Lump in Neck

There are multiple possible causes of neck lumps, including: skin infections, lymphadenopathy, tumours, salivary gland lumps, congenital development lumps such as thyroglossal cyst, carotid body tumours/aneurysms.

• History:
  • Suggestive of local malignancy (weight loss, dysphagia or odynophagia, persistent hoarseness, earache, sore throat, or haemoptysis)
  • Haematological malignancy (fatigue, night sweats, fever, weight loss, generalized itching, breathlessness, bruising or bleeding, recurrent infections, bone pain).
• Examination:
• Look for signs of stridor or superior vena cava compression. This is a medical emergency requiring immediate referral as below.
• Examine the neck for masses and pulsation; assess size, mobility, character and position of lump.
• Examine ENT as well as scalp/skin for any signs of malignancy or infection

Lateral neck swelling

• Suspected infection: short history often secondary to a viral upper respiratory tract infection. Treat conservatively unless systemically unwell (consider screening for glandular fever, toxoplasmosis and HIV). If not resolving after 2 weeks, refer urgently.
• If suspicious of malignancy or generalised lymphadenopathy:
  • Bloods - (FBC) consider haematological cause if abnormal, (TFTs) if a suspect thyroid mass.
  • Imaging - an urgent chest X‑ray if supraclavicular and >40yrs old
  • Consider laryngeal cancer in >45 years and lymphadenopathy with persistent unexplained hoarseness.
  • Consider oral cancer if persistent lymphadenopathy and unexplained oral cavity ulceration lasting >3 weeks.

Suspected thyroid swelling

• All need thyroid function tests and thyroid USS then referral as below
• Refer to ENT if suspicion of airway compromise or dysphagia associated with thyroid mass.

Salivary gland mass

• Persistent and unexplained - refer urgently (cancer 2 week referral)
• If a calculus is suspected - manage conservatively and if unresolved with maximum measures referral to ENT
• If mumps is suspected - manage as per NICE guidelines for mumps¹. This does not need referral to ENT.

Unexplained lump

• Consider an urgent referral (cancer 2 week referral) if:
  • There is an unexplained neck lump in a person aged 45 years or older
  • There is a persistent and unexplained neck lump in a person younger than 45 years of age.

Emergency referral

• Signs of airway compromise or sepsis (on call ENT team Ninewells bleep 4496).

Urgent referral

• Lymph nodes increasing in size or greater than 1cm in size.
• Neck lump present for more than 3 weeks.
• Widespread lymphadenopathy with/without ‘B’ symptoms.

Thyroid

• Referral to thyroid clinic run by endocrinology or general surgery.

Routine referral

• Any other longstanding neck lump with no associated sinister symptoms/features but affecting quality of life. E.g. large lipoma restricting neck movement or known multinodular goitre.

ENT UK Patient Information Leaflet on H&N conditions/neck lumps

1. NICE CKS. Mumps. Last revised December 2023.
2. NICE CKS. Neck lump. Last revised May 2025.
3. NICE. Suspected cancer: recognition and referral. NICE guideline NG12. Published 23 June 2015. Last updated 01 May 2025.
4. Pynnonen MA, Gillespie MB, Roman B, Rosenfeld RM, Tunkel DE, Bontempo L, Brook I, Chick DA, Colandrea M, Finestone SA, Fowler JC, Griffith CC, Henson Z, Levine C, Mehta V, Salama A, Scharpf J, Shatzkes DR, Stern WB, Youngerman JS, Corrigan MD. Clinical Practice Guideline: Evaluation of the Neck Mass in Adults. Otolaryngol Head Neck Surg. 2017 Sep;157(2_suppl):S1-S30. doi: 10.1177/0194599817722550. Available from:https://pubmed.ncbi.nlm.nih.gov/28891406/