Finding a Lump in the Neck
A doctor may discover an abnormal lump in the neck of a person who has no other symptoms. Most lumps are enlarged lymph nodes, which may enlarge because of a nearby infection, such as of the throat. However, an enlarged lymph node may also be caused by cancer, either a cancer of the lymph node (lymphoma) or a cancer that has spread to the lymph node from elsewhere in the body (metastasis). Lymph nodes in the neck are a common site for the spread of cancer from many parts of the body. Painless lumps are somewhat more worrisome than painful ones. Any lump that stays more than a few days should be evaluated by a doctor.
A doctor first examines the ears, nose, throat (pharynx), voice box (larynx), tonsils, base of the tongue, and thyroid and salivary glands. This examination often includes looking down the throat with a mirror or a thin flexible viewing tube. If there is no obvious source of infection or a visible cancerous spot, further tests are needed. The initial test is often a needle biopsy of the enlarged lymph node but may be 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 obtain 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) may be needed.
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.