Intrahepatic cholestasis: This is a condition where bile gets backed up in the liver. It can be due to problems in the bile ducts.
  • Hepatic arterial occlusion: A blockage or narrowing of the hepatic artery can reduce oxygen to the liver tissue and lead to pain under the right rib cage.

Gallbladder pain related causes:

  • Gallbladder: Gallstones, inflammation of the gallbladder, and inflammation of the bile ducts can cause pain on the right side under the rib cage.
  • Gallbladder cancer: Much like liver cancer, this is a malignant tumor that can occur as a result of a metastatic spread from somewhere else in the body.

Kidney pain related causes:

  • Kidney stones: Large stones can become lodged and cause sharp pain under the right rib cage. Many people who experience this also feel back pain.
  • Pyelonephritis: This is an infection of the kidney, likely due to bacteria entering the urinary tract. Bleeding in the kidney due to severe trauma or hydronephrosis, which is the accumulation of urine in the kidney, can also cause pain under the ribs.
  • Polycystic kidney disease: The accumulation of small fluid-filled sacs in the kidney. Polycystic kidney disease has a genetic link.

Colon pain related causes:

  • Colon problems: Diverticulitis, which is inflammation of the pouches that form the walls of the colon; irritable bowel disease, which impacts bowel habits colonic polyps, trapped gas; and inflammatory bowel disease, which is a chronic inflammation of the wall of the large intestine, are all potential causes of pain under the right rib cage.
  • Fecal impaction: When colon contents accumulate and a person experiences severe constipation, fecal impaction occurs.
  • Colorectal cancer: This is a malignant growth in the large intestine and usually impacts the lower parts of the colon and rectum.
  • Gastrointestinal problems: Acid reflux and ulcers can lead to burning and pain sensations. Sometimes, the discomfort is under the right rib cage.
  • Gas: When you overeat, it doesn’t allow for the proper digestion of food, so excess gas can build up. Gas can cause abdominal pain, including pain under the right rib. This will eventually pass but be a good reminder to chew your food and eat slowly.

Lung pain related causes:

  • Lung disease: There are a number of lung conditions that can cause pain under your right rib cage. The pain is most noticeable when breathing in. Pleurisy, caused when fluid builds up between the layers of tissue that cover the lungs, is one example. Pleurisy can be the result of a lung infection, rheumatoid arthritis, or even a rib fracture.
  • Pneumonia: This usually leads to sharp, stabbing chest pains that get worse when breathing in deeply. Depending on which lung is affected, you could have pain under the right rib cage.
  • Lung cancer: May cause aches and pain in the chest area or shoulders. Although it doesn’t happen in all cases of lung cancer, some people do experience discomfort under the right rib cage.

Appendicitis: The appendix is a part of the intestine on the right lower side of the abdomen. If it becomes infected and inflamed, it can cause right side pain.

Tuberculosis: The dangerous bacterial infection known as tuberculosis is contagious and can spread to the spine and brain. In the 20th century, TB was a leading cause of death in the United States. Thankfully, there is a cure for TB.

Peritonitis: The peritoneum is a double-layered sac that houses most of our abdominal organs. Inflammation of this sac is dubbed peritonitis.
Shingles: An infection of nerve and skin surface caused by the varicella-zoster virus. It is the same virus that causes chickenpox. Anyone who has recovered from a case of chickenpox has the potential to get shingles.

Pancreatitis: Inflammation and infection of the pancreas can result in pancreatitis which will signal itself as pain under your right rib. This pain may also travel to your back. Other symptoms include yellowish skin, increased heart rate, and vomiting.

Musculoskeletal problems: Osteoporosis or costochondritis, which is inflammation of the costal cartilage, has been linked to pain under the right rib cage. The costal cartilage is a structure connecting each rib to the sternum at the costosternal joint.

Intercostal muscle strain: The intercostal muscles are those that connect the ribs. If you strain the intercostal muscles on your right side, this can lead to pain. When these muscles become strained, it is quite noticeable because the muscles appear inflamed and very painful. Relaxation and medication can help reduce intercostal muscle strain.

Treatment for pain under the right rib cage

As you can tell, diagnosis is not always quick. In some cases, it can take a detailed investigation for doctors to pinpoint exactly what is leading to the pain right under the rib cage. Once a diagnosis is made, treatment may include rest and specific medications to control the pain.
If you have experienced pain under the right rib cage due to an injury, rest will be vital to ensure muscles and soft tissues can heal. When it comes to medications, depending on the cause, you may receive prescriptions to address pain, fever, infections, or gastrointestinal conditions. There are situations where medications and rest are not enough and additional measures, such as surgery, are required.

