neck lumps - unwanted accessories
"YOU HAVE A NECK LUMP!"... THIS SIMPLE YET often insidious finding often not only drives fear into an individual but also can alter the cause of the a person's life. There are many types of lumps in the neck although there are common diagnoses that doctors watch out for in the history and physical examination of the neck. This article will help you better understand the issues involved in the event that someone should find a lump in the neck.

PAINFUL LUMP VS PAINLESS LUMP
A painful lump is a "good feature". The pain from neck lumps usually indicate an infection, inflammation or bleeding (e.g into cyst). The painless lump would have been present for some time and is usually notice by another individual be it a family member, friend or doctor. The common lumps in the neck arise from the lymph glands, thyroid glands and salivary glands.

YEARS VS MONTHS
Neck lumps that have been present for a long many years without change is unlikely to be significant concern. However, we do know that occasionally benign (or nor cancerous lumps) can do transform to cancerous ones. If the lump has arisen in the past few months, it is wise to get this checked by your family doctor or specialist to ensure that there is no major concern.
WHAT ARE LYMPH NODES
There are between 50-75 small normal functioning lymph nodes on each side of the neck. These lymph nodes are the places where bacteria, virus and even cancer cells tend to congregate and is the "battleground" for unwanted cells in the body. In general, infective and inflammatory causes of lymphatic enlargement tend to be painful and of recent onset in weeks. Chronic infection such as Tuberculosis can cause painless enlargement for several months. However, the painless gradual enlargement of the lymph gland should be evaluated to exclude malignancy.
WHAT ARE THE COMMON CANCERS IN THE HEAD AND NECK THAT SPREAD TO LYMPH NODES?
Up to 60 percent of nose cancer patients present with a painless neck lump for several months duration. The affected lymph glands are usually in the upper part of the neck although they can also occur in the lower parts of the neck. The lymph nodes do no move on swallowing – a difference from thyroid lumps. The other common cancers that spread to the neck include tongue cancer, tonsil cancer, voice box cancer, thyroid cancer, salivary gland cancers, breast and stomach cancers.
WHAT CAN IT BE OTHER THEN LYMPH NODES?
In the upper neck, the most common differential other then a lymph node would be tumours of the salivary. At the angle of the jaw, parotid glands tumours are common. Fortunately, 80 percent of tumours in this location are benign. The submandibular gland tumours are under the jaw in the upper part of the neck and 50 percent of tumours here tend to be cancerous. Uncommon lesions that cause neck lumps in the upper neck include branchial cyst, nerve tumours, carotid vessel related tumours.
In the lower part of the neck, the lymph nodes tend to be at the side of the neck. The common lump in the lower part of the neck comes from the thyroid gland.
Neck lumps are not a normal part the head and neck anatomy. The commonest neck lumps are lymph nodes and thyroid enlargement, followed by salivary gland tumours. Painless lumps are more worrisome then painful lumps. 60 percent of nose cancers present with lymph nodes in the neck. Thyroid lumps move up with swallowing. Thyroid nodules tend not to be malignant. Salivary gland tumours in the mouth tend to be cancerous.
A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg