October 14, 2016

Neck Masses

Neck Masses

A lump in the neck can be a distressing thing to find. While neck masses may have a benign explanation, any lump that persists longer than 2 weeks or continues to grow should be evaluated.

What causes a lump in the neck?

There is a long list of potential causes for a mass in the neck. A thorough history and physical examination by an ENT doctor can often help narrow down this list. Some of the more common lumps we see are:

– Enlarged lymph node. The most common cause of an enlarged lymph node is reactive adenopathy, meaning the lymph node, which is part of the immune system, is growing simply as a reaction to a source of inflammation. In the neck, this may be due to inflammation or infection in the tonsils or other areas of the throat, teeth or gums, or skin. If a source of infection is identified, often a course of antibiotics will help reduce the swollen lymph node. If infection is ruled out, or the lymph node does not respond to treatment for an infection, we must consider other more serious causes. A cancer of the throat, salivary glands, thyroid gland, or skin may spread to lymph nodes in the neck. Sometimes the enlarged lymph node is the first sign of an underlying cancer, which may have existed for some time already without causing symptoms. A cancer of the lymph node itself, called lymphoma, can also occur.

Thyroid nodule. A thyroid nodule causes a lump in the lower neck that moves up and down with swallowing. These may or may not be associated with abnormalities in the thyroid’s function (such as under- or overactive thyroid). Most thyroid nodules (about 90%) are benign, but additional testing is typically recommended to rule out a thyroid cancer.

Salivary gland mass. A growth of one of the salivary glands can cause a lump that is felt in front of or below the ear, or under the jaw bone. The majority of these growths are benign, but additional testing and sometimes surgery is generally needed to exclude a cancer.

Congenital cysts. Some cysts that are due to a congenital problem may in fact not become apparent until adulthood. These include branchial cleft cysts as well as thyroglossal duct cysts. The recommended treatment for these cysts is usually surgery to remove the cyst.

What will be done to investigate a lump in the neck?

Your ENT physician will first perform a thorough history and physical exam. This may include a fiberoptic laryngoscopy if an underlying throat disorder is suspected. Depending on the level of concern at this point, additional testing may be recommended. An imaging study such as ultrasound, CT scan, or in some cases MRI may be necessary. A biopsy of the mass can often be performed initially with a needle. This is called fine needle aspiration and obtains a sample of cells from the mass to be examined by a pathologist. This may be performed either in the office by the ENT physician, or under ultrasound guidance by an interventional radiologist. Finally, depending on the results of this testing, surgery to remove the mass may be recommended. Often, surgery is the most definitive way to rule out a cancer.