Diagnosis and when to see a doctor

After you get a physical and your medical history is taken, laboratory tests, chemical analysis, and imaging studies may be done to help view structures, fractures, organ enlargement, or tumors.

Some people will experience pain under the right rib cage that doesn’t last very long and is probably food related. Adjusting your diet ensures this doesn’t happen again. There are, of course, those who have recurring, constant, or severe pain under the right rib cage. If you have sudden, unexplained pain, you should see a doctor.

Most physicians agree that if pain under the right rib cage radiates to the left arm, back, or jaw, is accompanied by rapid heart rate, rapid breathing, a squeezing or tightness feeling, nausea, fever, chills, dizziness, or very low blood pressure, immediate medical attention should be sought.

Since our rib cage keeps many of our internal organs safe, there is a tendency to worry when we experience pain in this location. In the vast majority of cases, pain under the right rib cage is related to an injury or lifestyle factor, such as eating spicy and greasy foods. Just be sure to visit your physician if you think it’s serious.

Related: Right flank pain: Causes and symptoms

8 possible causes of aching rib cage

6. Inflammatory bowel disease

Inflammatory bowel disease, is the collective name for ulcerative colitis and Crohn’s disease. These 2 diseases involve the inflammation of the gut. The symptoms usually include:

  • Abdominal pain
  • Recurring or bloody diarrhoea
  • Weight loss
  • Extreme fatigue

7.Trauma/damage to ribs and cartilages

Trauma/damage to ribs and cartilages – If you have had an accident recently you may have bruising to the ribs or may have even cracked a rib.

8. Appendicitis

Appendicitis, is when the small part of the intestine known as the appendix becomes infected and inflamed. This needs examination by a GP or emergency doctor as it may need surgery.

With any of these issues it is important to get a diagnosis and treatment through your GP. If symptoms worsen or you experience any of the following, you should go to the accident and emergency department of your hospital:

  • Pain becomes unbearable
  • Vomiting blood or passing blood when you have your bowels open
  • Black stools
  • Crushing pain in chest
  • Worsening symptoms that you cannot manage at home

While of course no amount of healthy living can absolutely guarantee good health, the fact that you have such a healthy lifestyle makes a serious cause much less likely.

If you’re otherwise entirely well and have no other symptoms, it would be reasonable for you to try some regular anti-inflammatory tablets to see if they help your symptoms (as long as there’s no medical reason you can’t take them). Otherwise, after this length of time, see your GP – they can ask more detailed questions on associated symptoms.

Answered by the Health at Hand nurses

Sources and further reading

  • I’ve found a lump between my ribs – Ask the Expert
  • Fluttering feeling in rib cage – Ask the Expert
  • Aches and pains – AXA PPP healthcare

What is an abdominal mass?

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

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).
  • Just below your ribs in the middle (epigastrium).
  • Just below your ribs on the left side (left upper quadrant).
  • Right side of your middle abdomen (right loin).
  • Around your tummy button (periumbilical).
  • Left side of your middle abdomen (left loin).
  • Right side of your lower abdomen (right lower quadrant).
  • Middle of your lower abdomen (suprapubic and pelvis).
  • Left side of your lower abdomen (left lower quadrant).

What are the symptoms of an abdominal mass?

Although you may feel a lump (mass) in your tummy (abdomen), the mass is often first felt by a doctor examining your abdomen for a different symptom, such as abdominal pain.

Therefore, in the first instance, you are more likely to be aware of a mass caused by a problem with your gut (bowel) because of other symptoms such as abdominal pain, diarrhoea, constipation, rectal bleeding or 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.

What are the causes of an abdominal mass?

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, 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, an abscess or cancer of the pancreas.

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.

What tests are needed for an abdominal mass?

Initial tests will include blood tests. Further tests may include a urine test, an abdominal ultrasound scan, a CT scan or an MRI scan. Any further tests will depend on the likely underlying cause of the intestinal malabsorption.

What is the treatment for an abdominal mass?

The treatment will depend on the cause of the abdominal mass. There are many serious causes of an abdominal mass so you must see a doctor as soon as you think you can feel a mass in your tummy (abdomen).

Multimedia Encyclopedia

Mass in the abdomen

An abdominal mass is swelling in one part of the belly area (abdomen).

