Many people have neck lumps and don’t even notice them. These are often picked up by a loved one or your family doctor. Other people may notice a neck lump when pulling clothes over their head or shaving. The location of the lump may give us some clues as to the underlying cause. It is important that any neck lumps have a thorough assessment.
Lumps in the neck can be congenital (present from birth) cysts, normal but active lymph nodes, inflammatory disease, benign tumours or cancer. In adults it is a general rule that a persistent neck lump with no other symptoms should be considered cancer until proven otherwise. Often a persistent neck lump is the only symptom of HPV related oropharyngeal cancer.
Diagnosis and Treatment
I start by listening to patients describe their symptoms, also referred to as taking a history. After taking a history I then perform a physical examination of the lump and then a direct video nasolaryngoscopy with a flexible telescope.
The telescope contains a video camera which records to a computer. I use it to perform a direct video nasolaryngoscopy (this is also sometimes called a flexible nasolaryngoscopy, a flexible laryngoscopy or a flexible nasoendoscopy).
Direct video nasolaryngoscopy is a minor procedure which gives me a magnified, high definition, live action view of your nose, throat and larynx. The video camera is linked to a screen and the examination is recorded so we can look at the images together. All Otolaryngology – Head and Neck Surgeons perform nasolaryngoscopies to examine patients but my practice is one of only a handful in Australia which uses video nasolaryngoscopy.
The great advantage of videoscopes over standard flexible fibreoptic telescopes is that they provide a superior (4K) magnified image on a wide screen. The videos I record during your consultations are saved to your medical record used to track your progress following treatment. I originally used fibreoptic telescopes in my practice but I changed over to video in 2013. This was because I recognised that the superior image offered by video significantly improves my ability to identify pre-cancerous and cancerous changes in the lining of the throat and voicebox.
It is important to determine whether or not the lump is benign or cancerous. Further investigations to determine the cause include medical imaging with a computed tomography scan (CT scan), and fine needle aspiration biopsy (FNAB). The FNAB is either performed by me or by a pathologist using ultrasound guidance.
The neck includes many different structures such as lymph nodes and glands from which neck lumps most commonly arise. Some of these structures and problems are: