A Sister Mary Joseph node is a metastasis manifesting as a periumbilical nodule secondary to abdominal or pelvic cancers (one-half are gastrointestinal, one-quarter are gynecologic). Cancers of the colon may cause pain, change in bowel habits, anemia, and obstruction. In general, left-sided cancers cause obstruction, whereas right-sided tumors may have significant metastases before they create signs and symptoms. These metastases typically involve peritoneal and omental spread with distant metastases to the liver. Spread to the umbilicus is colloquially known as the Sister Mary Joseph node.
Sister Mary Joseph Node. Sister Mary Joseph nodule of a patient with ovarian cancer. (Photo Contributor: Stephen W. Corbett, MD.)
Prognosis is poor if cancer is the cause (survival time of 10 months).
Management and Disposition
Prompt referral for staging and treatment of the tumor is indicated. Other signs and symptoms (from obstruction, blood loss, malnutrition, and pain) should be addressed and treated.
Virchow node, presenting as a supraclavicular mass, also heralds bowel carcinoma.
A Sister Mary Joseph node is commonly due to gastric carcinoma.
All umbilical masses require evaluation with contrast-enhanced CT scan of the abdomen/pelvis.
Sister Mary Joseph Node. This 63-year-old woman presents with abdominal swelling and ascites. She was diagnosed with ovarian cancer. Axial CT scan of the abdomen at the level of the umbilicus demonstrates ascitic fluid and the umbilical nodularity (arrows). (Photo contributor: R. Jason Thurman, MD.)
Nodular Umbilicus. Firm umbilical nodule and abdominal distension due to a germ cell tumor. (Photo contributor: Lawrence B. Stack, MD.)
Nodular Umbilicus—CT. Contrast-enhanced CT of the abdomen/pelvis reveals an umbilical nodule and large mass, which is a germ cell tumor. (Photo contributor: Lawrence B. Stack, MD.)