Lymphadenopathy

Background: Of all head and neck red flag symptoms, persistent neck lumps (without any other precipitating cause) are most likely to be associated with malignancy. However, lymphadenopathy with a clear history of a infection (URTI, AOM) prior to onset is more likely to be of benign causation. A persistent neck lump for >3 weeks is a red flag ENT symptom (as per Scottish Referral Guidelines for Suspected cancer).

Lymph glands can be present under the chin, under the jawline, in the neck anterior to the sternocleidomastoid muscle, posterior to the sternocleidomastoid muscle or just above the clavicle

Figure – location of cervical lymph nodes

How to assess:

Check for other ENT red flag symptoms

Palpate the neck mass – firm, fixed or nodes >1cm are more likely to indicate malignancy

Referral Guidance:

Refer any persistent neck lump >3 weeks as urgent suspicion of cancer

If there is a clear history of an infective cause and a persistent neck lump for >3 weeks, consider urgent referral rather than urgent suspected cancer