Neck Lumps Flashcards
What are the red flags associated symptoms for neck lumps
- Hoarseness of voice
- Weight loss
- Ulceration of mouth
- Painless neck lump
- Lymphadenopathy – enlarged supraclavicular nodes are the most concerning for malignancy of the cervical lump nodes (can be caused by malignancy in chest or abdomen)
- Night sweats (e.g. indicating lymphoma)
- Fevers
- Fatigue
- Symptoms >3 weeks
- Risk factors – FH, age, smoking status
What 4 categories can lymphadenopathy be generally grouped into?
- Reactive
- Infected
- Inflammatory
- Malignancy
Give some examples of reactive lymph nodes
- swelling caused by viral URTIs
- dental infections
- tonsillitis
What are reactive lymph nodes?
Reactive lymphadenopathy is when lymph glands respond to infection by becoming swollen.
What are infective lymph nodes?
Lymphadenitis is an infection in one or more lymph nodes.
Give some examples of infected lymph nodes
TB, HIV, infectious mononucleosis
What are some inflammatory conditions can cause lymphadenopathy
SLE, sarcoidosis
What malignancies can cause lymphadenopathy?
Leukaemia, lymphoma, metastasis
What are the 6 S’s of examining any neck lump?
- Size
- Shape
- Smoothness
- Surface
- Surroundings
Gives some red flag features of a neck lump
- Unexplained (e.g. no infection)
- Persistently enlarged (particularly >3cm in diameter)
- Abnormal shape (normally oval shape where the length is more than double the width)
- Hard or ‘rubbery’
- Non-tender
- Tethered or fixed to skin or underlying tissues
- Associated symptoms e.g. night sweats, weight loss, fatigue, fevers
What should you always remember to examine in a neck lump examination
Oral cavity!
What is the urgent 2 week referral criteria for a neck lump?
2 week wait referral for:
- An unexplained neck lump in someone aged 45 or above
- A persistent unexplained neck lump at any age
What is the urgent ultrasound referral criteria for a neck lump?
A lump that is growing in size:
- Within 2 weeks in patients 25 and older
- Within 48 hours in patients under 25
Give some blood tests indicated in a neck lump
- FBC & blood film → leukaemia, infection
- HIV test
- Monospot test or EBV antibodies → for infectious mononucleosis
- TFTs → for goitre or thyroid nodules
- Antinuclear antibodies (ANA)
- Lactate dehydrogenase
What do ANAs indicate?
SLE