Editorial NexoScience
If you have ever felt a small, firm bump near your belly button and written it off as a hernia or an infected patch of skin, you were doing what almost everyone does. So, quite often, are the doctors who see it. A review of two decades of published cases suggests that reasonable assumption is sometimes all that stands between a patient and a cancer diagnosis.
The lump has a name, the Sister Mary Joseph nodule, and it is a metastasis, a colony of cancer cells that has traveled from a tumor elsewhere and settled at the navel. The review, published in 2024 in the International Journal of Surgery Case Reports, was prompted by a patient at the authors’ own clinic: a woman in her sixties with an ulcerated umbilical lesion, told at several clinics that she had an infection or a hernia. A full workup found adenocarcinoma, a cancer of glandular tissue, in her cecum, the pouch where the colon begins. She died less than two years after surgery.
In most reported cases the nodule arrives before anyone knows there is cancer at all. The authors pooled nearly 1,200 cases from published clinical reports and two large autopsy series. Where doctors recorded the sequence of events, the umbilical lump was the first sign of malignancy 73.4% of the time, and only in the remaining quarter did it appear in someone already diagnosed. In roughly one case in seven it was mistaken for an umbilical hernia first.
The sign is named after the nurse who spotted the pattern. Sister Mary Joseph, a Catholic nun who spent thirty years at the Mayo Clinic, prepared patients’ abdomens for surgery and pointed out to surgeon William J. Mayo that these lumps kept turning up in people who went on to do badly. Mayo described it in 1928 as a marker of inoperable gastric cancer, and it remains the most prominent medical eponym named for a nurse.
Almost all of these tumors start inside the abdomen. The ovary accounted for about a quarter of the pooled cases and the colon for nearly a fifth. Ovarian cancer dominated among women, colorectal cancer among men, and patients were typically in their sixties. The nodules were hard and fibrous with irregular edges, tethered to the abdominal wall in the vast majority of cases, and often no bigger than a grape.
The navel is a crossroads left over from before birth. It sits where arteries, veins and lymphatic channels once converged to feed the fetus, an old interchange whose roads never fully closed. The authors offer that anatomy as one explanation for why circulating cancer cells can seed there directly, sometimes with no other visible disease in the abdominal cavity.
Once the nodule appears, the outlook depends heavily on where the cancer started. Median survival from the moment the metastasis was diagnosed was about seven months overall, and the spread around that number is wide: patients whose cancer began in the ovary lived a median of 18 months, those with colon primaries about eight, those with pancreatic primaries about three. In a small group of colon cancer patients treated with surgery and chemotherapy rather than palliative care alone, several lived well beyond a year, and one, despite cancer spread throughout the abdomen, reached five-year survival.
The design of the review puts a firm ceiling on what it can prove. It is a systematic review and meta-analysis of retrospective material, case reports doctors chose to write up plus autopsy series, not a study that followed patients forward in time. Published cases skew toward the unusual, so the pooled percentages describe the reported literature rather than a true population-wide incidence. The treatment finding is weaker still, because those patients were operated on and given chemotherapy only because they were well enough for it, so their longer survival cannot be untangled from the possibility that their disease was less advanced to begin with. The authors framed it as clinical experience suggesting an aggressive approach may help selected patients, not as proof that the treatment bought the extra months.
What the review argues, and what its own index case illustrates, is that the cheapest intervention here is suspicion. A new umbilical lump that is hard, fixed to the abdominal wall and does not settle with treatment for infection is worth a full workup rather than reassurance. The open question is whether catching it that early, while it is still just a bump somebody shrugged at, would change any of these numbers.
The study, “Sister Mary Joseph’s nodule as metastasis of colorectal cancer. Systematic review of the literature and meta-analysis,” by R. Gabriele, M. Campagnol, V. Borrelli, I. Iannone, P. Sapienza and A. Sterpetti, was published in 2024 in the International Journal of Surgery Case Reports. DOI: 10.1016/j.ijscr.2024.110132.
