What is a Neck Mass?

A neck mass is any abnormal lump or swelling in the neck. These masses can vary in size and may be caused by various factors, ranging from infections to benign (non-cancerous) or malignant (cancerous) tumors.

Neck masses can be categorized into four main types:

1. Benign (non-cancerous) Conditions:

• Reactive Lymphadenopathy: Enlarged lymph nodes due to infections, often treated with antibiotics or anti-inflammatory medications.

• Benign Tumors: Non-cancerous growths like lipomas (fatty tumors) or fibromas (connective tissue tumors), which may require surgical removal if they cause symptoms or grow significantly.

2. Inflammatory Conditions:

• Infectious Lymphadenitis: Inflammation of lymph nodes caused by bacterial or viral infections, treated by addressing the underlying infection and sometimes requiring drainage if abscesses form.

• Granulomatous Diseases: Chronic inflammatory conditions like tuberculosis or sarcoidosis, managed with specific medications (e.g., anti-tubercular therapy or corticosteroids).

• Salivary Gland Disorders: Acute (new) or Chronic (persistent/recurrent) blockage of saliva can lead to recurrent pain and swelling, infections and inflammation. Various management options are available and will be discussed as appropriate.

3. Malignant Conditions (Cancer):

• Head and Neck Cancers: Cancers originating in the mouth, throat, nose, or salivary glands, often treated with a combination of surgery, radiation, and chemotherapy.

• Lymphomas: Cancers of the lymphatic system, treated with chemotherapy and/or radiation, requiring thorough staging and systemic evaluation.

• Thyroid Cancer: Cancer of the thyroid gland, managed with surgical removal (thyroidectomy), radioactive iodine therapy, and thyroid hormone suppression.

4. Congenital (born with) Neck Masses:

• Thyroglossal Duct Cyst: A fluid-filled cyst that develops from a remnant of embryonic tissue, typically requiring surgical removal.

• Branchial Cleft Cyst: A cyst that forms from a remnant of embryonic development in the neck, often removed surgically to prevent recurrent infections.

Risk Factors for Cancerous Neck Masses

Long-term tobacco and alcohol use significantly increases the risk of head and neck cancers. Additionally, human papillomavirus (HPV) infection has emerged as a leading cause of certain head and neck cancers, particularly in younger adults.

Worrisome Symptoms of a Neck Mass

Not all neck masses are cancerous, but certain symptoms warrant immediate medical attention:

• Mass persisting for more than two weeks

• Increasing size of the mass

• Voice changes

• Difficulty or pain with swallowing

• Ear pain or hearing difficulties

• Unexplained weight loss

• Bleeding from the nose or mouth

• Breathing difficulties

• Skin lesion on the face of scalp that is growing or changing color

If you notice a persistent neck mass or experience any of the above symptoms, it's crucial to consult a doctor promptly. Dr. Yerukhim, an experienced otolaryngologist (ENT specialist), can perform a comprehensive evaluation.

Your Evaluation

During your visit, Dr. Yerukhim will review your medical history, conduct a physical examination, and likely perform a flexible laryngoscopy. This basic office procedure involves inserting a thin, flexible tube with a camera through your nose to visualize the back of your throat, including the larynx (voice box). It's a very quick minimally invasive procedure that can provide valuable information for diagnosing the cause of the neck mass.

Diagnosis and Treatment

After the examination, additional tests like Ultrasound, CT, or MRI scans may be necessary and ordered for a more detailed evaluation.

If necessary, a biopsy will be performed to analyze a sample of the mass tissue and determine the diagnosis. Biopsy options include:

1. fine-needle aspiration (FNA) - best initial test to diagnose a neck mass. A small needle is put into the mass and some cells are pulled out for microscopic analysis. An FNA is often done easily during your office visit if it can be clearly felt. If it is more difficult to feel, an ultrasound guided FNA will be ordered through the radiology department for the most reliable result.

2. core biopsy - A core biopsy is another way to diagnose a neck mass, typically performed if an FNA did not provide a diagnosis. A core biopsy uses a slightly larger needle and gets a larger piece of tissue. It is well tolerated and has a low risk of complications.

3. open biopsy - An open biopsy should typically be done only after FNA and/or core biopsy have failed to make the diagnosis. It is the next step to diagnose a neck mass. It is a more invasive procedure. Open biopsy is done by a surgeon in the operating room and you will need anesthesia. An open biopsy may remove only portion of the mass or the whole mass through a small incision.

Once a diagnosis is established, Dr. Yerukhim will develop a personalized treatment plan tailored to your needs. Treatment options may include antibiotics for infections, surgical removal for benign and malignant tumors, or a combination of surgery, and a referral for radiation and chemotherapy for cancerous masses.

Follow-Up and Monitoring

Regular monitoring is essential, especially if the neck mass is cancerous. Follow-up appointments and imaging scans can help detect any recurrence or progression, ensuring timely intervention and the best possible outcome.