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
What are the red flag symptoms of parotid tumours? 6
facial nerve weakness
rapid increase in the size of the lump
ulceration or induration of the mucosa or skin overlying
paraesthesia or anaesthesia of nearby sensory nerves
Intermittent pain, increasingly relentless
History of previous skin cancer, Sjorgen’s syndrome or radiation to head or neck
What investigations should be done in suspected parotid tumours?
USS- limted used in visualising the deep lobe however
USS guided fine needle aspiration for cytology
MRI or CT to evaluate
-the tumour bulk
-local invasion
-perineural spread- only if tumour is thought to be in the deep lobe
How do you manage parotid tumours?
Radiotherapy- following surgery for high grade ones or alone for non-resectable ones
Superficial parotidectomy
chemotherapy- for palliative care only
Which salivary gland is most likely to swell?
Parotid
What causes parotid swelling? 7
Viral parotitis--> mumps stone tumour Sjorgen's syndrome Sarcoidois-Heerford'ts syndrome bacterial parotitis wegner's granulomatosis HIV related lymphocytic infiltration
What are the features of mumps? 3
Bilateral parotid gland swelling
low grade pyrexia
malaise
What causes submandibular gland swelling? 3
stone in salivary duct
tumours
Sjorgern’s syndrome
What are the risk factors for salivary gland swelling? 8
Bulimia anorexia Cushing's DM Hypothyroidism Coeliac and malnutrition alcoholism Drugs- thiourea, anticholinergics
What are the signs and symptoms of salivary gland swellings? 6
pain may be referred to ear or throat
dry mouth
abnormal or foul tastes- due to purulent discharge
mouth of facial pain, especially associated with eating
decreased mouth opening- difficulty talking
fever/ systemically unwell
What is a sign of parotid gland swelling?
loss of the angle of the jaw
Where will swelling be present in sublingual swelling?
beneath and anterior to the angle of the jaw
the floor of the mouth
What investigations should be done in salivary gland swelling?
FBC CRP ESR U&Es blood culture viral serology or salivary antibody testing Pus swab- for culture sialography USS CT/MRI scan to rule out neoplasm fine needle aspirate or incisional biopsy
How do you manage salivary gland swellings?
Mumps= self limiting
Acute suppurative infection- Abx, incision and drainage if abscess
Encourage salivary flow:
- warm compress
- sialagogues e.g. lemon drops, gum or vitamin C lozenges
- hydration
- salivary gland massage
- oral hygiene
Remove stones
