Head and neck lumps: what to know

Finding a lump in the head or neck can understandably cause alarm. However, not all lumps are a sign of cancer, and in many cases, they are due to harmless or treatable conditions. In this article, Mr Jason Fleming, a consultant ENT surgeon discusses common causes for head and neck lumps, when to seek help, and what to expect if further investigation is needed.

Common causes of head and neck lumps

One of the most frequent reasons for a lump in this area is swollen lymph nodes. These small glands are part of your immune system and can swell in response to infections such as a cold, sore throat, or dental problems. Such lumps are often soft, slightly tender, and move slightly under the skin. Most importantly they go down once the infection has cleared, usually within two weeks.

Other benign (non-cancerous) causes include: cysts - fluid-filled sacs that can form under the skin or within salivary glands, lipomas - soft, fatty lumps beneath the skin, enlarged salivary glands - often caused by blockage, infection, or a small stone, and thyroid swellings - such as goitres or nodules, which are very common and usually harmless.

In younger patients, particularly children and teenagers, the cause typically tends to be benign. In adults, especially those over the age of 35 - a lump that persists (>3 weeks) or slowly grows is more likely to need medical assessment.

When to seek medical advice for head and neck lumps

Most lumps are harmless, but you should see a doctor promptly if you notice any of the following:

An unexplained neck lump for more than three weeks, especially if it is firm to touch, or fixed in place.
A change in your voice or hoarseness lasting more than three weeks.
Ear pain on one side without any ear infection.
Difficulty swallowing or a persistent sore throat for more than three weeks.
A mouth ulcer for over three weeks that isn't healing, or red and white patches in the mouth, especially if associated with a neck mass.

If you are a current or ex-smoker, or drink heavily, your risk of certain head and neck cancers is higher, so it's especially important to get checked early. However, there are some types of head and neck cancer that occur in young people without any of these risk factors, so if in doubt, seek medical attention early.

How doctors investigate a head or neck lump

When you see an ENT/head and neck specialist, they will first go through a full medical history with you together with a careful examination of your neck, mouth, and throat. This will often include a specialist examination using a small flexible camera (called a nasendoscope) to examine deeper areas of your throat and voice box.

Although this can sound scary, it doesn’t take more than a few minutes, and most people are pleasantly surprised with how straightforward it is to complete.

Depending on the findings, you might be referred for imaging investigations that can include ultrasound, CT scan, or MRI to assess the area of concern. Different scans are useful for different conditions and your clinician will select the appropriate test based on your presenting symptoms and medical history. Finally, a biopsy may be collected, where a small tissue sample is taken and analysed in a laboratory. This might be done at the same time as your ultrasound with a fine needle, or alternatively under local anaesthetic or general anaesthetic as a minor procedure depending on the location of the biopsy.

What if the lump is cancerous?

A cancer diagnosis can be daunting, but treatment is often very effective – particularly when caught early. Head and neck cancers can develop in the mouth, throat, voice box, thyroid gland, or salivary glands, and may spread if untreated. The neck is often the first site that these cancers spread to and therefore the first time that it is noticed. This is why it's so important to get any neck lumps lasting more than 3 weeks seen by a doctor.

After this point, your care will be managed by a multidisciplinary team (MDT), usually made up of ENT and maxillofacial surgeons, oncologists, radiologists, speech therapists, and other specialities. They work together to create a treatment plan tailored to you.

Treatment and recovery

Treatment depends on the cancer type, location, and stage (the description for the extent of disease growth and spread), and may include:

Surgery - to remove the lump or affected tissue, and any sites of lymph node spread.
Radiotherapy - either as a primary treatment or to help treat any possibl remaining cancer cells after surgery.
Chemotherapy - sometimes combined with radiotherapy.
Immunotherapy - designed to stimulate your own immune system to target cancer cells, often used when other treatments haven't worked, or in clinical trials to help us understand when best to use this treatment.

Recovery and rehabilitation are a key part of the process. This can involve speech therapy, help with swallowing, or reconstructive surgery to restore appearance and function.

Key message: Most lumps in the head and neck are not cancer. But, if one persists, changes, or is accompanied by other symptoms, it's worth getting it checked. Early diagnosis gives the best chance of succesful treatment.