Considerations

An abdominal mass is most often found during a routine physical exam . Most of the time the mass develops slowly. You may not be able to feel the mass.

Physical exam

During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat…

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Locating the pain helps your health care provider make a diagnosis. For example, the abdomen can be divided into 4 areas:

  • Right-upper quadrant
  • Left-upper quadrant
  • Right-lower quadrant
  • Left-lower quadrant

Other terms used to find the location of abdominal pain or masses include:

  • Epigastric — center of the abdomen just below the rib cage
  • Periumbilical — area around the belly button

The location of the mass and its firmness, texture, and other qualities can provide clues to its cause.

Causes

Several conditions can cause an abdominal mass:

  • Abdominal aortic aneurysm can cause a pulsating mass around the navel.

    Abdominal aortic aneurysm

    The aorta is the main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aor…

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  • Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones. In extreme cases it can reach as far up as the navel.

    Bladder distention

    Urge incontinence occurs when you have a strong, sudden need to urinate. The bladder then squeezes, or spasms, and you lose urine.

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  • Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).

    Cholecystitis

    Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.

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  • Colon cancer can cause a mass almost anywhere in the abdomen.

    Colon cancer

    Colon, or colorectal cancer, is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Other types of cancer can affect …

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  • Crohn disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen.

    Crohn disease

    Crohn disease is a disease where parts of the digestive tract become inflamed. It most often involves the lower end of the small intestine and the be…

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  • Diverticulitis can cause a mass that is usually located in the left-lower quadrant.

    Diverticulitis

    Diverticula are small, bulging sacs or pouches that form on the inner wall of the intestine. Diverticulitis occurs when these pouches become inflame…

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  • Gallbladder tumor can cause a tender, irregularly shaped mass in the right-upper quadrant.
  • Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).

    Hydronephrosis

    Hydronephrosis is swelling of one kidney due to a backup of urine. This problem may occur in one kidney.

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  • Kidney cancer can sometimes cause a mass in the abdomen.

    Kidney cancer

    Renal cell carcinoma is a type of kidney cancer that starts in the lining of very small tubes (tubules) in the kidney.

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  • Liver cancer can cause a firm, lumpy mass in the right upper quadrant.

    Liver cancer

    Hepatocellular carcinoma is cancer that starts in the liver.

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  • Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage, or on the left side in the stomach area.

    Liver enlargement

    Hepatomegaly is swelling of the liver beyond its normal size. If both the liver and spleen are enlarged, it is called hepatosplenomegaly.

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  • Neuroblastoma , a cancerous tumor often found in the lower abdomen can cause a mass (this cancer mainly occurs in children and infants).

    Neuroblastoma

    Neuroblastoma is a very rare type of cancerous tumor that develops from nerve tissue. It usually occurs in infants and children.

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  • Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.

    Ovarian cyst

    An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. This article is about cysts that form during your monthly menstrual cycl…

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  • Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.

    Pancreatic abscess

    A pancreatic abscess is an area filled with pus within the pancreas.

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  • Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.

    Pancreatic pseudocyst

    A pancreatic pseudocyst is a fluid-filled sac in the abdomen. It may also contain tissue from the pancreas, enzymes, and blood.

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  • Renal cell carcinoma can cause a smooth, firm, but not tender mass near the kidney (usually only affects one kidney).

    Renal cell carcinoma

    Renal cell carcinoma is a type of kidney cancer that starts in the lining of very small tubes (tubules) in the kidney.

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  • Spleen enlargement (splenomegaly) can sometimes be felt in the left-upper quadrant.

    Spleen enlargement

    Splenomegaly is a larger-than-normal spleen. The spleen is an organ in the upper left part of the belly.

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  • Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.

    Stomach cancer

    Stomach cancer is cancer that starts in the stomach.

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    Cancer

    Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.

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  • Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (sometimes can be felt if the fibroids are large).

    Leiomyoma

    Uterine fibroids are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign).

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  • Volvulus can cause a mass anywhere in the abdomen.

    Volvulus

    A volvulus is a twisting of the intestine that can occur in childhood. It causes a blockage that may cut off blood flow. Part of the intestine may …

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  • Ureteropelvic junction obstruction can cause a mass in the lower abdomen.

    Ureteropelvic junction obstruction

    Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder (ureters). …

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Home Care

All abdominal masses should be examined as soon as possible by the provider.

Changing your body position may help relieve pain due to an abdominal mass.

