A lump in the neck is a common clinical problem. Most neck lumps are benign, but differentiation from lesions that could be malignant is vital. Therefore, a sensible, structured approach is required to assess and evaluate each patient to decide who can simply be reassured and who requires further investigation and referral for a specialist opinion.

Evaluation

All approaches to a neck lump begin with a thorough and complete history of the lump, including the site, chronicity, aggravating and relieving factors, lumps in other body sites, pain and discharge from the lump. A full ENT and head and neck history is mandatory, ensuring ‘red flag’ symptoms are asked about:

• Hoarseness (persisting for more than 3 weeks)
  
• Dysphagia
  
• Odynophagia (painful swallow)
  
• Unexplained otalgia
  
• Non-healing ulcers
  
• White or red patches in the mouth or oropharynx
  
• Facial or cheek swelling
  
• Unexplained loosening of teeth.

The history should also include information on systemic symptoms including the following:

• Weight loss
  
• Night sweats
  
• Lethargy and tiredness.

Past medical and surgical, drug and family history should be taken. Importantly, smoking and alcohol use should be documented as well as other pertinent social history.

Examination should include the lump in the context of the rest of the head and neck (see Chapter 28). A full ENT examination is also undertaken assessing the upper aero-digestive tract. Axillary, abdominal and groin examination should be performed if nodes are present in these sites.

Investigations

Investigation of the mass should be to confirm or refute the suspected diagnosis. As with breast masses, triple assessment comprising of clinical, radiological and cytological evaluation is needed (Figure 29.1). Radiology and cytology are often combined by performing an ultrasound-guided fine needle aspiration (FNA). Use of the ultrasound allows the mass in question and the rest of the neck to be identified and characterised as well as accurately guiding the needle for the FNA. Ultrasound-guided FNA is more likely to yield a positive and representative sample of the mass in question. Further radiological assessment with magnetic resonance imaging (MRI) or computed tomo­graphy (CT) scanning is sometimes required for further characterisation of the mass or of the primary lesion in the case of malignancy. Upper aero-digestive tract endoscopy under general anaesthetic might be required after the above inves­tigations, again to evaluate a primary lesion in the case of malignancy. Neck nodes should not be excised without a full diagnostic work-up as this may compromise disease management in cancer cases. Referral to a specialist head and neck clinic should take place for further management, especially in the case of diagnostic difficulties.

Stay updated, free articles. Join our Telegram channel

Join