I have a neck mass – now what?

06/18/2014 by Penn Medicine Becker ENT & Allergy

Should I just wait and see what happens? The discovery of a neck mass is often an anxiety-provoking discovery and should involve consultation with a physician. Lumps and bumps in the neck are very common and present among all age groups. Depending on the age and health of the patient, location and character of the mass your doctor may have a good idea of what it could be on your first visit. Tests specifically seeking to confirm these suspicions may be ordered and an answer is often available within a week or so. Don’t delay, timely diagnosis can save you a lot of anxiety and lead to a simpler and rapid resolution.
What are swollen glands? One of the most common reasons to have swelling in the neck is an upper respiratory tract (or throat) infection. Although these swellings are often referred to as “glands” they are actually lymph nodes that swell as part of our immune system responding and fighting the illness. These swellings are often on both sides of the neck and may be tender and warm. These typically resolve with treatment of the primary illness; however, a consultation with your physician should be considered if neck mass symptoms persist.
What if I’m not sick? Occasionally a lymph node may swell in the absence of an obvious illness. In adults, these masses require timely attention and a tissue sample is often needed for evaluation. In this setting, imaging followed by biopsy is usually sufficient to obtain a diagnosis. Most neck masses do not require surgery; however, specific treatments depend on the nature of the neck mass and are tailored to each patient’s individual needs. In children, the immature immune system more commonly causes lymph node swelling and can often be serially observed prior to investigation. Any persistent swelling should be evaluated by a physician.
Are all neck masses lymph nodes? Although lymph nodes are the most common source of neck masses, other structures in the neck may also produce swelling. The thyroid, parathyroid and salivary glands may all develop masses. The vast majority of these growths are benign; however, thorough evaluation is required to determine the nature of these growths. Depending on the location and structure involved, different tests will be ordered.
What kinds of tests are used to evaluate neck masses? Ultrasound is very effective at identifying lymph nodes, and cystic structures, and is the best method for evaluating the thyroid gland. CT scans are often used to examine the neck masses relationship to other structures in the neck, which is essential in surgical planning. Imaging will usually show if the neck mass exhibits more concerning features. Tissue biopsy can often be accomplished with a fine needle aspiration biopsy that is similar to getting an injection. Instead of injecting medicine, cells are removed with a very small needle. In some instances, a surgical biopsy may be recommended.
What if it is cancer? In the setting of a head and neck malignancy, such as lymphoma or thyroid cancer, the patient’s best weapon is early diagnosis and treatment. Malignancies of the head and neck have effective, well-established treatment protocols that regularly save lives and leave patients cancer free. If you have a concerning neck mass, it is imperative that you seek evaluation from a physician immediately.
What if I have to have surgery? Surgery in the neck is typically a routine procedure with a relatively quick recovery when compared to common abdominal or pelvic procedures. Under the care of an experienced surgeon, many neck mass procedures can be safely conducted on an outpatient basis with a short-term recovery. Other surgeries will require an inpatient stay where patients can be observed to ensure a healthy recovery.

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