Masses in the neck may be a sign of a simple infection or an indicator of a more serious condition!
Swelling in the neck may be caused by benign conditions but can also indicate malignant tumors in some cases. Common causes of neck masses include enlarged lymph nodes, infections, congenital cysts, salivary gland and thyroid diseases, and malignant tumors in the larynx or head and neck region.
Rapidly growing, firm, and painless masses in the neck, especially in older adults, may suggest malignancy. Such masses should always be evaluated by an ENT (Ear, Nose, and Throat) specialist!
Most Common Causes of Neck Masses
Lymph Node-Related Masses
Infection-Related Lymph Node Enlargement (Reactive Lymphadenopathy)
- The most common neck masses are lymph nodes enlarged due to infection.
- Conditions like sinusitis, tonsillitis, dental infections, and flu can cause lymph node swelling.
- Typically appear as painful, soft, and mobile nodes.
- May resolve on their own or require antibiotic treatment.
Lymphoma and Metastatic Lymph Nodes
- In blood cancers like lymphoma, lymph nodes may enlarge as firm, painless, and immobile masses.
- Head and neck cancers can spread to lymph nodes (metastasis), causing enlargement.
- These enlargements are usually painless and can grow rapidly.
While infection-related lymph nodes often shrink over time, malignant ones tend to keep growing!
Congenital Cysts
- Some cystic structures present from birth can become symptomatic as a person ages.
- Most often seen in childhood but can also be detected in adulthood.
- Common types include: branchial cleft cysts, thyroglossal duct cysts, and dermoid cysts.
- Treatment is surgical, and complete removal is usually recommended.
Salivary Gland Diseases and Tumors
- Swelling in the neck may be due to salivary gland stones, infections (sialadenitis), or tumors.
- Usually seen in the parotid (in front of the ear) and submandibular (under the jaw) glands.
- Benign tumors grow slowly, while malignant ones tend to grow faster.
Ultrasound, MRI, and biopsy may be necessary to diagnose salivary gland conditions.
Thyroid Gland Disorders
- Thyroid nodules and thyroid cancer may also present as neck masses.
- Thyroid masses are generally soft and painless.
- Accompanying symptoms like hoarseness and difficulty swallowing may suggest cancer.
Blood tests, thyroid ultrasound, and biopsy are used for definitive diagnosis of thyroid nodules.
Head and Neck Cancers
- Cancers of the larynx, base of tongue, nasopharynx, salivary glands, and thyroid can present as neck masses.
- Typically appear as firm, painless, and progressively enlarging lumps.
- Smoking, alcohol consumption, and HPV are known risk factors for head and neck cancer.
In individuals over 40, painless, hard, and growing neck masses should raise suspicion for malignancy!
How Are Neck Masses Diagnosed?
The following tests may be performed to determine the cause of a neck mass:
Physical Examination and Endoscopic Evaluation:
- Assessment of the size, consistency, mobility, and tenderness of the mass.
- An ENT specialist may use endoscopy to examine the mouth and throat areas.
Ultrasound:
- The most commonly used imaging technique for evaluating neck masses.
- Helps differentiate between cysts, lymph node enlargement, and tumors.
Fine Needle Aspiration Biopsy (FNAB):
- A fine needle is used to extract fluid or cells from suspicious masses to check for cancer.
MRI and CT Scans:
- Used to evaluate lymph node enlargements and tumors in greater detail.
A biopsy may be required for definitive diagnosis!
Treatment Options for Neck Masses
Treatment varies depending on the cause of the mass!
Infection-Related Lymph Node Enlargement:
- Usually treated with antibiotics and pain relievers.
- Lymph node swelling typically resolves within 2–3 weeks.
Congenital Cysts:
- Typically require surgical removal.
Salivary Gland and Thyroid Nodules:
- Benign nodules are monitored regularly.
- Malignant nodules are removed surgically.
Lymphoma and Head and Neck Cancers:
- Systemic diseases like lymphoma are treated with chemotherapy.
- Treatment for head and neck cancers may include surgery, radiation therapy, and chemotherapy.
Early diagnosis can be life-saving in malignant conditions!
When Should You See a Doctor?
Consult an ENT specialist immediately if you experience any of the following:
- A painless, firm, and rapidly growing mass in the neck
- Lymph node swelling that does not shrink within 2–3 weeks
- Difficulty swallowing, hoarseness, or breathing problems
- Unexplained weight loss and night sweats along with neck swelling
Early diagnosis can make a big difference in the treatment of malignant conditions!
Prof. Dr. Elif Aksoy
ENT Specialist – Head and Neck Surgery
