Lumps in the Neck

by Dr. Ong Chun Chiang

Have you ever wondered what those lumps that some people have on their necks are? Some have had them for many years and are not bothered by them. Chances are, if they have been there for a long time, they are more likely to be benign (not cancerous).

Cancerous neck lumps tend to appear within a short period of time and become larger as the days go by. They also tend to be more irregular and hard in consistency.

Neck lumps can be anything that range from benign cysts to cancerous lymph nodes. The site of these lumps may give a clue as to what they actually are.
Lumps in the neck should be thoroughly investigated to rule out the possibility of malignant disease, including cancer.

However, only thorough clinical examination and tests can confirm their nature. Below are some of the commoner neck lumps.

Thyroid Lumps

Thyroid glands are bi-lobed anatomical glands at the lower front part of the neck that secrete thyroxine hormones. These hormones control the rate of metabolism of cells in our body.

When insufficient thyroxine is produced, patients become lethargic, constipated, put on weight, dislike cold weather and feel depressed. Overproduction of these hormones causes the opposite. Some patients do not develop thyroid swelling.

Simple goitre is generalised diffuse enlargement of the thyroid glands. It can also present as multinodular goitre. A lot of them are benign and do not become cancerous.

A single thyroid nodule can be cystic (filled with watery substance) or solid. Approximately 20% of solid nodules are cancerous and should be removed.

Thyroid cancers are not common but warrant urgent treatment. Follicular carcinomas, papillary carcinomas, medullary carcinomas, anaplastic carcinomas and malignant lymphomas are some of the cancers that affect thyroid glands.

Most of these require surgery and possibly post-operative radiation treatment either in the form of external radiation or radio-iodine ingestion.

Salivary Glands Swellings

We have 3 types of major salivary glands (parotid, submandibular and sublingual) and a lot of minor salivary glands. These glands produce saliva and secrete it into our oral cavity.

The parotid glands are on both sides of the face, in front of the earlobes. Submandibular glands are below the lower border of the mandible or jaw bone on both sides of the neck. The sublingual gland, on the other hand, is behind the chin.

Lumps can arise from any of these glands and they can be benign or malignant.

Blockage of the ducts by calculi (small stones) can cause the glands to swell after meals. They subside gradually.

Occasionally, these calculi can be removed to relieve the obstruction, but more often than not, the glands have to be removed to prevent recurrence or infection.

Cancers of the salivary glands come in many different forms. Relatively benign tumours such as pleomorphic adenoma can become cancerous as the years go by. It is advisable to have these lumps removed once detected.

Cancers require urgent treatment in the form of surgery and possibly post-operative radiotherapy with or without chemotherapy, depending on their extent and nature.

Thyroglossal Cyst

This is a painless lump in the middle part of the neck just below the chin. It moves up on swallowing. When infected, it becomes painful.

A thyroglossal cyst is benign and is believed to be due to a defect in the closure of the tract that connects the thyroid gland to the foramen caecum (developmental part of the back of the tongue).

It can present in children or in young adults. It requires complete excision to prevent recurrence. If not removed, a small percentage of them do become malignant.

Branchial Cysts

These are another group of developmental cysts that present as painless lumps on the side of the neck, usually in young adults. They require complete excision to prevent recurrence or infection. Similar to thyroglossal cysts, a small percentage can turn malignant.

Neck Nodes

There are many lymph nodes in our neck that help us fight infection. These nodes are small and cannot be felt or seen.

However, it is quite common to see children develop swelling of these nodes when they have upper respiratory tract infections such as tonsillitis and pharyngitis. They usually settle after the infection is gone.

Persistent swelling of these nodes in children and adults should be investigated. It may be harbouring some sinister pathology.

Tuberculosis of neck nodes, lymphomas (lymph node cancers) and metastatic neck nodes (spread of other cancers to the neck) are some of these pathologies.

Treatment will depend on the exact diagnosis. Cancers arising from the nasopharynx (NPC), oropharynx, larynx (voice box) and hypopharynx can present with neck nodes enlargement. Urgent treatment is essential.

Neck Abscess

A neck abscess is a collection of pus that develops in spaces or structures that are present in the neck. It usually follows an upper respiratory tract or dental infection. It presents with a painful lump on the neck that can be tender on palpation.

Ultrasound or CT scans of the neck can help with this diagnosis. Some patients develop high fever. A neck abscess needs to be treated by drainage and antibiotics to prevent other complications, such as septicaemia. Cold abscess is a term given to neck abscess caused by tuberculosis.

In general, persistent neck lumps can be caused by many different illnesses. There are other rare causes that are beyond the scope of this article. It is best to seek expert opinion to rule out any sinister pathology.

Treatment of early cancers of the head and neck can yield very high success rates. Any delay in the diagnosis and treatment can be disastrous.

More info on NECK LUMPS here.

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