Neck lumps Flashcards
Which lymph nodes can you palpate in healthy people?
Submandibular
axillary
inguinal
What causes cervical lymphadenopathy? 11
1- URTI (reactive lymphadenit- 2-Infectious mononucleosis 3-HIV 4-Hepatitis 5-Syphilis 6-Dengue fever 7-TB 8-Metastatic disease 9-Lymphoma 10-Acute leukaemia 11-SLE
What are the red flag symptoms of cervical lymphadenopathy? 12
1- persistent lymph node/s for >6 weeks 2-firm, hard lymph nodes 3- lymph node >2cm 4-rapidly increasing in size 5- weight loss 6- night sweats 7- appetite loss 8- exposure to HIV or hepatitis 9- unexplained fever in returning traveller 10- breast lumps 11-symptoms suggesting bronchogenic cancer 12- associated generalised lymphadenopathy
What is the normal size of lymph nodes?
up to 1cm
What causes painful lymph nodes?
Inflammatory process or suppuration- normally
can also result from haemorrhage into the necrotic centre of a malignant node
What do stony-hard nodes suggest?
Cancer usually metastatic
What will nodes feel like in lymphoma?
very firm and rubbery
What will nodes feel like due to infection?
softer
What do shotty nodes suggest?
Viruses, especially in children
What are the benign causes of matted nodes? 3
TB
sarcoidosis
lymphgranuloma venereum
What are the malignant causes of matted nodes? 2
Metastatoc carcinoma
or lymphoma
What are right supraclavicular nodes associated with?
cancer in the mediastinum, lungs or oesophagus
What are left supraclavicular nodes (Virchow’s) associated with?
cancer in the testes, ovaries, kidneys, pancreas, prostate, stomach or gallbladder
What investigations should you do in cervical lymphadenopathy? 10
FBC- crucial if suspecting acute leukaemia
U&Es
CRP
LFTs
Monospot test
CXR- if bronchogenic cancer is suspected
HIV, syphilis or hepatitis testing- in high risk patients
USS of abdomen- if suspect hepatosplenomegaly
Paul Bunnel test- if positive indicates infectious mononucleosis
If these don’t make a diagnosis- do an excisional biopsy of the largest and most abnormal lymph node
Which patients should undergo a lymph node biopsy?4
Patients with unexplained localised lymphadenopathy
who have constitutional signs and symptoms
risk factors for malignancy
or lymphadenopathy that persists for more than 3-4 weeks
When should lymph node biopsy not be carried out?
In patients with probable viral illness as lymph node pathology in these patients may look like lymphoma–> false positives
When should lymphadenopathy be referred?10
If the node persist for more than 6 weeks
If it is >2cm and not improving
If it is rapidly enlarging
If you suspect TB –> urgent to respiratory
HIV, syphilis, hepatitis positive
Unexplained fever in a returning traveller
Any significant systemic symptoms
generalised lymphadenopathy
significant abnormalities on blood work or imaging
Evidence of hepatomegaly or splenomegaly
Where in the parotid gland do tumours typically occur?
In the tail of the gland, as a discrete mass in an otherwise normal gland
Are most parotid tumours benign or malignant?
benign
What are the most common malignant tumours of the parotid gland?
Adeonoid cyst carcinoma- most common
mucoepidermoid carcinoma
acinic cell carcinoma
What are the most common benign tumours of the parotid gland?
Pleomorphic adenoma - most common parotid tumour
- it’s slow growing and asymptomatic
Warthin’s tumour- 2nd most common
When do malignant parotid tumours tend to present?
after 60
When do benign parotid tumours tend to present?
after 40
What are the risk factors for parotid tumours? 4
Radiation
smoking is linked to Warthin’s tumour
previous skin cancer
sjorgen’s syndrome
