Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Neck Swellings

Introduction

Finding a lump in the neck naturally causes considerable anxiety and worry. If a neck lump is found, it is sensible too seek medical advice. The neck contains a wide variety of structures and therefore there are a large number of different causes for lumps or swellings to appear, many of which are not serious although certain problems will need to be excluded by an ENT/Head and Neck Specialist.

A consultation with a thorough examination and perhaps some simple investigations will usually lead to a clear diagnosis. In some cases early treatment may be important to prevent serious consequences and persistent or growing neck lumps should never be ignored. Any lump in an adult which persists for more than two to three weeks should be investigated thoroughly and typically requires referral to an ENT/ Head and Neck Specialist.

Causes of neck swelling or lump

Infection:

Perhaps the commonest reason for a newly-discovered lump is infection of the upper airways. Viruses and bacteria causing colds and sore throats will also lead to inflammation of the lymph glands of the neck; these may be tender and swollen for at least 2 weeks. For this reason doctors will often wait for the inflammation to settle, often prescribing antibiotics before investigating a lump any further. In children and younger adults these infections can cause a neck lump. A variety of infections can cause persisting lumps, most commonly viruses such as glandular fever, mumps or even (in some high risk groups) HIV. Tuberculosis (TB) is much rarer today, but is still found in those without childhood immunity; TB-like organisms can also cause large neck lumps in children who are apparently well.

The Thyroid Gland:

Lying low in the neck is the thyroid gland, which may swell (producing a “goitre”) or contain lumps which are usually benign in nature. Thyroid cancers tend to have a very good prognosis, but early diagnosis and treatment in a specialist clinic is essential. Some people are born with cysts associated with the thyroid gland higher in the neck, which may become infected and enlarge later in life. Similar cysts may be found in other parts of the neck and will need to be removed if causing troublesome symptoms.

The Salivary Glands:

High in the neck there are two pairs of glands which produce saliva; inflammation, or blockage, of the salivary duct can cause painful neck lumps. If the salivary duct is blocked the gland may swell during eating.

Other Structures:

Some lumps felt in the neck may simply be normal structures which are present in everyone but more prominent in some. For example the glands producing saliva, bones of the vertebral column or cartilages of the voice-box may be mistaken for an abnormal lump, particularly if they are different on one side compared to the other and seem more prominent on one side of the neck. In these cases a careful examination by an ENT specialist will frequently be enough to give reassurance to both the patient and doctor.

Is a lump cancerous?

Malignant swellings in structures and glands of the neck are increasingly common with age and often associated with heavy use of tobacco and/or alcohol. The cancer has usually started in the mouth or throat and tends to spread to the neck glands long before dissemination elsewhere in the body. It is therefore very important to diagnose and treat early before the disease has spread further than the neck to increase the chance of success of treatment. Cancerous lumps tend to be firm but not painful and grow gradually in size over weeks or months. There may be other symptoms related to cancer, such as weight loss or changes in speech, swallowing or breathing.

What can the specialist do to help me?

The purpose of seeing a specialist is to obtain the correct diagnosis and start the required treatment (if any) as soon as possible. Many hospitals have neck lumps clinics. In the UK these clinics are usually run by Ear Nose and Throat surgeons, but General and Maxillo-Facial Surgeons may also be involved. A careful evaluation includes questions about the lump itself but also changes in voice, swallowing, breathing, appetite, and weight. Further questions may be regarding fevers, night sweats, pain in the throat or ear, hearing loss, mouth ulcer, dental problems, blockage of the nose, serious illnesses or operations, family medical history and recent foreign travel.

The Examination:

The specialist will need to examine the neck itself and also the face, scalp, nose and mouth. The inside of the throat is more difficult to examine and in the past this was usually done by placing an angled mirror at the back of the mouth. Now it is more common to use a fine flexible endoscope (telescope) which is gently passed through a nostril to the back of the nose. A preliminary spray of local anaesthetic into the nose may cause a little irritation, but the procedure should not be uncomfortable.

Investigating the Lump:

One common way to reach a diagnosis is to remove some tissue from the lump itself. This may be done by carefully passing a very fine needle through the skin into the lump, removing some cells, and arranging their examination through a microscope (Fine Needle Aspiration Cytology). Again this should produce only minor discomfort. This procedure may be carried out in the clinic or in the X-Ray department where a specialist doctor may use an ultrasound probe on the outside of the neck to guide the needle. It may take a few days for the tissue sample to be analysed and the doctor may also order some blood tests, X-Rays or special scans of the neck in the meantime if needed. Occasionally in spite of all these investigations it is impossible to achieve an accurate diagnosis. If this is the case, and certainly if there is significant clinical concern, it may have to be removed so that the whole lump can be analysed.  This procedure is likely to be combined with more detailed examination and biopsy procedures and sometimes may entail “Frozen section” specimens taken for histological analysis during the procedure to guide management.

Bringing a partner or friend to the clinic can help make the best of the experience in an often stressful and busy atmosphere. It is very important not to ignore a neck lump, which may lead to delaying urgently—needed treatment with potentially serious consequences.