EVALUATING NECK AND LUMP MASSES

Neck lumps and masses

Neck lumps or masses are extremely common, and they have numerous possible causes. They may arise from the skin or from structures underneath. The tendency on finding a lump is to worry that it might be cancer. Thankfully, the vast majority of neck lumps are not cancerous, particularly in children and younger adults.

Where could the lump come from?

The lump can arise from the surface of the neck ie the skin to deeper lying structures such as fat and muscles. Other deep organs within the neck include:

  • Lymph glands
  • Salivary glands
  • Thyroid gland
  • Arteries, veins and lymphatic vessels
  • Nerves

Should I be concerned?

Broadly speaking, most lumps can be classified into three categories:

  • Congenital (present at early childhood but presenting later in life)
  • Inflammatory (due to an acute infection or chronic inflammation)
  • Neoplastic (can be benign or cancerous)

As a general rule, if it is soft, it is less likely to have a worrying cause. If it goes away on its own, or comes and goes, it is also less likely to be anything serious. If it is red or very tender, it might well be an infection and it may need antibiotics. The most worrying types of lump tend to feel very hard, solid or craggy, and have gradually grown over a period of a few weeks to months.

You will need to see a doctor for any lump that persists or enlarges, and especially if it is associated with any of the following worrying symptoms:

  • Weight loss that is unintended and significant
  • Night sweats
  • Persistent fatigue
  • A change in your voice (such as a hoarseness) that persist more than a month
  • Difficulty swallowing or sensation of food getting stuck in the neck
  • Feeling out of breath or having difficulty breathing.
  • Coughing out blood or nose bleed

The only way to be sure the lump isn't anything to worry about is to visit a head and neck specialist for a comprehensive evaluation. The consultation begins with a detailed history and physical examination. Other than examining your neck, the doctor will also need to examine other related body sites such as your mouth, throat, ears, nose, chest and abdomen.

A recently discovered neck mass in a young female
A recently discovered neck mass in a young female

Will I need any tests?

Depending on what is found on examination and on where the lump is, additional tests are necessary. Simple blood tests may be helpful, to check on your thyroid function, and to rule out blood-related cancers such as lymphomas or leukaemias. They may also be helpful to check for infections such as glandular fever.

An ultrasound of the neck is usually performed during the consultation. This is one of the simplest and most sensitive tests to evaluate the origin of the neck mass, to differentiate between cystic from solid masses, and to get a sense of whether it is benign or malignant (cancerous).

When there is a suspicion of a cancerous growth, the specialist may perform a fine needle biopsy on the mass. This is usually done under ultrasound guidance to enhance the accuracy of the biopsy.

A fine needle biopsy requires little preparation. The specimen is smeared onto a glass slide and sent off to the laboratory for an examination under the microscope. A result is usually ready within three days. The patient often does not feel much discomfort during the procedure and is well enough to resume normal activities immediately after.

A fine needle biopsy of a thyroid nodule.

A nasendoscopy is also usually performed as part of the consultation. This involves the insertion of a fine and flexible lighted instrument through the nostril and carefully maneuvered into the back of the nose and down the throat for a detailed examination. The instrument projects a video image onto an external monitor that can be recorded.

What are the costs of these tests?

Both the ultrasound-guided biopsy as well as the nasendoscopy are classified under the table of surgical procedures (TOSP) by MOH. As such, both procedures are Medisave claimable, subject to the approved surgical limit. If you have an Integrated Shield Plan, you can claim part or all of your surgical bill, depending on your private insurance coverage.

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