A mass (lump) of the head and neck is a common reason for patients to seek the consultation of an Ear, Nose, and Throat (ENT) physician. Masses of the head and neck may represent a variety of conditions such as infections, congenital lesions, benign growths, or malignant tumors. Physicians will determine the etiology of a head and neck mass by reviewing the patient’s symptoms.
Important questions your doctor will ask you:
- How long has it been there?
- Does it hurt?
- Does it grow or shrink?
- Is it causing problems with swallowing, speaking, or breathing?
- Have you recently been ill with any infections?
- Do you use tobacco products regularly?
The next step in evaluating a patient with a head and neck mass is to examine the patient. This includes a comprehensive examination of the head and neck.
- How large is the mass?
- Is the mass fixed or mobile?
- Is the mass tender to palpation?
- Is the mass fluctuant (fluid-filled) or solid?
- Are the mouth, throat, and larynx normal?
- Are there any other masses?
Your doctor may recommend an imaging study such as ultrasound or CT scan to further evaluate the cause of the neck mass.
NECK MASS DUE TO BENIGN MASSES
There are some benign (non-cancerous) masses that can literally occur ANYWHERE in the neck. Such benign masses include cysts, inflamed lymph nodes, and lipomas (fatty growths). In kids, other benign masses that can occur anywhere in the neck are lymphatic or vascular malformations. However, some benign neck masses generally occur in well-delineated locations of the neck. Biopsy will confirm a diagnosis.
NECK MASS DUE TO INFECTION
The vast majority of infectious causes for neck masses are due to infected lymph nodes from an infection somewhere else in the head or neck (lymphadenitis). Lymphadenitis can occur ANYWHERE in the neck. If lymphadenitis gets bad enough, a neck lump may turn into an abscess (pocket of infected fluid). However, other underlying infectious processes may be going on contributing to a painful neck mass with overlying skin that is red and tender in certain distinct areas of the neck. Biopsy is usually not necessary, but a CT/MRI scan may be recommended by your doctor.
NECK MASS DUE TO CANCER
When a neck mass pops up due to cancer, it almost always is due to spread from another location, such as tonsil, throat, tongue, lung, etc. The one exception is lymphoma, which can pop up anywhere. Based on where the neck mass is, we can determine the most likely location of the main cancer to be, and a vigorous search for the main cancer will be performed by your doctor. Such a “vigorous search” may include endoscopy, CT/MRI scans, chest X-rays, blood tests, etc. Some signs that suggest a neck mass may be due to cancer are neck pain, rock hard (indurated), fixed in position (immobile), adherent to surrounding tissues and muscles, and slowly enlarging. Biopsy is required for diagnosis.
If you have a neck mass, make an appointment to see one of our Otolaryngologists for evaluation.