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Lump in neck

This man has a significant lump in his neck.

Definition

So this seems fairly obvious but when it comes to feeling for lumps in the neck, make sure you feel right down into the supraclavicular fossa.

Epidemiology

Common.jpg Mostly harmless but there are lots of them so it's worth knowing about.

Pathophysiology

Essentially, you've got to look at the anatomy of the neck. It basically consists of musculoskeletal stuff, skin, lymph, trachea, soft tissue and thryoid. Of these, the most common to cause neck lumps are lymph nodes and the thyroid gland.

Differential Diagnosis

Clinical and Associated Features

  • Infection - lymphadenopathy, fever, fatigue
  • Haematological malignancy - lymphadenopathy, night sweats, bone pain, weight loss, fatigue, growing lump
  • Thyroid cancer - weight loss, fatigues, growing lump, in area of thyroid gland
  • Hyperthyroidism - in area of thyroid gland, nodules, loads of other features (check the page)
  • Hypothyroidism - as above, really
  • Salivary gland cancer - similar to thyroid cancer but in the area of the salivary glands.
  • Secondary malignancy - lymphadenopathy, features of primary cancer, weight loss, tiredness, loss of appetite

Investigations

  • FBC - anaemia, pancytopenia (haematological malignancy), WCC↑ (infection)
  • U+Es -
  • TFTs - obviously, for problems with the thyroid gland

You need to do an urgent CXR in somebody with hoarseness of voice for greater than 3 weeks. Particularly important if they are smokers or drinkers. Biopsy is important if you suspect any sort of cancer.

Management

Urgent referral

  • Lump that is unexplained or new and has changed in the last 3-6 weeks
  • persistent swelling in the parotid or submandibular gland
  • unexplained persistent sore throat
  • unexplained unilateral head-and-neck pain of >4 weeks, particularly with earache but normal otoscopy
  • oral mucosa ulceration for >3 weeks
  • unexplained red and white patches

Thyroid-based urgent referral, should be due to the following: stridor; solitary nodule increasing in size; previous neck radiation; family history of endocrine tumour; hoarseness or voice change; cervical lymphadenopathy; and very young or old patient (pre-pubertal or >65 years old).