Neck lumps come in a variety of shapes and sizes and may be painless or painful. They can be on the side of the neck, under the jawline, at the back of the neck or at the front in the throat area. Most neck lumps are not serious – the neck is full of glands called lymph nodes that swell up in response to any infection. Sometimes they take a while to subside and become more noticeable.

Common causes of neck lumps

  • Swollen lymph nodes or tonsils due to infection. Neck lumps are typical of several viral infections such as mumps, TB or glandular fever.
  • Sebaceous cysts in the skin.
  • Lipomas – fatty cysts just under the skin that can occur anywhere.
  • Thyroid problems – the typical example is goitre.
  • Problems with the parotid gland (one of the salivary glands).
  • Cancer: lumps in the neck can also be one of the first signs of head and neck cancer.

Remember that most neck lumps are not cancer but if you have a neck lump that is worrying you it is best to get it checked out. By doing so you can either set your mind at rest or you can get prompt treatment.

Your initial consultation

When you come to see Mr Cascarini, he will start by asking you detailed questions about your symptoms and your medical history.

  • When did the neck lump or lumps appear?
  • Have they grown rapidly, slowly or not at all?
  • Are they painful all the time, just when touched, or completely painless?
  • What makes the lump feel worse or better?
  • Have you had an infection or injury recently?
  • Have you any other symptoms other than the neck lump/lumps?
  • Are you having any trouble swallowing or breathing?
  • Have you had any serious illness or other diagnoses in the last few years?
  • How is your general health?

Mr Cascarini will then examine your neck thoroughly and then make recommendations for further tests.

Diagnostic tests

These will depend on your particular neck lumps and symptoms but commonly include:

  • Blood tests: Testing your blood can reveal if your white cell count is normal. If it isn’t, that can mean that you may have an infection or something more serious, such as a blood cancer. Some tests can be done for specific viral infections. Mr Cascarini may think it’s a good idea to check that your thyroid gland is working correctly.
  • A fine needle aspiration biopsy: a fine needle is used to draw off some of the fluid in the lump, together with the cells inside. These are examined under a microscope by a histologist who provides an expert opinion on what the problem could be.
  • Scans: CT, ultrasound, PET scans and MRI scans are all used to investigate neck lumps. X-rays are not used because the soft tissue of a neck lump will not show up in enough detail.
  • Panendoscopy: Specially designed endoscopes can be used to look inside the structures of the throat, such as the pharynx, larynx (voice box) and in the top of the windpipe and oesophagus. This is usually done under general anaesthetic as a day case.