I have a firm lump above my belly button during my pregnancy. Could it be a cancer lump?

Question

Hello doctor,

I am a 34-year-old woman, and I am 27 weeks pregnant. When I was 20 weeks pregnant, I could occasionally feel a hard round lump of around 8 mm right above my belly button, on the top of uterus when I was lying down. It would just sit there then disappear within minutes or less. At first, I thought it was on the uterus, maybe a fibroid, but I normally cannot feel it, even when I have a contraction, so that does not make any sense. So I think it is in the colon or possibly the small intestine.

Then I felt it again around 23 weeks and it felt like it was around 1 cm. Then I never felt it again until yesterday at 27 weeks and now it feels like it is around 1.3 cm.

It is always in the exact same place, 2 cm above the belly button and feels right under the skin. I must mention I have a diastasis recti from my previous pregnancy so there is no muscle right above my belly button to cover whatever is underneath.

This lump feels smooth, round, and not rock-hard but firm and somewhat like cartilage? Perhaps similar to a lymph node. It does not sit in one place long enough to show it to anyone else like a doctor. I think it may be in the colon or small intestine and I can feel it when the colon or intestine happens to position itself above the uterus and then the lump becomes palpable. I cannot exactly explain why it is always in the same position when it does since the uterus has grown upwards since, but I only feel it immediately above the belly button. Otherwise (most of the time), it slides back into the abdomen above or behind the uterus and I cannot feel anything. That is just a theory though.

I do not know what this is and the fact that it appears to have become bigger worries me a lot and makes me think of cancer. I have no family history of colon cancer, but my mother did have breast cancer when she was 52. All my blood work has been normal for many years, including hemoglobin. The hemoglobin is now a bit lower (12) in my second trimester but I assume it due to pregnancy. I have no particular gastrointestinal complaints except some mild constipation.

What are my odds that this is in fact cancer? What else could it be in your opinion? What should be my next steps considering I am pregnant at the moment? How soon after a C-section can I have a colonoscopy?

I am on Progesterone 400mg daily and Nifedipine 40 mg daily for contractions.

Answer 1

Hello,

Welcome to icliniq.com.

The description you mentioned is quite characteristic of an umblical hernia or central hernia. You rightly pointed out that it appears and disappears indepedently and while you lie supine over the bed for a while.

Since you have diastasis recti abdominus which is seperation of the rectus muscle in the midline of right and left muscles sheat. This condition is common due to pregancny. Because pregancny and thus uterus enlargement cause stretch to the muscles of the abdomen. The lump is protrusion of possibly fat, or a small intenstinal loop. It cannot be colon because colon is afixed to the underlying fascia (tissues) and is not a mobile organ. Small intestine however, is a small caliber mobile organ and it can protrude whenever there is a gap in the skin, muscles of the abdomen. Neither a fibroid nor a small intestine or colon cancer can appear like that.

You can further confirm this by performing a cough impulse. You can do it by making a cough while seeing that area for the lump to appear or gets larger in size if already appeared. Umbilical hernia (since it is just at or around the belly button) is not alarming and not going to hurt you unless it is very large in size such as 5 cm or more than that or get incarcerated. Incarceration means the small bowel loop or fat get trapped in the sac of hernia and get loss of blood supply with black discoloration of the skin with pain. The chances are very low of this hernia especially due to pregnancy to get incarcerated or get infected.

The things that you can do to prevent further enlargement of this hernia is by avoiding lifting heavy objects, avoiding excessive bending, wearing an abdominal belt (not that much tight), and avoiding constipation.

For constipation, you can use Ispagol Husk two tablespoons full once daily and take plenty of water. To answer your concerns of odds of having this as cancer is nearly 0.

You just take precaution as I advised and no more should be done. Since you are not at increased risk of developing colorectal cancer given your negative family history, the next colonoscopy ideally be done at age 50 years. Plus given your first colonoscopy does not reveal anything and it was negative for any polyps. So there is no need to have a colonoscopy after pregnancy (just for your information, the colonoscopy can be performed once the incision completely heals after c-section delivery, may be in four to six weeks after there is no other contraindication to it). Time is variable and is not in the guidelines.

I hope this helps.

I have a firm lump above my belly button during my pregnancy. Could it be a cancer lump?

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