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 mumps. 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

• NICE guidance neck lump
• NICE suspected cancer guideline
• American academy clinical practice guidelines