Neck Lump — Ankara

Why do lumps appear in the neck?

The neck contains many structures: lymph nodes, salivary glands, the thyroid, blood vessels, nerves and muscle. A lump can arise from any of them, which is why a neck lump is a finding rather than a diagnosis.

In children and young adults the commonest cause is an enlarged lymph node reacting to infection — after a throat infection, a dental problem or an upper respiratory infection. It usually shrinks over a few weeks.

With increasing age the possibilities shift. In an adult, particularly with a history of smoking or alcohol use, a persistent lump without an infectious explanation calls for a different assessment.

When should it be assessed without delay?

The 2017 clinical practice guideline of the American Academy of Otolaryngology–Head and Neck Surgery sets out the features that raise concern in an adult. The guideline's stated purpose is to reduce delays in diagnosing malignant disease.

• Present for two weeks or more without significant fluctuation
• Duration uncertain — the person does not know when it appeared
• No history of infection — no sore throat, fever or dental infection to explain it
• Firm consistency and fixation to surrounding tissue
• Larger than 1.5 cm
• Ulceration of the overlying skin

The same guideline makes a further point about antibiotics: they should not be prescribed routinely for a neck mass unless there are signs and symptoms of bacterial infection. In practice one of the commonest reasons for delay is weeks lost to successive courses of antibiotics.

These points are not a diagnosis; which of them apply, and what they mean, is determined by examination.

What the assessment involves

The order is deliberate: the lump itself first, then the areas it might have come from, then tissue sampling where needed.

• Head and neck examination — site, size, consistency and mobility. Which region of the neck the lump sits in narrows down its likely origin.
• Endoscopic assessment — the nose, nasopharynx, pharynx and larynx are viewed with an endoscope. A neck node can be the first sign of a focus in one of these areas, and none of them can be seen from the outside.
• Ultrasound — shows whether the lump is solid or cystic, the architecture of lymph nodes and any relationship to the thyroid. No radiation involved.
• Fine-needle aspiration (FNA) — a cell sample under ultrasound guidance. It is the first-line tissue sampling method for neck lumps.
• CT or MRI — requested when the extent of the lump and its relationship to neighbouring structures need to be shown.

Taking a surgical piece directly from the lump (open biopsy) is usually not the first step; performing it out of sequence can complicate later treatment. This is why the order of assessment matters.

Salivary gland swellings

Some swellings in the neck and face arise from the salivary glands. The parotid gland in front of the ear and the submandibular gland under the jaw are the most commonly affected.

A swelling that appears or worsens while eating and then settles usually suggests obstruction of the gland's duct, most often by a stone. A swelling that is constantly present and slowly enlarging suggests a mass arising in the gland itself and is assessed differently.

The nerve that moves the facial muscles runs through the parotid gland. For swellings in this area, weakness or asymmetry of the face is therefore specifically asked about and examined.