When to Contact a Medical Professional

Get medical help right away if you have a pulsating lump in your abdomen along with severe abdominal pain . This could be a sign of a ruptured aortic aneurysm, which is an emergency condition.

Abdominal pain

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

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Contact your provider if you notice any type of abdominal mass.

What to Expect at Your Office Visit

In nonemergency situations, your provider will perform a physical exam and ask questions about your symptoms and medical history.

In an emergency situation, you will be stabilized first. Then, your provider will examine your abdomen and ask questions about your symptoms and medical history, such as:

  • Where is the mass located?
  • When did you notice the mass?
  • Does it come and go?
  • Has the mass changed in size or position? Has it become more or less painful?
  • What other symptoms do you have?

A pelvic or rectal exam may be needed in some cases. Tests that may be done to find the cause of an abdominal mass include:

  • Abdominal CT scan

    Abdominal CT scan

    An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog…

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  • Abdominal ultrasound

    Abdominal ultrasound

    Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and…

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  • Abdominal x-ray

    Abdominal x-ray

    An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the spleen, stomach, and intestines. When the …

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  • Angiography

    Angiography

    An arteriogram is an imaging test that uses x-rays and a special dye to see inside the arteries. It can be used to view arteries in the heart, brain…

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  • Barium enema

    Barium enema

    Barium enema is a special x-ray of the large intestine, which includes the colon and rectum.

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  • Blood tests such as CBC and blood chemistry

    CBC

    A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota…

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  • Colonoscopy

    Colonoscopy

    A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm…

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  • EGD

    EGD

    Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine.

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  • Isotope study

    Isotope study

    A positron emission tomography scan is a type of imaging test. It uses a radioactive substance called a tracer to look for disease in the body. A po…

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  • Sigmoidoscopy

    Sigmoidoscopy

    Sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum. The sigmoid colon is the area of the large intestine nearest to the re…

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McQuaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 132.

Roxanne W.

Listening to the pain

In 2012, when I was 60 years old, I began feeling intermittent pain on my left side. I’d been treated for breast cancer years earlier, but did not know at the time that I had the genetic abnormality known as BRCA 2. This abnormality is associated with pancreatic cancer, as well as breast and ovarian cancer. I had some lower back pain, which I thought was due to driving, and had also lost my appetite.

I spoke with my internist and asked if the pain could be related to my gallbladder. She said no, because the gallbladder is on the right side, not the left. I told her I felt the discomfort under my left rib cage, and she told me that the pancreas is on the left side, but that she thought the pain was likely due to driving. At the time, I was an Account Executive with an Environmental Service company. I covered the Southeast and drove on average 800 to 1,000 miles a week.

Although, she did believe it was nothing to be worried about she did a test for pancreatic enzymes, but the results of this test showed the enzyme levels to be normal, not elevated. She suggested that I see my gynecologist to have my left ovary examined. (I had my right ovary removed when I was in my late 20s and had a solid cyst that engulfed my ovary.) She also recommended having a colonoscopy with a gastroenterologist.

I asked my internist what her next step would be if the examinations of my ovary and colon did not identify the cause of the pain, and she told me if that happened, she would do a CT scan. Eight weeks later, I still had no diagnosis. I went to see my internist again for blood tests and told that the pain had worsened and was now in my stomach, and that I’d lost more weight. She ordered a CT scan for me. Two days later, she called to tell me there were lesions on my pancreas.

The right treatment

I began treatment with an oncologist near my home in South Carolina. I wanted to make sure to get a second opinion. I knew I had just one chance to get the right treatment.

In December of 2012 I called Cancer Treatment Centers of America® (CTCA) and spoke with Matt Owens, a representative based in Chicago. Within two weeks I was at CTCA in Tulsa for a week of meetings with my Care Team.

The chemotherapy that I’d started in South Carolina continued at CTCA. I had six rounds in total of a regimen known as FOLFIRINOX. The goal of treatment was to shrink the cancer to the point where it was operable. After six rounds of chemotherapy, a PET scan showed that the tumor in the tail of the pancreas was gone, but that there was cancer in the abdominal lymph nodes.

After an additional six rounds of chemotherapy, a PET scan showed no visible signs of cancer. My surgeon, Dr. Greeff, conferred with several other oncologists, who agreed that I would likely benefit from surgery. The procedure was risky, but I had no other health risks like smoking or being overweight, so it made sense to go ahead with it.

