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People may discover an abnormal lump (mass) in their neck. Sometimes, doctors discover a neck lump during an examination. Neck lumps may be painful or painless depending on what has caused them. Painless neck lumps may be present for a long time before people notice them.
Causes
Most neck lumps are enlarged lymph nodes (see Sidebar: Symptoms of Nose and Throat Disorders: Enlarged lymph nodes). Sometimes, the lump is a congenital cyst, an enlarged salivary gland, or an enlarged thyroid gland.
Enlarged lymph nodes:
The most common causes of enlarged lymph nodes include the following:
One or more neck lymph nodes often enlarge in response to an upper respiratory infection, throat infection, or dental infection. These nodes are soft, not tender, and typically return to normal shortly after the infection goes away.
Sometimes, bacteria can directly infect a lymph node (lymphadenitis—see Bacterial Skin Infections: Lymphadenitis). Such infected nodes are quite tender to the touch.
Certain systemic infections typically cause multiple lymph nodes to enlarge, including some in the neck. The most common of these infections are mononucleosis, human immunodeficiency virus (HIV), and tuberculosis.
A much less common but more serious cause of enlarged lymph nodes is
Cancerous (malignant) neck lumps are more common among older people, but they may occur in younger people. The cancer most often is one that has spread (metastasized) from a nearby structure, such as the mouth or throat. However, cancerous lymph nodes may also be due to a cancer in a more distant part of the body, or be a cancer of the lymphatic system itself (lymphoma). Cancerous lumps are not painful or tender to the touch and often are stony-hard.
Other causes:
Cysts are hollow, fluid-filled masses that are usually harmless unless they become infected. Some cysts in the neck are present from birth because of abnormalities that occurred during fetal development. Sometimes cysts develop in the skin (sebaceous cyst), including in the skin of the neck.
A salivary gland under the jaw (submandibular gland—see Mouth and Throat Disorders: Salivary gland swelling) can enlarge if it is blocked by a stone, becomes infected, or develops a cancer.
The thyroid gland, which is in the middle of the neck just above the breastbone, can enlarge. The most common type of enlargement is goiter, which is noncancerous (benign). Cancers and thyroid inflammation (thyroiditis) are less common.
Evaluation
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.
Warning signs:
In people with a neck lump, certain symptoms and characteristics are cause for concern. They include
In general, painless lumps are somewhat more worrisome than painful ones.
When to see a doctor:
People who have any type of neck lump for more than a few days should see a doctor, particularly people with warning signs. Typically they can be seen within about a week unless they have other symptoms (such as fever) that warrant an earlier visit.
What the doctor does:
Doctors ask questions about the person's symptoms and medical history and do a physical examination. What doctors find during the history and physical examination helps decide what, if any, tests need to be done.
During the medical history, doctors ask about the following:
During the physical examination, doctors focus on the ears, nose, and throat (including the tonsils, base of the tongue, and thyroid and salivary glands). They look for signs of infection or abnormal growths, including looking down the throat with a mirror or a thin flexible viewing tube (laryngoscopy). They also feel the neck lump to determine whether it is soft, rubbery or hard, and whether or not it is tender.
Testing:
If there is an obvious source of infection, such as a cold or a sore throat, or the person is young and healthy and has a tender lump present for only a few days, no tests are needed immediately. Such people are watched closely to see whether the lump goes away without treatment. If it does not go away, tests are needed.
Most other people should have a blood count and a chest x-ray. For younger people without risk factors for or findings that suggest cancer (such as mouth growths), doctors often take a tissue sample (biopsy). For older people, particularly those with warning signs or risk factors for cancer, doctors often do several tests to look for a source of cancer before doing a biopsy. Such tests often include a needle biopsy of the lump, but some doctors start with computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck. Children, in whom lumps are caused most often by infection, are usually first given a trial of antibiotics.
To look for cancer originating in other parts of the body, doctors usually take x-rays of the upper digestive tract, do a thyroid scan, and do a CT scan of the chest. Direct examination of the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) may be needed.
Treatment
When cancer cells are found in an enlarged lymph node in the neck and there are no signs of cancer anywhere else, the entire lymph node containing the cancer cells is removed along with additional lymph nodes and fatty tissue within the neck. If the tumor is large enough, doctors may also remove the internal jugular vein, along with nearby muscles and nerves. Radiation therapy is often given as well.
Key Points
Last full review/revision July 2012 by Marvin P. Fried, MD
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