From the Guidelines
When evaluating a patient with a neck lump, comprehensive documentation should include the patient's complete history, physical examination findings, and relevant investigations, as outlined in the clinical practice guideline for evaluation of the neck mass in adults 1. The documentation should begin by recording the patient's age, gender, and detailed history including:
- When the lump was first noticed
- Any changes in size
- Associated symptoms like pain, dysphagia, voice changes, weight loss, or fever
- Relevant risk factors such as smoking, alcohol use, prior radiation exposure, or family history of cancer The lump's characteristics should also be documented, including:
- Location (using anatomical neck triangles or levels)
- Size (measured in centimeters)
- Consistency (soft, firm, hard)
- Mobility
- Tenderness
- Pulsatility
- Whether it moves with swallowing or tongue protrusion Note any additional findings such as:
- Skin changes
- Other masses
- Lymphadenopathy
- Abnormalities of the oral cavity, oropharynx, ears, nose, and larynx Include results of diagnostic tests like:
- Fine-needle aspiration
- Imaging studies (ultrasound, CT, or MRI)
- Blood tests
- Any endoscopic examinations This comprehensive documentation is essential because neck lumps can represent various conditions ranging from benign inflammatory processes to malignancies, and accurate documentation guides appropriate management and provides baseline information for monitoring treatment response, as emphasized in the guideline 1 and supported by the recommendation for patient education 1. The essential components to document when evaluating a patient with a neck lump should prioritize identifying patients at increased risk for malignancy, as recommended in the guideline 1.
From the Research
Essential Components of Neck Lump History
When evaluating a patient with a neck lump, the following components are essential to document:
- A careful medical history, including the onset and duration of the mass, as well as any associated symptoms such as pain, difficulty swallowing, or coughing 2, 3, 4
- A thorough physical examination to guide the need for follow-up examination with imaging, biopsies, and specialist referrals 2
- Patient demographics, such as age and smoking status, to help determine the likelihood of malignancy 3
- The location and characteristics of the mass, including its size, shape, and consistency 3, 4
Diagnostic Considerations
The diagnostic approach to a neck lump may involve:
- Imaging studies, such as contrast-enhanced computed tomography, to evaluate the mass and surrounding structures 3, 4
- Fine-needle aspiration biopsy to provide diagnostic information via cytology, Gram stain, and bacterial and acid-fast bacilli cultures 3
- Consideration of the patient's overall health and medical history, including any history of cancer or autoimmune disorders 2, 4
Special Considerations
In some cases, a neck lump may be associated with other symptoms, such as dysphagia (difficulty swallowing) 5