Neck Lumps

Lumps or swellings in the neck are common. Although the patient may discover the lump by himself or herself, very often the patient only becomes aware of the lump when another person points it out to them. Although most neck lumps are benign, they sometimes can be a presentation of a more serious underlying disease.

There are many causes of lumps/ swellings in the neck. Below are some of the more common causes.

1. Lymph Nodes
   There are many causes for lymph nodes in the neck to be enlarged, but one of the most common causes is due to infection. Lymph nodes may be enlarged due to acute infections such as upper respiratory tract infection, skin infections, ear infections. They can also be enlarged due to chronic infections such as tuberculosis.
   Sometimes an enlarged lymph node in the neck can also be the first sign of underlying cancer. Certain cancers (e.g. nasopharyngeal cancers, melanoma, oral cancers) tend to spread to lymph nodes and an enlarged lymph node can sometimes be the first sign of underlying cancer. Some cancers like lymphoma also first develop in lymph nodes.
   
2. Thyroid Nodules
   The thyroid is a butterfly-shaped gland located in the front of the neck. It produces hormones that control and regulate the growth and rate of function of many systems in the body. The thyroid gland can sometimes develop solid or fluidfilled lumps.
   Although most of these lumps are not cancerous lumps, a small proportion of them will be cancerous. Some of these lumps may also cause problems when they grow larger and compress on other structures in the neck causing swallowing and breathing difficulties.
   Some of these lumps may also secrete too much thyroid hormone that may cause symptoms of hyperthyroidism.
   It is important to see a doctor to evaluate these lumps, as it is not easy to tell which lumps need treatment without doing proper investigations.
   
3. Skin and Subcutaneous Lumps
   Lumps in the neck can also arise from the skin or just below the skin. Most of these lumps are not cancerous and do not cause symptoms. However a small proportion of these lumps can occasionally turn out to be cancerous. Worrying signs include:
   • Change in size of a lump
   • Change in colour of surface of the lump
   • Bleeding
   • Other lumps appearing around the lump
   • Enlarged lymph nodes
   It is important to seek a medical opinion if you have any of these symptoms.


4. Salivary Gland Enlargement
   Salivary glands are organs in the neck that secrete saliva, which helps us digest our food. These glands can sometimes become enlarged for various reasons that include tumours, infection or secondary to an underlying medical condition.
   
5. Thyroglossal Cysts/Branchial Cysts
   These are lumps/cysts that occur during the body’s development. Although present at birth, they may only enlarge and be discovered later on in life. These lumps/ cysts should usually be removed surgically to prevent complications.
   

What tests should I go for?

If you find a lump in a neck that you are worried about, the first step you take is to get it checked by a doctor. Depending on what he finds, he may order one or more of the following tests:

1. Imaging Tests
   Depending on the condition, the doctor may order one or more imaging tests to investigate the lump. These tests can include:
   
   • Ultrasound scans
   • X-rays
   • Computer Tomographic (CT) scans
   • Magnetic Resonance Imaging (MRI) scans
   • Positron Emission Tomography (PET) scans
   
   
2. Fine-needle Aspiration Cytology (FNAC)
   Your doctor may advise you to undergo a biopsy to evaluate the lump if he feels it is needed.
   A fine-needle aspiration biopsy is a procedure where the doctor will pass a small needle through the lump to aspirate some cells for the lump for further testing. To improve accuracy, most FNAC are performed under ultrasound guidance.
   

What kind of treatment will I undergo?

Depending on what the doctor finds, the doctor may advise you to have the lump removed surgically. In cases where the lump is cancerous, it may be necessary to remove the lymph nodes in the neck as cancer cells may have spread to them.

Some lumps in the neck can be safely observed. Your doctor may advise you to have a follow-up test at a later date to check if there are new changes.