Definition

Neck lump refers to any type of swelling or bump in the neck area. These lumps may occur due to fluid accumulation in the neck tissues or inflammation. Pain may or may not be present, depending on the underlying medical condition. Additionally, the size of the lump can vary. It may be so small that it is only noticed later or large enough to be easily seen and felt.

Causes

Enlarged Lymph Nodes in the Neck

Most neck lumps are caused by enlarged lymph nodes, often in response to infections in the neck, teeth, or upper respiratory tract. Sometimes, bacteria can directly infect the lymph nodes, leading to a condition known as lymphadenitis.
Widespread infections in the body can also cause multiple lymph nodes to enlarge, as seen in conditions like HIV, mononucleosis (caused by the Epstein-Barr virus), and tuberculosis.

Tumors and Cancer

Neck lumps may also be due to benign or malignant tumors (cancer), though this is less common. Most malignant lumps in the head and neck area are caused by squamous cell carcinoma (HNSCC). These cancerous lumps are more common in the elderly, although they can also be found in adults.
Neck lumps can also be a sign of cancer spreading from nearby structures, like the mouth or throat. Lymphatic system cells can mutate into cancer, called lymphoma. Other cancers may arise from the thyroid or salivary glands or metastasize from elsewhere in the body to the neck.

Other Causes

Other conditions that may cause a lump in the neck include:

• Cysts: fluid-filled lumps, typically harmless unless infected
• Enlarged salivary glands: due to infection or cancer
• Thyroid gland enlargement: due to goiter, thyroiditis, or cancer
• Severe allergic reactions cause swelling in the mouth and neck
• Recent medical procedures in the neck area
• Recent injury to the neck

Risk Factor

Smoking and long-term alcohol consumption increase the risk of cell mutations that lead to cancer in the neck. Neck malignancies are also more common in older individuals. Additionally, Human Papilloma Virus (HPV) infection increases the risk of cancers in the neck, throat, and mouth.

Symptoms

Symptoms depend on the underlying cause. Lumps may feel soft or hard, painful or painless, and may disappear or continue to grow. Generally, painless lumps are more concerning than painful ones.
In some cases, symptoms suggest a serious underlying cause, like cancer, which requires further evaluation. These include:

• A very hard lump
• Lump growth
• Lump persisting for more than 2-3 weeks
• A mouth sore or lump that grows
• Difficulty or pain when swallowing
• Hoarseness or voice changes
• New lumps in older individuals
• Hearing problems or ear pain on the same side as the lump
• Unexplained significant weight loss
• Nasal blockage on one side
• Difficulty breathing
• Nose or mouth bleeding
• Coughing up blood
• Skin changes or discoloration
  Generally, painless lumps are more worrisome than painful ones.

Diagnosis

To diagnose the cause of a neck lump, your doctor will gather information from your medical history, conduct a physical exam, and order additional tests if necessary.

Medical History

Your doctor will ask about your symptoms and medical history. Common questions include:

• • Where is the lump, and how long has it been there?
  • Has the lump grown, and if so, how long has the growth been occurring?
  • Do you feel pain in the lump area or stiffness in your neck?
  • Any accompanying symptoms, such as difficulty breathing, swallowing issues, allergic reactions, or inflammation?
  • History of neck injury or surgery?
  • Any other medical conditions or allergies?
  • Current medications?

Physical Examination

A physical exam will focus on your ears, nose, and throat (including tonsils, base of the tongue, thyroid gland, and salivary glands). Your doctor will check if the lump is soft or hard, movable or fixed, singular or multiple, and if it is localized or spread throughout the neck. If necessary, a flexible tube called a laryngoscope may be used to examine deeper throat areas.
This information will help determine the need for further testing.

Diagnostic Tests

If no obvious infection source is found, emergency tests are generally not required unless the neck lump persists for more than a few days. If the lump doesn’t resolve on its own, further evaluation will be needed.
Most patients undergo blood tests and imaging like CT or MRI scans of the head and neck. Ultrasounds are often preferred for children to avoid radiation exposure. Imaging helps provide a more detailed view of the lump compared to X-rays.
For further investigation, direct visualization with flexible tubes may be done for the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) to get images of specific organs.
In older individuals with serious symptoms or cancer risk factors, further testing might be done to search for cancer before performing a biopsy, which involves taking a tissue sample to check for cancer cells in the lab.

Management

Once the cause of the lump is determined, your doctor will explain the next steps and discuss treatment options. In children, neck lumps are often due to infections and treated with antibiotics if bacterial infection is suspected. Once the infection resolves, the lump usually subsides. Pain relief medications may be prescribed to manage discomfort.

If cancer cells are found, treatment options include surgery, radiation therapy, and chemotherapy, sometimes in combination, depending on the diagnosis and cancer stage. Tumor removal is an option for small, early-stage cancers. However, if the tumor is large, surrounding tissues like blood vessels and muscles may also need to be removed. In such cases, combination therapy with radiation and/or chemotherapy is typically required.

Prevention

Neck lumps caused by infections can be prevented by wearing masks and regularly washing hands with soap or disinfectants to avoid respiratory infections. Additionally, avoid smoking and limit alcohol consumption to reduce the risk of neck cancer.

Complications

A neck lump could indicate a serious condition, such as a severe infection or malignancy, requiring prompt treatment. Complications from delayed treatment include:

• Unmanageable pain
• Severe breathing difficulties
• Cancer spreading to other organs
• Worsening infection
• Thyroid problems

When to See a Doctor?

If you notice a lump on your neck that persists for several days, you should consult a doctor, especially if it is accompanied by serious symptoms.

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