Lumps in the neck are common and are frequently referred to ENT surgeons. They can be congenital, as a result of infection, autoimmune-related, or sometimes a tumour or cancer.
Neck lump evaluation
The management of neck lumps depends on the history and examination of the patient. Specific tests can then investigate and help diagnose the condition.
A thorough history is often the most important part in evaluating a person with a neck lump, and focuses on the lump and also related risk factors (such as smoking, alcohol, history of skin cancers), and symptoms that are specifically related to the head and neck (such as sore throat, swallowing problems, voice change).
Head and neck examination
A thorough head and neck examination not only requires palpation of the neck and the lump, but also involves specific examinations related to nearby structures that may be affected (such as cranial nerves that perform certain functions, for example). In the case of a metastatic lymph node in the neck, a primary site where the cancer originated needs to be identified. Examination may involve flexible nasendoscopy, which involves passing a fine diameter flexible fibreoptic scope through the nose and into the throat to see the larynx or voice box. This is minimally invasive, quick and well tolerated by everyone from children right through to the elderly. Sometimes the surgeon may perform an ultrasound to further look at the lump or surrounding areas.
Medical tests for neck lumps
Medical tests such as blood tests, ultrasound, CT, MRI or PET scans may be ordered after these steps have taken place. Almost always an ultrasound-guided fine-needle aspiration (FNA) of the lump is required and is best performed by the surgeon.
The oropharynx includes the tonsil and base of tongue. A diagnosis of ‘branchial cyst,’ a benign congenital neck lump, needs to be made carefully in the current epidemic of viral related/HPV positive squamous cell carcinoma. These patients are often younger, non-smokers and non-drinkers. Increasingly, patients are misdiagnosed with a branchial cyst when they actually have cancer that has spread from a primary tumour in the base of tongue or tonsil. These cancers can be very small. Cases of oropharyngeal cancer are treated with radiotherapy or may be appropriate for Trans-Oral Robotic Surgery (TORS).
Head and neck cancer
Head and neck cancer can originate from a number sites. These sites can include the skin, nasal cavity, sinuses, oral cavity (tongue, hard palate, floor of mouth), pharynx, larynx, salivary glands (parotid, submandibular and sublingual glands) and thyroid, with different benign and malignant tumours occurring throughout.
Head and neck cancer treatment
The head and neck is unique. It involves many special senses such as sight, smell, taste, speech and swallow. It is at the forefront of a person’s appearance and is at the core of who we are. It is integral to how we appear, and relate to, our loved ones and the rest of the world. The treatment for head and neck cancer has to take into account all of these incredibly special features. It should be undertaken by high-volume, fellowship trained head and neck cancer surgeons.
Tertiary referral centres
Surgeons who treat cancer are one important part of a much larger multidisciplinary team that include other medical specialists and allied health. Tertiary referral centres that specialise in head and neck cancer are the gold standard for management of these patients. Studies show better treatment and better outcomes for people when they are treated through these centres.