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Neck Lump

By

Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Last full review/revision Apr 2020| Content last modified Apr 2020
Click here for the Professional Version

People may discover an abnormal lump (mass) in their neck. Sometimes, doctors discover a neck lump during an examination. Neck lumps may be painful or painless depending on what has caused them. Painless neck lumps may be present for a long time before people notice them.

Causes of Neck Lump

Enlarged lymph nodes

The most common causes of enlarged lymph nodes among younger people include the following:

  • Reaction to nearby infection (such as a cold or a throat infection)

  • Direct bacterial infection of a lymph node

  • Certain bodywide (systemic) infections

One or more neck lymph nodes often enlarge in response to an upper respiratory infection, throat infection, or dental infection. These nodes are soft, not tender, and typically return to normal shortly after the infection goes away.

Certain systemic infections typically cause multiple lymph nodes to enlarge, including some in the neck. The most common of these infections are mononucleosis, human immunodeficiency virus (HIV), and tuberculosis.

A much less common but more serious cause of enlarged lymph nodes is

  • Cancer

Cancerous neck lumps

Cancerous (malignant) neck lumps are more common among older people, but they may occur in younger people. A lump may be a cancer of a nearby structure, such as the mouth or throat, that has grown into the neck. Or, a lump may be a cancerous lymph node, which may occur when a cancer spreads (metastasizes) from a nearby structure or from more distant parts of the body, or when a cancer arises in the lymphatic system itself (lymphoma). Cancerous lumps are not painful or tender to the touch and often are rock-hard.

Other causes

Cysts are hollow, fluid-filled masses that are usually harmless unless they become infected. Some cysts in the neck are present from birth because of abnormalities that occurred during fetal development. Sometimes cysts develop in the skin (epidermoid cyst Cutaneous Cysts Cutaneous cysts are common, slow-growing lumps. Epidermal inclusion cysts are the most common cutaneous cysts. (See also Overview of Skin Growths.) Epidermal inclusion cysts (epidermoid cysts)... read more Cutaneous Cysts ), including in the skin of the neck.

The thyroid gland, which is in the middle of the neck just above the breastbone, can enlarge. The most common type of enlargement is goiter, which is noncancerous (benign). Cancers and thyroid inflammation (thyroiditis) are less common.

Evaluation of Neck Lump

The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with a neck lump, certain symptoms and characteristics are cause for concern. They include

  • A very hard lump

  • Sores or growths in the mouth

  • Difficulty swallowing and/or hoarseness

  • A new lump or lumps in an older person

In general, painless lumps are somewhat more worrisome than painful ones.

When to see a doctor

People who have any type of neck lump for more than a few days should see a doctor, particularly people with warning signs. People with other symptoms (such as fever) should have an earlier visit.

What the doctor does

Doctors ask questions about the person's symptoms and medical history and do a physical examination. What doctors find during the history and physical examination helps decide what, if any, tests need to be done.

During the medical history, doctors ask about the following:

  • Symptoms of colds and throat or dental infections

  • Symptoms of cancer in the neck (such as difficulty speaking or swallowing) as well as risk factors for cancer, particularly smoking and alcohol drinking

  • Risk factors for HIV and tuberculosis infection

During the physical examination, doctors focus on the ears, nose, and throat (including the tonsils, base of the tongue, and thyroid and salivary glands). They look for signs of infection or abnormal growths, including looking down the throat with a mirror or a thin flexible viewing tube (laryngoscopy). They also feel the neck lump or lumps to determine whether it is soft, rubbery or hard and whether or not it is tender.

Testing

If there is an obvious source of infection, such as a cold or a sore throat, or the person is young and healthy and has a tender lump present for only a few days, no tests are needed immediately. Such people are watched closely to see whether the lump goes away without treatment. If it does not go away, tests are needed.

Most other people should have a blood count and a chest x-ray Plain X-Rays X-rays are high-energy radiation waves that can penetrate most substances (to varying degrees). In very low doses, x-rays are used to produce images that help doctors diagnose disease. In high... read more . For younger people without risk factors for or findings that suggest cancer (such as mouth growths), doctors often take a tissue sample (biopsy). For older people, particularly those with warning signs or risk factors for cancer, doctors often do several tests to look for a source of cancer before doing a needle biopsy or excisional biopsy (remove entire lump for testing). Such tests often include blood tests and computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more Computed Tomography (CT) (CT) or magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more Magnetic Resonance Imaging (MRI) (MRI) of the head and neck. Ultrasound Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more Ultrasonography is preferred for children to avoid radiation exposure and may be used in adults if doctors suspect a thyroid mass. 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 take x-rays of the upper digestive tract, do a thyroid scan, and do a CT scan of the chest. Direct examination of the larynx (laryngoscopy), lungs (bronchoscopy), and esophagus (esophagoscopy) and simultaneous biopsies may be needed.

Treatment of Neck Lump

Doctors treat the cause of the neck mass.

When cancer cells are found in a lump or an enlarged lymph node in the neck and there are no signs of cancer anywhere else, the entire lump or 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.

Key Points about Neck Lump

  • Most neck lumps are enlarged lymph nodes.

  • Painless lumps are somewhat more worrisome than painful ones.

  • Usually testing is not needed unless the doctor suspects cancer.

  • Cancerous neck lumps are removed surgically.

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