King’s Head & Neck Lump Clinic
I have lump in the neck – what should I do?
A neck lump or swelling is any lump, swelling or mass in the neck. Most neck lumps are non-cancerous enlarged lymph nodes or thyroid nodules. However, these non-cancerous neck lumps are often difficult to differentiate from cancerous neck lumps without specialist assessment and investigations. 15% of patients attending neck lump clinic have a neoplasm (an abnormal mass of tissue that may or may not be benign.
Neck or salivary gland swelling persisting more than 3 weeks are concerning for cancer – either a primary cancer in a lymph node (lymphoma) or a secondary cancer in a lymph node that has spread from a primary cancer somewhere in the head and neck, or rarely from somewhere distant from the head and neck.
What to do?
An Otorhinolaryngologic (ENT) evaluation to assess and diagnose your neck mass without delay is necessary when the mass/lump meets any of the following conditions:
- Is growing, or is greater than 2cm
- Persists beyond 3 weeks and is changing
- Persists beyond 6 weeks
- Is associated with a skin ulcer in the head and neck
- Is associated with an ulcer, lump or bleeding in the mouth / tongue / throat
- Is associated with pain in the mouth / tongue / throat / ear
- Is associated with a change in swallow or voice
- Is associated with malaise, fever, night sweats, weight loss
- Is associated with swelling in other body areas
What assessments will the specialist perform?
KCH offer a fast-diagnostic neck lump clinic where you will have access to the ENT surgeon, radiologist and pathologist in a preferential route with the objective of offering a complete neck mass assessment concluding with a diagnosis and treatment plan. The assessment includes:
Medical history – Examination including inspection of the oral and nasal cavities, throat, voice box, and neck, using modern endoscopes. Your ENT may also check for lumps in the mouth, lips, neck, and face.
Endoscopy – of the nasal cavity, throat (pharynx), and voice box (larynx). Endoscopy allows for the precise evaluation of the mucosa of the upper aerodigestive tract with a High Definition endoscope with Narrow Band Imaging (to precisely detect even very early cancer).
Ultrasound scan of the neck – performed by a specialist radiologist. This scan allows for obtaining a precise assessment of structures in the neck and to measure the size and find the nature of the mass(s). Some ultrasound findings of are highly suggestive of non-cancerous lumps. However, ultrasound can be just the first step of your assessment.
Fine needle aspiration biopsy (FNA) of the neck mass. This procedure is a routinely performed by our specialists and very informative for diagnosis. A fine needle reaches the neck mass through the overlying skin catching a small number of cells out from the mass. You can go straight back to your everyday activities after the test.
FNA biopsy cytology is performed by the pathologist, who evaluate the biopsy under microscopic view to make a diagnosis. A bigger biopsy can be necessary although FNA cytology is very accurate.
All these procedures are necessary to obtain the most accurate diagnosis of your neck lump. The ENT surgeon will explain the results of the tests, including the FNA biopsy, and recommend a treatment plan.
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