Neck lumps
A lump in the neck can arise from several different structures, including lymph nodes, the thyroid gland, salivary glands, skin and soft tissues.
Many neck lumps are benign or related to infection. However, a persistent or unexplained neck lump in an adult should be assessed to establish its cause, even when it is painless.
What can cause a neck lump?
Enlarged lymph nodes
Lymph nodes can enlarge in response to infection or inflammation. This is particularly common in children and younger adults.
A lymph node that remains enlarged without an obvious explanation, continues to increase in size or has other concerning features may require further investigation.
Thyroid lumps
Thyroid nodules and enlargement of the thyroid gland can present as a lump in the lower front of the neck.
Most thyroid nodules are benign. Assessment may include thyroid blood tests, ultrasound and, when indicated, needle biopsy.
Salivary gland lumps
The major salivary glands include the parotid glands in front of and below the ears and the submandibular glands beneath the jaw.
Swelling may result from obstruction, inflammation or a tumour. Persistent salivary gland lumps usually require specialist assessment.
Other neck lumps
Other causes include developmental cysts, skin and soft-tissue lesions and less common conditions affecting structures within the neck.
When should a neck lump be assessed?
A neck lump should be assessed when it persists without an obvious explanation, particularly in an adult.
Features that may warrant timely assessment include:
• A lump persisting for around two weeks or longer without a clear infectious cause
• Progressive enlargement
• A firm or fixed lump
• Persistent hoarseness or change in voice
• Persistent throat symptoms or difficulty swallowing
• Unexplained weight loss
• Coughing up blood
• Facial weakness associated with a lump near the parotid gland
These features do not necessarily mean that a lump is cancerous, but they can indicate that further investigation is appropriate.
How is a neck lump assessed?
Assessment begins by establishing where the lump arises and whether there are other symptoms that may help identify its cause.
Examination may include the mouth, throat, neck, thyroid and salivary glands.
Flexible nasendoscopy may be used to examine areas of the nose, throat and larynx that cannot be adequately seen through the mouth.
Ultrasound
Ultrasound is particularly useful for assessing lymph nodes, thyroid nodules and salivary gland abnormalities. It can also be used to guide a needle biopsy when tissue sampling is required.
CT or MRI
Cross-sectional imaging may be recommended depending on the location and characteristics of the lump and the suspected underlying condition.
Fine-needle aspiration and core biopsy
Fine-needle aspiration or core biopsy allows cells or tissue to be sampled without surgically removing the lump.
For an unexplained adult neck mass, image-guided needle sampling is generally preferred to an open surgical biopsy as the initial method of obtaining tissue when a biopsy is required.
What happens if a tumour is suspected?
If investigation identifies or raises concern about a head and neck tumour, further imaging or biopsy may be required.
Confirmed cancers are commonly discussed within a multidisciplinary team involving specialists from the relevant surgical, radiology, pathology, medical oncology and radiation oncology disciplines.
The appropriate treatment depends on the diagnosis, location and extent of the disease as well as the individual patient's circumstances.
Neck lump assessment at Hawthorn ENT
Dr Depak Patel is an ENT and head and neck surgeon with advanced fellowship training in head and neck surgery.
His practice includes assessment of adult neck lumps, lymph-node abnormalities, thyroid and salivary gland conditions and head and neck tumours.
Where appropriate, investigation may include flexible endoscopy, imaging and needle biopsy, with referral for multidisciplinary care when required.
Appointments for a neck lump
If you have a persistent or unexplained neck lump, specialist assessment can help determine which structure is involved and whether further investigation is required.