Merck Manual

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Neck Lump

By

Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Reviewed/Revised May 2023
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People may discover an abnormal lump (mas) 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 of a Neck Lump

Enlarged lymph nodes due to infections

The most common causes of enlarged lymph nodes among younger people include the following:

  • Reaction to nearby infection (such as a cold or a throat infection)

  • Direct bacterial infection of a lymph node

  • Certain bodywide (systemic) infections

One or more neck lymph nodes often enlarge in response to an upper respiratory infection, throat infection, or dental infection. In such cases,the nodes are soft and usually not tender. They typically return to normal shortly after the infection goes away.

Cancerous neck lumps

A much less common but more serious cause of enlarged lymph nodes is

  • Cancer

Cancerous (malignant) neck lumps are more common among older people, but they may occur in younger people. The cancerous lump may be any of the following:

Cancerous lumps are not painful or tender to the touch and often are rock-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 (epidermoid cyst Cutaneous Cysts Cutaneous cysts are common, slow-growing lumps. Epidermal inclusion cysts are the most common cutaneous cysts. (See also Overview of Skin Growths.) Epidermal inclusion cysts (epidermoid cysts)... read more Cutaneous Cysts ), including in the skin of the neck.

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 Simple Nontoxic Goiter Simple nontoxic goiter is noncancerous enlargement of the thyroid gland that does not involve over- or underproduction of thyroid hormones. Noncancerous thyroid enlargement can occur because... read more , which is noncancerous (benign). Thyroid cancer and thyroid inflammation (thyroiditis) are less common.

Evaluation of a Neck Lump

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

  • A very hard lump

  • Sores or growths in the mouth

  • Difficulty swallowing and/or hoarseness

  • A new lump or lumps in an older person

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. People with other symptoms (such as fever) should see a doctor as soon as possible.

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:

  • Symptoms of colds (such as a sore throat, sneezing, and a runny nose), and throat infections (such as pain when swallowing), and dental infections (such as toothache)

  • Symptoms of cancer in the neck (such as difficulty speaking or swallowing) as well as risk factors for cancer, particularly smoking and drinking alcohol

  • Risk factors for HIV and tuberculosis infection

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 or lumps to determine whether the lump is soft, rubbery or hard and whether it is tender.

Testing

If there is an obvious source of infection (such as a cold or a sore throat) or if 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 complete blood count (CBC) and a chest x-ray X-Rays X-rays are a type of medical imaging that use very low-dose radiation waves to take pictures of bones and soft tissues. X-rays may be used alone (conventional x-ray imaging) or combined with... read more . If younger people have no risk factors for cancer or findings that suggest cancer (such as mouth growths), imaging tests are often done, sometimes followed by 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 they remove a piece of the lump (a needle biopsy) or the entire lump for testing (an excisional biopsy). Tests often include blood tests and computed tomography Computed Tomography (CT) Computed tomography (CT) is a type of medical imaging that combines a series of x-rays to create cross-sectional, detailed images of internal structures. In computed tomography (CT), which used... read more Computed Tomography (CT) (CT) or magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more Magnetic Resonance Imaging (MRI) (MRI) of the head and neck. Ultrasonography Ultrasonography Ultrasonography is a type of medical imaging that uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. During an ultrasound, a device called a... read more Ultrasonography is preferred for children to avoid radiation exposure and may be used in adults if doctors suspect a thyroid mass. In children, infection is the most common cause of neck lumps, So before an imaging test is done, children are usually first given antibiotics to see if the lumps go away.

To look for cancer originating in other parts of the body, doctors usually take x-rays of the upper digestive tract, a thyroid scan, and a CT scan of the chest. Direct examination of the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) with biopsies, done at the same time, may be needed.

Treatment of a Neck Lump

Doctors treat the cause of the neck mass.

If the lump is a lymph node enlarged because of an infection, the lump usually goes away after the infection has resolved.

When cancer cells are found in a lump or an enlarged lymph node in the neck and there are no signs of cancer anywhere else, the entire lump or lymph node containing the cancer cells is removed along with additional lymph nodes and fatty tissue within the neck. If the tumor is large, doctors may also remove the internal jugular vein, along with nearby muscles and nerves. Radiation therapy is often given as well.

Key Points

  • Most neck lumps are enlarged lymph nodes.

  • Painless lumps are somewhat more worrisome than painful ones.

  • Usually testing is not needed unless the doctor suspects cancer.

  • Cancerous neck lumps are removed surgically if there are no signs of cancer elsewhere in the body..

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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