When Should You See an ENT Consultant for a Neck Lump?

When Should You See an ENT for a Neck Lump?

Noticing a lump in your neck can be concerning, but not all lumps are a cause for alarm. There are many different causes. Most are benign (non-cancerous), but a small number can be malignant (cancerous).

The chances of a neck lump being cancerous increase with certain risk factors. These include your age, general health, smoking, alcohol consumption, and family history. How the lump has changed, associated symptoms, and other likely causes are also important. If you saw me in clinic, I would ask about the following: how long the lump has been present, how it has changed, whether it is painful, and whether there are other symptoms such as a change in voice or swallowing difficulties.

After gathering this information from the history and conducting a thorough examination, we could decide whether further tests are required.

Sometimes, a flexible nasendoscopy is necessary. This involves inserting a small camera through your nose to check your throat. Occasionally, imaging (scans) such as ultrasound, MRI, or CT may be recommended to help with the diagnosis or provide reassurance. Rarely, a biopsy is required, but this may sometimes be the recommendation.

Patients often ask the following questions:

Is it Cancer?
People understandably want to know: is this lump cancerous? It’s usually fairly straightforward during the consultation to give people an idea of the likelihood of cancer and provide some initial reassurance. However, one or two additional tests may be required, such as a flexible nasendoscopy (a small camera through the nose to examine deep into the throat) or some imaging investigations (scans) to be more certain. These tests need to be tailored to the type of lump and your symptoms. The goal is to rule out cancer and establish a proper diagnosis of what is causing the lump. These investigations will be undertaken quickly. The flexible nasendoscopy is often done on the day of the clinic visit, while scans would usually be scheduled for a different day at the radiology department.

Most often, the lump is not cancerous.

When the lump is cancerous, the priority is to obtain a fast and accurate diagnosis and perform a thorough workup for staging. After this, there is a large meeting called an MDT (multidisciplinary meeting) where your case would be discussed, and treatments would be recommended. Please take reassurance in knowing that most neck lumps I see in clinic do not turn out to be cancerous. However, if you are worried, and if a new neck lump is not going away or is progressing, I would recommend seeking medical attention from your GP or booking an appointment with me sooner rather than later. It is probably not cancer, but if it is, it is better to catch it as early as possible.

What Should I Do if the Lump is Not Cancer?
This really depends on the diagnosis of the lump (what is causing it) and your symptoms. The goal is to recommend a treatment plan that maximises your health and helps you feel as good as possible. Sometimes, this involves doing nothing and providing reassurance. Sometimes, I may recommend a "watch and wait" approach, or perhaps a follow-up or surveillance scan. Occasionally, an operation may be recommended. The choice of treatment is entirely up to you, but I can provide recommendations and we can decide together.

What Are the Possible Diagnoses?
There are too many potential diagnoses to list them all here, but I will try to categorise many of them into broad groups.

1. Thyroid Lumps
   These tend to present toward the front of the neck, fairly low down. Thyroid lumps are very common. They usually move when swallowing. The first test a patient should have with a thyroid lump is a thyroid function blood test (TFT). I can arrange this for you, but many patients will have it done at their GP's surgery. The investigation of choice for a thyroid lump is typically an ultrasound scan, which I can arrange after a consultation once the thyroid function blood test results are available. Other lumps in this region, such as thyroglossal duct cysts, can also occur. Most thyroid lumps are benign, so try not to worry too much. However, it is recommended to have investigations done quickly to rule out concerning causes.

   There are fairly complex grading systems for the ultrasound appearance of a thyroid lump, and these help guide our decision on treatment and management. I can go through these with you in clinic in as much detail as you'd like.

2. Head and Neck Cancer
   Most head and neck cancer that presents as a neck lump is actually a lymph node (gland) metastasis (spread) from a primary cancer elsewhere. The primary cancer could be in a patient's tonsils, voice box, throat, or elsewhere. Symptoms such as progressive swallowing issues, pain when swallowing, or pain radiating to your ear are concerning signs, particularly if it's on one side. Smoking increases your risk. A persistent hoarse voice is also a worrying sign. Sometimes, cancer presents with no pain and only a lump. If you have a lump or symptoms that are not going away or progressing, or if you're worried, please don’t hesitate to see your GP or a suitably trained consultant, such as an ENT specialist such as myself.

   Sometimes, gland enlargement could be due to a node spreading from a skin cancer in the head and neck. If you have previously had skin cancer removed from your head and neck (face, scalp, neck, ears etc) and now have a persistent or progressive neck lump, please seek attention from your GP, myself, or another healthcare practitioner, as this can be a worrying sign.

   Most people who present with a neck lump do not have cancer, so try not to worry unnecessarily. However, it is good to have concerning underlying cases ruled out if you're worried.

3. Salivary Gland Lumps There are many types of lumps within the salivary glands, ranging from salivary gland stones, benign lumps such as pleomorphic adenomas, to primary salivary gland malignancies (cancer). The main salivary glands are the parotid glands (one on each cheek, just in front of the ears, extending down to the angle of the jaw) and submandibular glands (just under the jaw, toward the front of your neck). There are also many much smaller sublingual glands and numerous minor salivary glands throughout the mouth and throat.

4. Lymphoma
   This is another type of cancer that can present with enlargement of the glands in the neck. Lymphoma can affect lymph nodes all over the body, but it is relatively common for lymphoma to present with gland enlargement in the head and neck. Lymph nodes enlarged due to lymphoma have a characteristic appearance on ultrasound scan, in contrast to lymph nodes enlarged due to infection (referred to as reactive lymph nodes). After the history and examination, ultrasound scan and sometimes a biopsy usually are recommended.

5. Superficial Lumps and Bumps
   There are many causes of cysts and benign lumps in the skin and soft tissue around the head and neck, including sebaceous cysts, skin cysts, small lipomas etc. These are very common. Removal of these small cysts is often not funded by the NHS, and some patients choose to have them removed in the private sector. This can sometimes be done under local anaesthetic (with a numbing injection, while you're awake), which significantly reduces costs.

That is just a few of the common neck lumps patients present with. If in doubt or worried, please consult your GP or a qualified healthcare professional such as myself.