In September of 2013, I underwent a 10-hour sub-Whipple procedure, which removed 60 percent of my pancreas, all of my spleen, my left adrenal gland, my left fallopian tube, my right ovary and the covering of my stomach. I also had intraoperative radiation therapy during the surgery.

The treatments were difficult to get through at times. My hands became numb and I had very painful mouth sores that lasted throughout chemotherapy. After the six hours of chemotherapy infusion, there were times when I could not make it to my room unassisted.

But the truth is, I never had to make it to my room unassisted. There was always someone there to help. My Care Team did their best to help reduce the pain of the mouth sores and to provide comfort in whatever way they could.

Life begins again

Today I am feeling great. I have had three additional PET scans since completing chemotherapy and surgery, all of which showed no visible signs of cancer. I return to Tulsa every four months for follow-up visits, and I am preparing for additional preventative surgery.

I can take long walks, go to yoga classes, and work out with free weights. I am starting to think again about the trip to Europe that I put on hold. I meet friends for lunch. And I’m hoping to get my golf swing back to where it was before I was diagnosed.

I had one grandchild before I was diagnosed with pancreatic cancer, and now I have two—the second one was born the day after I finished chemotherapy. My family keeps me motivated—I need to be here to watch my grandchildren grow up—as does my simple love of life. I have a long list of adventures still to come.

Hello everyone, I will try to make this as brief as possible. I am 35 year old female looking for someone/someone’s who are or have been where I am now.

A few weeks before Easter while in the shower I felt a lump under my ribs on the left side. I called my primary for an appt and found out my insurance assigned me to a new primary Dr. I called my new primary and was given an appt for May 1st (over a month and a half away) because I was a new patient they had nothing sooner. I called ever morning trying to get in sooner but had no luck. May 1st comes, I go to my appt, Dr says he feels something there and orders chest x ray, x ray of ribs, basic blood work and a cat scan of my abdomen without contrast. On May 9th I go for my follow up appt and am told x rays were normal, blood work was normal except high triglycerides and low good cholesterol and cat scan is normal other then a kidney stone and a small umbilical hernia. I am very confused by this because the lump can be felt when felt for and I can also feel it inside my body when it’s touched. My Dr tells me he will refer me to a general surgeon and I get an appt for May 22nd.

Since I first found this thing, it has gotten bigger and for weeks now I can feel it without having to touch it. It feels very uncomfortable and awkward. I am guessing because of it’s location. The lump/mass itself does not hurt when touched but for the last week and a half the area it’s in is becoming somewhat painful, also on my back level with where this thing can be felt from the front has been numb going on 2 weeks and it feels like something is putting pressure on my ribs back there from the inside and the numbness is also somewhat present on my side at the same level. The numbness started off and on a little over 2 weeks ago but has been constant for the most part for almost 2 weeks now.

When the numbness first started I went to the emergency room cause it was a weekend. I explained everything that had been going on. They did a cat scan of my chest without contrast which came back normal.

I am very afraid and this is starting to cause me great anxiety. I think its absurd the amount of time I had to wait to see a Dr and it worries me that if it’s something bad it would have been better off figuring it out sooner and I don’t understand why these scans are not showing anything. Perhaps it’s because they were done without the use of contrast but surely the DR must have known this would be the case.. Please has anyone been through similar? I have 3 kids that need me to be well and the worry is starting to cause me depression.

Signs and Symptoms of Liver Cancer

Liver cancer has been called a “silent disease” because very often symptoms do not occur until the illness is in its late stages.

“Usually the disease is picked up on screening, before symptoms appear,” says Eugene R. Schiff, MD, a professor of medicine and director of the Center for Liver Diseases at the University of Miami School of Medicine in Florida. As with many forms of cancer, liver cancer is most curable when it’s detected early, so he recommends that people at high risk be screened every six months.

High-risk individuals include people with hepatitis B or C, or with cirrhosis from any cause. Screening for liver cancer usually involves a physical exam, blood tests to look for a protein made by liver cancer and other abnormalities, and possibly imaging tests such as an ultrasound or CT scan of the abdomen.

Liver Cancer: The Liver’s Role

Roughly the size of a football, the liver is the largest organ in the body. It has four lobes and fills the right side of the abdomen, inside the rib cage.

The liver plays a critical role in many metabolic processes, including digestion, regulation of blood sugar levels, and breaking down drugs and alcohol so they can be excreted from the body.

