NECK LUMPS PATIENT INFORMATION

A neck mass is an abnormal lump in the neck. Neck lumps may be any size. They can be large enough for you or your doctor to see or feel or sometimes small. At times neck lumps are only identified incidentally on scans (such as ultrasound or CT scans) performed for other reasons. Neck lumps can be a sign of infection or occasionally something more serious, such as cancer.

Neck lumps are common in adults and can occur for a variety reasons. The most common cause of a neck mass is enlarged lymph glands due to a viral or bacterial infection, such as ear or sinus infection, dental infection or strep throat. If the neck lump is from an infection, it should go away completely when the infection goes away (within a few weeks).

However, neck lumps in adults that persist (more than 2-3 weeks) should be assumed to be either a benign (non-cancerous) or malignant (cancerous) tumour until proven otherwise. Malignant (cancerous) neck lumps in adults are most commonly due to head and neck squamous cell carcinoma (SCC). Other cancers such as lymphoma, thyroid cancer, salivary gland cancer, skin cancer, or more rarely, cancer that has spread from elsewhere in the body, may also cause a neck lump. Many patients assume lack of pain in a neck lump means it’s not cancerous and they shouldn’t worry. However, most cancers manifesting as a neck lump are painless, at least in the early stages, so all persistent neck lumps in adults need further investigation.

Some common causes of neck lumps are classified below:

Lymph nodes

• Infectious lymphadenopathy
  • Enlarged lymph glands due to infection with viruses, bacteria and occasionally TB
• Metastatic (secondary deposit) cancer in a lymph node
  • squamous cell carcinoma (SCC) most commonly
    • Note that there are also lymph nodes in the salivary glands (parotid and submandibular glands) that can be involved. The primary will usually be somewhere in the mouth, throat or voice box and may have no symptoms at all. The other possibility is a secondary from a skin SCC, often treated before the neck lump appears
  • Metastatic melanoma
  • Thyroid cancer
    • often this is the first sign of thyroid cancer in these patients since the primary cancer in the thyroid is almost always asymptomatic. The types of thyroid cancer are papillary (the most common), follicular or Hurthle cell, medullary (uncommon) and anaplastic thyroid cancer which is rare and aggressive
  • Salivary gland cancer
• Lymphoma

Salivary glands

• Sialadenitis (inflammation of the salivary gland, most commonly due to duct obstruction from a stone)
• Benign tumours (pleomorphic adenoma, Warthin’s tumour, monomorphic adenoma)
• Malignant tumours
  • Primary salivary gland cancers: mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, and many others
  • Secondary deposits: from cutaneous SCC or melanoma

Thyroid gland

• Benign nodules: simple cyst, colloid nodules, adenomas
• Thyroid cancer

Other neck benign masses

• Branchial cyst
• Thyroglossal duct cyst
• Plunging ranula
• Vascular malformations
• Dermoid cyst
• Lipoma

In adults, a persistent unexplained neck lump is likely to be either a benign or malignant tumour. All such patients need a thorough evaluation, appropriate investigations and referral to a Head & Neck surgeon for comprehensive assessment to exclude malignancy.

Neck lumps in adults need further evaluation to exclude cancer IF any of the following apply:

• The mass lasts longer than 2-3 weeks
• The mass continues to get larger
• The lump doesn’t completely go away
• The neck lump is suspicious. Your doctor will determine this based on whether the mass is large (>1.5cm), feels hard, is fixed to adjacent structures and therefore not mobile, or involves overlying skin.
• Other persistent symptoms are present
  • Throat pain
  • Unexplained ear pain (referred otalgia)
  • Trouble or pain with swallowing
  • Voice change
  • Coughing up blood or difficulty breathing
  • Unexplained weight loss, fever or night sweats
• A neck lump in any patient with a history of head and neck cancer, skin cancer in the head and neck region, a history of smoking or excess alcohol intake should raise suspicion of cancer

Suspicious neck lumps are usually best assessed with a CT scan and Ultrasound-guided fine needle aspiration biopsy (FNAB).

Thyroid lumps (nodules) should be assess with a dedicated thyroid US, thyroid blood tests, and if appropriate a fine needle aspiration biopsy (FNAB)

• Neck lumps are common in adults and most are not cancerous
• Any neck lump that persists beyond 2-3 weeks or raises clinical suspicion for cancer should be further investigated with a CT scan, fine-needle aspiration biopsy (FNAB) and prompt referral to a Head & Neck surgeon for further evaluation.
• Most cancerous neck lumps are painless and cause no symptoms at all. Lack of pain does not provide any reassurance the lump is benign.
• Cystic neck masses in adults should not be assumed to be benign, even when FNAB results are benign. Biopsies are unreliable when a neck mass is mostly filled with fluid (cystic) and very prone to missing cancer due to sampling error. They all require evaluation by a Head & Neck surgeon and removal.
• A patient with a persistent neck mass where the diagnosis remains unclear after FNAB should be referred to a head and neck surgeon for prompt evaluation. A thorough evaluation of the throat and voice box with office nasoendoscopy may clarify the diagnosis and avoid the need for open (excisional) biopsy.