Neck Lumps

A neck lump is an abnormal growth or swelling that occurs within the region of the jawline to the collarbone.

Neck lumps are very common, and can appear and disappear from time to time. Indeed, the majority of neck lumps are benign in nature, and resolve spontaneously or after conservative management or a course of antibiotics. The main cause of concern of a neck lump, however, particularly for an adult, is that it may be the first presentation of a cancer.

Clinical assessment and investigations are geared therefore towards excluding the possibility of an underlying malignancy.

There are three basic categories neck lumps:

• Congenital
• Infective and Inflammatory
• Neoplastic

Congenital Lumps

Congenital lumps present at birth, but are often not noticed until late childhood or early adulthood when they have had some time to grow. Besides a lump detectable by careful inspection or palpation, most of these lumps are completely asymptomatic. Common congenital lumps include:

• Thyroglossal cysts
• Branchial Cleft Cysts
• Cystic hygromas

Congenital neck lumps are often harmless, but may be recommended removal if they are symptomatic or are enlarging over time.

Infective and Inflammatory Lumps

Lymph nodes are small bean shaped structures that measure between 3 – 5mm and are stationed at various zones in the head and neck (termed "levels"), as well as at other regions of the body. A normal lymph node cannot usually be seen or felt. An integral part of the immune system, these lymph nodes filter tissue fluid from organs and structures within the head and neck, and mount a response by producing antibodies when subjected to a source of infection or inflammation. At that point they swell up, and become noticeable as tender lumps measuring between 1 – 2 cm in diameter at the sides and back of the neck. The infective agent in most instances is viral, such as the flu or a common cold, or bacterial as in throat, sinus or tonsil infections.

Infective or inflamed lymph nodes are the most common causes of head and neck lumps.

They are benign, and as with most infections, are self-limiting after symptomatic treatment or a short course of antobiotics. The lymph nodes will typically revert to their normal size within 4 – 6 weeks of resolution of the infection.

Any enlarged lymph node that persists beyond 4 – 6 weeks after recovery from an infection needs to be carefully evaluated to exclude any underlying malignancy.

It should be mentioned that Tuberculosis is fairly common in the Asian subcontinent, and a persistent enlarged lymph node is occasionally the first presentation for Tuberculosis in a young, otherwise healthy patient.

Neoplastic Lumps

Neoplasms are tumorous growths, that may be either benign (non-cancerous) or malignant (cancerous).

Neoplastic lumps most commonly arise from the

• Thyroid gland
• Major salivary glands like the parotid or submandibular gland
• Upper aero-digestive tract
• Lymph nodes

Thyroid lumps or nodules present as central neck swellings that move well on swallowing. They are otherwise completely asymptomatic. The vast majority of thyroid nodules are benign, but should be evaluated by an ultrasound and a fine needle biopsy.

Parotid and submandibular tumors present as painless lumps at the angle of the jaw (beneath the ear) or just below the jawline, on either side of the chin, respectively. The risk of cancer in a major salivary gland in inversely proportional to the size of the gland. 75 – 80% of parotid gland tumors are benign, while 40 - 50% of submandibular gland tumors are cancerous. Neoplasms of the parotid and submandibular gland are often recommended surgical removal.

Tumors arising from the upper aero-digestive tract, often simply referred to as Head and Neck tumors, may present with hard painless neck lumps, or with a variety of symptoms related to the site of origin, eg throat pain, difficulty swallowing and voice change for throat or voice box cancer, or a non-healing tongue ulcer or tooth socket for cancers of the oral cavity.

Hard, painless neck lumps are often the first manifestation of a head and neck cancer. These lumps represent lymph nodes swollen by the spread of cancer. Unlike lymph nodes swollen from infection or inflammation, lymph nodes swollen by cancer do not decrease or resolve over time.

Finally, cancer can arise from the lymph nodes themselves, a condition called lymphoma. Patients with lymphoma may be completely asymptomatic except for the neck lump, or may have systemic symptoms like fever, night sweats or joint pain. Lymphoma should be considered for a patient with persistently enlarged lymph nodes and no other detectable abnormality in the head and neck.

Common Accompanying Symptoms of Neck Lumps

Neck lumps can occur with various accompanying symptoms, including:

• Chronic Neck or Throat Pain – This indicates the lump may be causing irritation or inflammation.
• Difficulty Swallowing (Dysphagia) – Pain or discomfort when swallowing can occur especially if the lump is near the throat.
• Trouble Hearing or Ear Pain – Hearing issues or ear pain on the same side as the neck lump can occur due to an infection, tumour, or conditions like nasopharyngeal cancer.
• Voice Changes – Hoarseness or changes in voice quality can occur if the lump affects the nerves involved in voice production.
• Unexplained Weight Loss – Significant weight loss without a clear reason may indicate serious underlying conditions including lymphoma and head and neck cancers.
• Coughing Up Blood – This is a serious symptom that requires immediate medical attention; it may occur when the underlying condition also affects the respiratory system.