It also:

  • Stores vitamins and minerals
  • Controls cholesterol production and excretion
  • Produces substances essential for normal digestion and absorption of nutrients
  • Helps convert food into energy, protein, hormones, and immune factors
  • Plays a role in fighting infection by removing bacteria from the bloodstream

It may take a while before symptoms of liver cancer occur, but when they do arise it’s often because some of the vital functions that the liver performs are diminished or lost.

Liver Cancer: Early Symptoms

Most symptoms of liver cancer are caused by physical changes in the liver — such as swelling — and changes in organ function that the cancer produces. They include:

  • Pain or discomfort in the upper right portion of the abdomen, possibly reaching to the back or shoulder. Abdominal pain is probably the most common symptom of liver cancer, Dr. Schiff says.
  • A hard lump just below the rib cage on the right
  • Unintentional weight loss
  • Nausea or loss of appetite
  • Fatigue

Liver Cancer: Later Symptoms

As the disease progresses, later symptoms may include:

  • Ascites, or accumulation of fluid in the abdomen, which may lead to abdominal swelling
  • Jaundice, or yellowing of the skin and the whites of the eyes

Jaundice results when a substance called bilirubin accumulates in the blood. Bilirubin is a waste product formed by the breakdown of red blood cells. Normally, the liver removes bilirubin from the blood and processes it for excretion in the stool, but when a disease like cancer impairs the liver’s ability to perform this function, bilirubin can build up in the blood and impart its yellowish-orange tinge to the skin or eyes.

Finally, if liver cancer diagnosis is delayed long enough, bleeding into the digestive tract could occur, warns Schiff.

Keep in mind that these symptoms occur in many other diseases of the liver and other organs, so none of them is a sure sign of cancer. They are, however, signals to see your doctor as soon as possible so she can perform the necessary tests and make an accurate diagnosis.

As Schiff says, “early detection is best, because it increases the chance of cure.”

Signs and Symptoms of Castleman Disease

Castleman disease (CD) can cause a lot of different types of symptoms, and in some people it might not cause any symptoms at all. If symptoms do occur, they are often like those seen with other diseases, such as infections, autoimmune diseases, or even some types of cancer. Because of this, doctors might not suspect CD at first.

Common symptoms of localized CD

In the localized form of CD, symptoms are found in a particular part of the body. Localized CD often starts as an enlarged lymph node. If the node is just under the skin, such as in the neck or underarm area, it might be seen or felt as a lump. But if it’s in the chest or abdomen (belly), it might not be noticed until it grows large enough to cause other symptoms:

  • An enlarged node in the chest might press on the windpipe, which could cause trouble breathing, wheezing, a cough, or a feeling of fullness in the chest.
  • An enlarged node in the abdomen can cause trouble eating, pain, or just a feeling of fullness.

In general, most people with localized CD feel well otherwise. In fact, some people have no symptoms at all, and CD is found only when the doctor does a test for another reason. On the other hand, some people with localized CD can also have some of the other symptoms listed below.

Common symptoms of multicentric CD

People with multicentric CD have more than one area of enlarged lymph nodes. The enlarged nodes can be in the chest or abdomen, but multicentric CD often affects lymph nodes in the groin, the underarm area, and on the sides of the neck, which can often be seen or felt as lumps under the skin.

Multicentric CD can also affect lymphoid tissue of internal organs, causing the liver, spleen, or other organs to enlarge. Enlarged organs might be seen or felt as masses under either side of the rib cage. They can also cause problems eating or a sense of fullness (or even pain) in the abdomen.

Other symptoms of CD

In addition, people with either type of CD can have other symptoms (although these symptoms are much more common in people with multicentric CD):

  • Fever
  • Night sweats (that soak the sheets)
  • Weight loss
  • Loss of appetite
  • Weakness
  • Fatigue (tiredness)
  • Shortness of breath
  • Nausea and vomiting
  • Nerve damage that leads to numbness and weakness (neuropathy)
  • Leg swelling (edema)
  • Skin rashes

Some of these symptoms might come and go over time.

Amyloidosis, a condition where abnormal proteins build up in body tissues, can occur in CD. This can lead to kidney damage, heart damage, nerve damage, and intestinal problems, mainly diarrhea. If CD is treated successfully, the amyloidosis may improve or even go away.

Anemia (having too few red blood cells) is very common in multicentric CD, and can lead to problems such as fatigue and shortness of breath.

CD is rare, and the symptoms above often have other causes. Still, if you have any of these symptoms and they don’t go away within a few weeks (or they get worse), see a doctor so that the cause can be found and treated, if needed.

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