The evaluation of a neck mass, or lump, is largely based on the patient history, and the physical examination. In this way, an extensive list of possible causes can be shortened. For example, a recent cold or sore throat might indicate an infected lymph node. Swelling with eating could be the result of a blocked saliva gland. Associated voice changes or difficulty swallowing in a patient that smokes and/or drinks alcohol regularly could be caused by a tumor of the throat that has spread to a lymph node in the neck.
Age
The age of a patient with a neck mass is important in the evaluation. Pediatric patients are considered to be less than 15 years old, young adults are between 16 and 40 years old, and older adults are over 40 years of age. In general, a neck mass in a child is most likely inflammatory (infectious) in origin followed by a congenital (birth) defect. Neoplasm, or tumor, is least likely to occur in this age group. With advancing age almost the opposite is true. Neck masses in adults are most commonly neoplastic followed by inflammatory in nature. Congenital defects are least likely in this age group.
Location
The location of the neck mass also provides clues as to its origin. For, example, certain congenital masses arise in the middle of the neck while many cancers of the throat that have spread to the lymph nodes cause swelling on the side of the neck.
Diagnostic Testing
Numerous tests exist to further characterize a neck mass. Probably the most useful include the fine needle aspirate (FNA) and computed tomography (CT). FNA involves the placement of a small gauge needle into the mass with withdraw of representative cells. These cells are examined under a microscope. A CT scan is a two dimensional x-ray that can better characterize the mass and its relationship to surrounding structures. If a bacterial infection is suspected as a cause of the neck mass, the physician may wish to attempt a course of antibiotics before employing these tests.
Treatment
Treatment for a neck mass depends on the cause. As mentioned, occasionally antibiotics are used if infection is suspected. Removal of the lump might be appropriate for further diagnosis and treatment. In some circumstances, however, the mass is part of a larger problem and additional testing may be required to define the disease, its extent, and outline appropriate therapy.
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