Neck lumps

Question 1

What investigations should be carried out in neck lumps?

Answer 1

1st line = USS and fine need aspiration cytology (FNAC) guided by USS

CT
Excision biopsy
MRI

Question 2

What are the features of reactive lymphadenopathy?

Answer 2

Most common neck swelling

Hx of local infection or generalised viral infection

Question 3

What are the features of lymphoma?

Answer 3

Rubbery, painless lymphadenopathy
Pain whilst drinking alcohol (rare)
Night sweats and splenomegaly

Question 4

What are the features of thyroid swelling?

Answer 4

May be hypo-, eu-, or hyperthyroid symptoms

Moves upwards on swallowing

Question 5

What are the features of a thyroglossal cyst?

Answer 5

More common in <20yr olds
Usually in midline of neck
Moves upwards with protrusion of tongue
May be painful if infected

Question 6

What are the features of a pharyngeal pouch?

Answer 6

More common in older men
It is a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not visible but if large then midline lump in neck that gurgles on palpation

Symptoms include:
Dysphagia
regurgitation
aspiration
chronic cough

Question 7

What are the features of cystic hygroma?

Answer 7

A congenital lymphatic lesion (lymphanioma - a cancer) found in the neck, typically on the left side
Most are evident at birth

Question 8

What are the features of branchial cyst?

Answer 8

This is an oval, mobile cystic mass that develops in anterior triangle, just anterior to sternocleidomastoid muscle
Develops at birth and noticed in adulthood when it becomes swollen due to infection

Question 9

What are the features of cervical rib?

Answer 9

an extra rib that forms above the 1st rib
More common in adult females
some develop thoracic outlet syndrome

Question 10

What are the features of a carotid aneurysm?

Answer 10

Pulsatile mass with audible bruit

Doesn’t move on swallowing

Question 11

What factors would indicate an urgent 2 week cancer referral?

Answer 11

Hoarseness (dysphonia) >6weeks
Oral swellings >3 weeks
Dysphagia >3weeks
Unilateral nasal obstruction, especially when associated with purulent discharge (suspect sinonasal carcinoma)
Unresolving neck masses >3weeks
Cranial neuropathies
Orbital masses

Question 12

What are risk factors for oral/throat cancer?

Answer 12

Tobacco, especially smokeless tobacco (most important risk factor for SCC of upper aerodigestive tract)
Excess alcohol, especially when coupled with tobacco use
EBV
HPV
GORD
Vocal abuse i.e. overuse and asthma inhalers (these are benign)
Betel nut chewing