NECK MASSES (LUMPS)

The neck is full of an astonishing number of structures, basically everything that connects your head to your body.  Muscles, backbones, spinal cord, blood vessels, voice box (larynx), breathing pipe (trachea), swallowing tube (esophagus), nerves, lymph nodes (often erroneously called “glands”), and true glands (thyroid, saliva).  Many of these can be felt in their normal state but when discovered for the first time, can cause worry.  Most of us don’t spend a lot of time poking around on our necks but between shaving, washing, putting on make-up, looking in the mirror, etc., we have at least some familiarity with what should be there and what might be new.

Common normal lumps include one of the back bones just below the ear, the parotid saliva gland (in front of the ear), the submandibular saliva gland (just behind the chin on either side), the carotid bulb (where the main artery on each side splits into two branches, one to the brain and one to the face), the larynx (voice box) and the hyoid bone (a small bone just above the voice box).  These can usually be ignored and the patient reassured.

“Abnormal” lumps can still be very common and are better considered separately for children and adults.

Essentially all children have lymph nodes (glands) which can be felt.  They are easy to see since children are small and thin.  These arise after various viruses, sore throats, strep throats, skin rashes or infections, animal or insect bites or scratches.  Sometimes the lymph node is reactive (additional cells are being grown and activated to help fight off infection or inflammation) but sometimes it will actually be infected.  These usually pop up rather quickly, may be somewhat tender, and then go down over a few weeks after the source has been treated or has gone away on its own.  An infected lymph node may heal to a small scar nubbin which may remain permanently.  This is what grandma used to call a “kernel.”  Most of these lymph nodes will be less than an inch but there may be several or even many (like in mononucleosis).  Uncommonly, a child may develop lymphoma (one example is Hodgkin’s disease) where they may have lymph nodes which get bigger and bigger. These do not hurt and take several weeks to months to grow.  Other kinds of cancer which might go into the lymph nodes are rare in children.  Bottom line:  lymph nodes which come and go and are not too large and not too tender are usually not much to worry about.

Children are the most likely to show up with several different types of cysts which are basically minor birth defects.  Branchial cleft cysts are to either side while thyroglossal duct cysts are right in the middle under the chin.  Although present since birth, they may pop up rather suddenly at almost any age.  They require surgical removal but otherwise are not particularly serious.

Actual tumors (lumps) of the normal neck structures, either benign or malignant, are very unusual in children.

In adults, reactive lymph nodes are still the most common cause of “abnormal” lumps.  They can be more difficult to feel because they are often underneath the heavier muscles and often fatty tissues of the adult.  In adults, some unusual causes are more common, including infectious mononucleosis, cat scratch fever, Lyme disease, lupus, and syphilis.

The cysts mentioned above for children can also occur in adults with the same discussion pertaining.

Actual tumors of structures are more common in adults.  The salivary glands can have tumors or cysts, usually benign.  The thyroid gland is commonly enlarged, usually as a goiter which is an overgrown gland, but tumors and cysts happen to this gland also.  Abnormalities causing lumps/tumors of the nerves, muscles, or blood vessels are unusual.

Cancer is the big concern with enlarged lymph nodes in adults.  Lymphoma, which is a cancer of the lymph nodes themselves, often shows up first in the neck.  Again, the lymph nodes will get slowly larger, are rubbery firm but not tender, and can get very large!

Most serious are lymph nodes with cancer spread into them (metastases) usually from a cancer somewhere in the mouth or throat.  Almost all of these happen to smokers only.  The lymph node will usually be very hard, slow growing, and again, not tender.  There may be one or several.  The original location of the cancer must be determined to take proper care of these. With proper questions and examination, the initial location can usually be determined.  Occasionally, cancer will spread into neck lymph nodes from other parts of the body, including skin cancer, lung cancer, breast cancer, thyroid cancer, and colon cancer.

To evaluate neck masses, in adults or children, usually CT scans or MRI scans are used.  Ultrasound is especially useful in thyroid masses.  Depending on location and level of concern, sometimes a thin needle is inserted into the lump to suction off a small number of cells which can help decide what the cause of the lump is.  With proper diagnosis, many neck masses can be ignored or treated with medications.  Some will require surgery just to establish the answer and for others, surgery is the cure.  For cancers, there is a much wider array of appropriate therapies than can be discussed here.

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