A neck lump is an abnormal mass 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 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:

           Infective and Inflammatory

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).

A benign growth is one where there is overactive, but regulated cell growth. There is no propensity for a benign tumor to invade into the surrounding structures, or spread to distant sites through the blood stream. A malignant or cancerous growth, however, consists of a single cell or group of cells that breaks free of normal regulation, and grows relentlessly. The unregulated growth results in invasion to surrounding structures, spread to lymph nodes in the vicinity, and dissemination into the blood stream to sites like the lungs, bones or liver.

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.   (see THYROID DISEASE)

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.    (see PAROTID)

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.    (see HEAD & NECK CANCERS)

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.

Patients with neoplastic lumps need to be very carefully assessed, and further investigations like a fibreoptic nasoendoscopy, ultrasound, CT or MRI scans, and needle or open biopsies.    (see CLINIC SERVICES)

Clinical Assessment

The patient’s age and duration of the lump are the two most significant predictors for malignancy.

If the patient is:

          Below 15 years of age, 90 percent of neck lumps are benign
          Between the ages of 15 and 40 years about 60 – 70% of neck lumps are benign

* Above the age of 40 the risk of malignancy increases with age.

A lump that has been present for:

          Days to weeks is usually infective or inflammatory
          Many years it is usually benign, a congenital lump or a benign process

* Lumps that are present for weeks to months need to be very carefully evaluated. These are the ones that are of
  most concern to harbor malignancy.

The Thyroid Head & Neck Surgery Centre