Common Causes of Neck Lumps

Neck lumps can occur due to several reasons, such as:

• Swollen Lymph Nodes – When fighting infections, lymph nodes swell when producing white blood cells to fight germs.
• Infections – Bacterial or viral infections can cause swollen tissues or pus-filled abscesses that create a noticeable lump.
• Cysts – Cysts are fluid-filled sacs that can grow beneath the skin. They are usually harmless but can cause a palpable lump.
• Benign Tumours – These non-cancerous growths can grow slowly and feel like firm lumps.
• Malignant Tumours – Cancer cells can grow uncontrollably and form tumours that present as lumps in the neck. They can grow in the lymph nodes, thyroid gland, or throat.
• Thyroid Nodules – These growths in the thyroid gland are common and can be benign or cancerous. Large nodules can cause a visible lump in the front of the neck.
• Trauma – Neck injuries can result in hematomas or fractures, leading to lump formation.

Risk Factors for Neck Lumps

Several factors can increase the risk of developing a neck lump, including:

• Age – The risk of developing lumps increases with age. Conditions like malignancies, thyroid nodules and lipomas commonly cause neck lumps in older individuals.
• Family History – People with a family history of head and neck cancers, thyroid disease, or congenital cysts may have an increased risk of developing a neck lump.
• Lifestyle Factors – Smoking and excessive alcohol consumption significantly increase the risk of head and neck cancers. This risk is further amplified when these habits are combined.
• Chronic Infections or Immune System Conditions – Chronic infections like human papillomavirus (HPV) and Epstein-Barr virus (EBV) can weaken the immune system, increasing the risk of cancer-related lumps or chronic swelling.

How Are Lumps on the Neck Diagnosed?

Diagnosing a neck lump involves several diagnostic tests:

• Imaging Tests – Ultrasounds, CT scans, MRIs or X-rays help visualise the neck lump and surrounding structures, providing valuable information about the lump.
• Fine-needle Aspiration Cytology (FNAC) – This is a minimally invasive test where a thin needle is inserted into the lump to withdraw a sample of cells. These cells are examined under a microscope to determine whether the lump is benign, infectious, or malignant.
• Nasoendoscopy – This procedure involves inserting a thin, flexible tube with a tiny camera through the nose. It examines the nasal passages, throat, and voice box to identify the cause of the neck lump.
• Blood Test – Blood tests help identify infections, inflammation, and other conditions that may be contributing to the neck lump, providing valuable information about its underlying cause.

Common Treatment Options for Neck Lumps

Treatment for neck lumps depends on the underlying cause.

Non-Surgical Treatments

• Antibiotics – Prescribed for neck lumps caused by bacterial infections such as tonsillitis, infected lymph nodes, and salivary gland infections.
• Antiviral Medications – Used for neck lumps caused by viral infections like EBV, mumps, and HIV/Aids.
• Anti-inflammatory Medications – Pain relievers may be recommended to reduce pain and inflammation.

Surgical Removal

Surgery may be necessary for persistent, symptomatic neck lumps, particularly those that raise concerns for malignancy. Some surgical interventions include:

• Excisional Biopsy – Removal of the abnormal lump and some healthy tissue around it for further analysis.
• Thyroidectomy – If the lump is a thyroid nodule and is suspected to be cancerous or causing other health issues, partial or total thyroidectomy may be performed.
• Cyst Removal – Cysts may be surgically removed to prevent growth and complications.

Why Choose Us for Neck Lumps Diagnosis and Treatment?

Led by Dr Ranjiv Sivanandan, our clinic provides comprehensive care for various neck lump conditions. With more than 20 years of experience, Dr Ranjiv specialises in head and neck surgery, including thyroid, parathyroid, and parotid procedures. He pioneered robotic surgery in the region, performing the first robotic thyroidectomy in Singapore in 2010 and the first robotic neck dissection in Southeast Asia in 2011.

Contact us today to schedule a consultation with Dr Ranjiv.

Frequently Asked Questions (FAQs)

Can a lump in the neck go away on its own?

Some neck lumps can resolve on their own, especially those caused by minor infections or small benign cysts.

Can a neck lump reoccur in the same spot after treatment?

In some cases, a neck lump can reoccur in the same spot particularly if it is not completely addressed.

Are there preventive measures to avoid the formation of neck lumps?

Neck lumps cannot be prevented but some measures can help reduce the risk. These include:

• Maintaining a healthy lifestyle
• Limiting sun exposure
• Practising safe sex
• Staying up-to-date with vaccinations