Neck Masses

by Sergey Koyfman, D.O., F.A.A.O.A.

A lump in the neck is a relatively common ocurrence. It can be small and can sometimes be very large and disfiguring. The majority of the neck lumps are benign, however, a smaller percentage of them are malignant.

The neck is comprised of many organs such as:

• Thyroid
• Salivary glands
• Nerves, muscles
• Windpipe
• Voice box
• Throat
• Tongue
• Mouth
• Spine
• Ears
• Nose,sinuses

Some lumps will originate in those organs, however, the great majority of neck lumps arise from lymph nodes, which are the filtering stations of our immune system. Generally, we have 60-70 lymph nodes on each side of the neck. Most lymph node swelling is related to the infectious or inflammatory processes, such as bacteria and viruses. Younger patients who suffer from recurrent tonsil infections will often present with swelling in the neck. Head and Neck region is rich with organs and areas that directly contact the outside such as mouth, nose, throat, ears, eyes,scalp etc. Most of the infections will enter through those routes. Some autoimmune diseases, such as lupus and rheumatoid arthritis, will also result in enlarged lymph nodes. Any swelling of the head and neck that persists over 2 weeks can also be a sign of a malignancy. The majority of head and neck cancer will originate in the lining of the mouth, tonsils, tongue, throat, salivary glands, thyroid and nasal lining. Some of the others will be lymphomas, leukemias, or traveling cancers from other sites (rare).

Age over 50 years old and past history of tobacco and alcohol will increase the odds of the mass being cancerous. Also, exposure to a human papilloma virus (HPV), a sexually transmitted virus, was linked to increased risk of developing tonsil and tongue cancers in younger patients who never smoked or consumed alcohol. If a neck mass persists over two week you need to see your doctor. A good history should be obtained and a thorough examination of the head and neck should be performed. Exposure to smoking, alcohol, viruses, pets, tuberculosis should be noted. Any lining change in the areas of mouth, throat, and nose needs be investigated. If no obvious source of the swelling is found then an endoscopic evaluation of the nose and throat should be performed next.

Infectious sources of swelling are usually treated with an antibiotic. Oral or throat lining changes that persists or are suspicious visually should be biopsied. Imaging may be ordered per your doctor’s discretion. Biopsy is indicated for the persistent neck lumps of suspicious origin. Usual method of biopsy is fine needle aspiration or core biopsy under the ultrasonographic guidance. If these biopsy results are inconclusive an open biopsy may be performed. Your doctor will discuss the treatment options once the diagnosis had been established. Most of the head and neck lumps are benign. However, lumps over 2 weeks duration should be evaluated by a specialist proficient in diseases of Head and Neck. Here, at ENTA we are committed to providing highest level of specialty care for Head and Neck Related Diseases.