Neck lump or mass

September 20, 2013 Namou Kim, MD, FACS

A palpable neck lump in any patient should raise some concern.  In the case of a pediatric patient, the concern may be less, since reactive and infectious nodes in the neck can be fairly common in children.  When a child has a bad episode of pharyngitis, tonsillitis (sore throat), or even a bad cold, the lymph nodes of the neck may react and become enlarged.  In that type of scenario, your doctor should prescribe appropriate antibiotics to resolve the enlarged lymph nodes and follow up to make sure that the nodes have regressed.

Very few pediatric neck masses will end up being concerning.  Besides infectious neck lymph nodes as stated above, some of the other more common causes of pediatric neck mass are congenital cysts.  However, none of the pediatric neck masses should be ignored.  A neck lump that persists for more than a few days should be looked at by a pediatrician.

In the adult population, a neck mass or lump can be much more concerning.  Essentially when an adult patient presents to us with a neck mass, we have to fine the root cause and basically rule out a tumor.  Of course, infectious lymph nodes do happen in the adult patients as well, but it is less common.  Congenital cysts are also much less common in the adult patient. 

The more common causes of a neck mass in the adult patient are metastatic tumors in the neck nodes.  Metastasis means that the tumor has migrated from the primary site into the lymph nodes of the neck.  Most often the primary sites of tumor are from the mouth and throat, thyroid, salivary glands, or skin of the head & neck.  This is why a cascade of diagnostic workup is initiated when a patient presents with a neck lump.

Diagnosing a neck lump or mass

We will often complete a full head & neck examination, including using a small fiber optic scope to inspect the nose, mouth, and throat.  This is followed by scans (CT, MRI, or ultrasound).  After reviewing the scans, a biopsy will be required to establish a diagnosis.  In fact, a diagnosis can only be established after a tissue sample is reviewed by pathology under the microscope.  To this end, we often perform an FNA (Fine Needle Aspiration) in the office, and this minimally invasive, quick biopsy method will typically provide the answer. 

No patient should delay seeing a physician if he/she feels a lump in their neck.  Basically, no human being should have a palpable neck mass under normal circumstances.  It is sometimes saddening to meet patients for the first time, after they have ignored their neck masses for weeks, if not months.  Those are the patients that unfortunately present with late stage tumors.  With more awareness and vigilance, patients can be more proactive, and prevent a bad situation.

An example of a neck lump.

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