A lump in the neck is also called a neck mass. Neck lumps or masses can be large and visible, or very small. Most neck lumps are benign (noncancerous). Many are caused by minor conditions such as cystic acne or swollen lymph nodes. But a neck lump can also be a sign of a serious condition such as an infection or cancer.
Any neck lump in a child or adult should be evaluated by a healthcare professional as soon as possible. See your doctor right away if you have an unexplained neck mass.
A lump in the neck can be hard or soft, tender or non-tender. It can be located in the skin (sebaceous cyst, acne) or arise from a structure within your neck. Where the lump is located plays an important role in determining what it is. Because there are many important muscles, tissues, and organs near the neck, there are several possibilities. Structures within your neck include:
- lymph nodes
- thyroid gland (a small, butterfly shaped organ below your Adam’s apple)
- parathyroid glands (four small glands located above the thyroid gland)
- recurrent laryngeal nerves (nerves within the vocal cords)
- neck muscles
- trachea (wind pipe)
- larynx (voice box)
- nerves of the sympathetic and parasympathetic nervous system
- brachial plexus (a series of nerves that supply the upper limbs and trapezius muscle)
- salivary glands (parotids)
- arteries and veins
An enlarged lymph node is the most common cause of a neck mass. Lymph nodes contain cells that help your body fight off infection (bacterial or viral), and get rid of malignant cells (cancer). Bacterial infections of the scalp, sinuses, tonsils, throat, teeth, or salivary glands are common causes of enlarged lymph nodes. Autoimmune diseases, cancer, and other disorders of the thyroid gland, such as goiter due to iodine deficiency, can also cause enlargement of a part or all of your thyroid gland. Enlargement of your salivary gland can be caused by viruses (mumps) or cancer. Injury or torticollis can cause a lump in the muscles of the neck.
Children are most likely to have treatable, infectious, causes for a neck lump. Most neck lumps in adults are benign. The risk of a neck lump being cancerous increases with your age and lifestyle habits, such as smoking and drinking. Other causes of enlarged lymph nodes include:
Most cancers of the head and neck are caused by tobacco products (smoking or chewing tobacco). Alcohol use is another risk factor. Prolonged use of tobacco and alcohol are the most common risk factors for cancers of the mouth, throat, voice box, and tongue. For adults who do not smoke, the most common risk factor for cancers of the neck, throat, and mouth is HPV (human papilloma virus) infection. This infection is a sexually transmitted virus and is very common.
Most neck lumps in children are benign, but cancer is still possible. For adults, the chances that a neck lump is cancerous increases after the age of 40.
Cancers that show up as a lump in the neck could include:
- cancers of the head and neck–most likely to spread to lymph nodes in the neck (AmericanAcademyofOtolaryngology, 2010).
- Hodgkin’s disease
- Non-Hodgkin’s lymphoma
- other types of cancer including lung, skin, throat, and breast cancer
We commonly think of viruses like the common cold and flu. However, there are other viruses out there and many can cause a neck lump. These include:
- HIV/ AIDS
- infectious mononucleosis
- viral pharyngitis
There are several bacterial conditions that can cause neck and throat problems, leading to inflammation and a potential mass on the neck. Many of these are treated with common antibiotics. These include:
- atypical mycobacterium (a type of bacteria most common in people with compromised immune systems and lung disease)
- cat scratch disease
- peritonsillar abscess (an abscess or sore on the tonsils)
- strep throat
- allergic reaction to medications
- food allergies
- stone in salivary duct
Because a neck lump can be caused by such a variety of conditions and diseases, there can be many other symptoms. Symptoms that occur along with a neck lump often relate to the part of the neck or throat affected by the underlying disease. They can include:
- weight loss, tremors, increased heart rate, sweats (associated with hyperthyroidism)
- weight loss, susceptibility to infection, thrush (associated with HIV/ AIDS)
- hoarseness (caused by injury to your vocal cords or its nerves)
- difficulty swallowing solids or liquids (caused by pressure on your esophagus)
- difficulty breathing (caused by blockage of your airway)
- sore throat
- tongue ulceration or other growth in the mouth
- blood in saliva and phlegm
- changes in the skin (skin cancer)
- persistent ear pain (can be caused by infection)
Diagnosing the cause of a neck lump begins with your history and physical examination. Your doctor will ask if you have a history of drinking or smoking. He or she will also want to know how long you have been smoking or drinking, and how much you drink and smoke on a daily basis. Your doctor will also ask about all of your symptoms, including when they started and how severe they are.
Your physical exam will include a careful examination of your scalp, ears, eyes, nose, mouth, throat, and neck. Here, your doctor is looking for any abnormal skin changes and other related symptoms.
Your doctor may refer you to an ENT (ear, nose, and throat) specialist for a detailed evaluation of your ears, nose, throat, and sinuses. The ENT specialist may perform oto-rhino-laryngoscopy. This is a procedure that uses a lighted instrument that allows the doctor to directly see areas of your ears, nose, and throat that are not otherwise visible. This evaluation does not require general anesthesia. In other words, you will be awake during the procedure.
Your doctor and any specialist may run a variety of tests to determine the cause of your neck lump. These tests could include:
- CBC (complete blood count) This test evaluates your overall general health and can provide insight into a number of possible conditions. For instance, your white blood cell count may be high if infection is present.
- HIV test
- sinus X-rays
- chest X-ray (allows the doctor to see if there is a problem with your lungs, trachea, and chest lymph nodes)
- ultrasound of the neck (a noninvasive test that uses sound waves to evaluate neck lumps).
- biopsy with a fine needle or by surgical removal (tissue samples are sent for testing to determine if cancer is present)
- MRI of the head and neck (a noninvasive test that uses nuclear magnetic resonance to make detailed images of the structures in your neck)
Treatment of a neck lump depends upon the underlying cause. Lumps caused by bacterial infections are treated with antibiotics. Treatment options for cancer of the head and neck include surgery, radiation, and chemotherapy.
Early detection is the key to successful treatment of the underlying cause of a neck lump. According to the American Academy of Otolaryngology, most cancers of the head and neck are curable (with few side effects), if they are detected early. (AAO)
Failure to diagnose the underlying cause of a neck lump can be fatal. While the cause of your neck lump could be nothing more than a viral infection that needs to run its course, it could also be something serious and potentially deadly, like cancer. For this reason, your outlook depends largely on what is causing the lump and how quickly you seek treatment.