What to do if I have a mass in my neck?

From the Guidelines

If you have a mass in your neck, you should see a healthcare provider promptly for evaluation. Neck masses can have various causes ranging from benign conditions like infections or cysts to more serious issues such as thyroid disorders or cancer. Your doctor will likely perform a physical examination and may order imaging tests like ultrasound, CT scan, or MRI to determine the nature of the mass, as recommended by the clinical practice guideline: evaluation of the neck mass in adults 1. Blood tests might also be necessary to check for infection or thyroid function.

Depending on the findings, a fine needle aspiration biopsy might be recommended to sample cells from the mass for laboratory analysis, as suggested by the guideline 1. While waiting for your appointment, monitor the mass for any changes in size, pain, or associated symptoms like difficulty swallowing, voice changes, or breathing problems, which should prompt more urgent medical attention. Don't attempt to squeeze or drain the mass yourself, as this could cause infection or complicate diagnosis.

The neck contains many important structures including lymph nodes, salivary glands, thyroid gland, and blood vessels, so professional assessment is essential to identify the specific cause and appropriate treatment for your neck mass. The American Academy of Otolaryngology-Head and Neck Surgery recommends that clinicians should order a neck computed tomography (or magnetic resonance imaging) with contrast for patients with a neck mass deemed at increased risk for malignancy 1.

Some key points to consider when evaluating a neck mass include:

• Avoiding antibiotic therapy unless there are signs and symptoms of bacterial infection 1
• Identifying patients at increased risk for malignancy based on history and physical examination characteristics 1
• Performing a targeted physical examination, including visualizing the mucosa of the larynx, base of tongue, and pharynx, for patients at increased risk for malignancy 1
• Ordering imaging tests, such as CT or MRI, to determine the nature of the mass and assess for additional nonpalpable masses 1
• Considering fine-needle aspiration biopsy to sample cells from the mass for laboratory analysis 1

It's essential to follow the guideline recommendations and seek medical attention promptly if you have a neck mass, as early evaluation and treatment can significantly impact outcomes.

From the Research

Initial Steps

• A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass 2
• Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up 2

Possible Causes

• Inflammatory processes such as cervical lymphadenitis, tuberculous lymphadenitis, cat-scratch disease, and infectious mononucleosis can cause nodules or swelling in the neck 3
• Neoplastic causes such as primary or metastatic cancer, histiocytic lymphoma, Hodgkin's disease, rhabdomyosarcoma, thyroid cancer, and salivary gland tumor can also be the cause of a neck mass 3
• Congenital causes such as thyroglossal duct and branchial cleft cysts and fistulas, lymphangiomas, cystic hygromas, dermoid cysts, and hemangiomas can be found in patients of any age 2

Diagnostic Approach

• A complete physical examination and, usually, laboratory testing are required to establish the diagnosis 3
• Imaging studies such as contrast-enhanced computed tomography can be helpful in determining the etiology of a mass 4, 5
• Fine-needle aspiration biopsy can be performed to provide diagnostic information via cytology, Gram stain, and bacterial and acid-fast bacilli cultures 4
• Referral to an otolaryngologist is frequently warranted to obtain a definitive diagnosis and develop an appropriate treatment plan 5

Treatment Options

• Symptomatic treatment is sometimes adequate for infectious disease, but administration of antituberculous drugs or antibiotics may also be necessary 3
• Incision and drainage are required for some nodes and abscesses 3
• For neck masses caused by neoplasms, treatment consists of dissection, radiation therapy, and/or chemotherapy 3
• Surgical removal is nearly always the treatment for congenital neck masses 2