A lump or mass in the neck is common and often causes worry. The neck contains numerous structures, including lymph nodes, glands, and muscles, any of which can swell. While a medical professional should always evaluate any unexplained mass, the vast majority of neck lumps are caused by non-cancerous conditions. Understanding the differences in the feel, duration, and associated symptoms can help guide the conversation with a healthcare provider.
Common Benign Causes of Neck Lumps
The most frequent source of a neck lump, especially in younger individuals, is a reactive lymph node responding to an infection. These bean-shaped glands swell when fighting off viruses or bacteria from a cold, strep throat, or ear infection. Lumps caused by this inflammation are typically soft, tender, and easily movable beneath the skin. They usually shrink back to normal size within two to three weeks as the infection resolves.
Other non-malignant lumps may originate from the thyroid gland or congenital remnants. Thyroid nodules, palpable in about five percent of the population, are usually benign growths or fluid-filled cysts within the butterfly-shaped gland. Cysts, such as thyroglossal duct cysts or branchial cleft cysts, form from embryonic tissue remnants and may become noticeable if they become inflamed or infected. Additionally, lipomas, which are soft, slow-growing tumors made of fatty tissue, are harmless and often feel rubbery under the skin.
Physical Signs of Concern
While most neck masses are benign, a cancerous lump generally displays a distinct set of physical characteristics and associated symptoms. A distinguishing feature is the consistency of the mass, as malignant lumps are frequently described as feeling firm or hard. Unlike mobile, benign lymph nodes that shift when pushed, a cancerous mass often feels fixed or tethered to the surrounding deep tissues, making it difficult to move.
The duration and growth pattern are also indicators. A lump that persists for longer than two to three weeks without shrinking, particularly in an adult, raises suspicion. Malignant masses tend to grow steadily. Furthermore, while an infection-related lump is usually painful, cancerous masses are often painless or non-tender to the touch, which can delay evaluation.
Beyond the lump itself, several systemic symptoms may accompany a malignancy originating in the head and neck region. Unexplained weight loss is a concerning sign that can occur alongside a persistent neck mass. Persistent hoarseness or voice changes lasting more than two weeks are also important symptoms to report. Difficulty or pain when swallowing (dysphagia or odynophagia) suggests the mass may be obstructing or irritating nearby structures. Other associated symptoms include persistent ear pain on the same side as the lump, or drenching night sweats.
Anatomic Sources of Cancerous Neck Lumps
Cancerous lumps in the neck most commonly arise from four anatomical sources: the lymph nodes, the thyroid gland, the salivary glands, or direct primary tumors of the upper aerodigestive tract. The majority of malignant neck masses are secondary, meaning they are metastases from a primary cancer located elsewhere, usually in the head and neck region. These metastatic cells proliferate within the cervical lymph nodes, causing them to swell and harden.
Squamous cell carcinoma, originating from the mucosal linings of the oral cavity, throat, and voice box, is the most common primary cancer to metastasize to the neck lymph nodes. The location of the involved lymph node can hint at the original cancer site. For example, lumps in the supraclavicular area, just above the collarbone, often suggest a primary cancer below the neck, such as the lungs or abdomen.
Cancers of the lymphatic system (lymphomas) can also manifest as neck lumps, often presenting with multiple, rubbery nodes accompanied by systemic symptoms like fever and fatigue. Primary cancers can also arise directly from the thyroid gland, presenting as a nodule that moves vertically with swallowing due to its attachment to the trachea.
The salivary glands, particularly the parotid gland near the ear and the submandibular gland under the jaw, are another potential source. While most salivary gland tumors are benign, a persistent, slow-growing mass in these areas may indicate malignancy. Finally, tumors of the larynx or pharynx can sometimes be felt as a neck lump due to the enlargement of a draining lymph node near the primary site.
The Diagnostic Process
A persistent neck lump requires prompt medical evaluation, beginning with a detailed history and a thorough physical examination to assess the lump’s size, texture, mobility, and associated symptoms. Following this initial assessment, imaging is typically the next step to visualize the mass and surrounding structures.
An ultrasound is often the preferred first-line test, as it is non-invasive and can differentiate between a fluid-filled cyst and a solid mass, characterizing suspicious lymph nodes or thyroid nodules. If the mass is highly suspicious or the ultrasound is inconclusive, advanced imaging like a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) may be used to define the extent of the mass and search for a potential primary tumor site.
The definitive method for determining if a neck lump is cancerous is a biopsy, where a tissue sample is collected for microscopic examination. The most common procedure is a Fine-Needle Aspiration (FNA), where a thin needle is inserted into the lump, often guided by ultrasound, to collect cells. The FNA procedure is effective and minimally invasive, providing the pathologist with material to determine if the mass is benign, inflammatory, or malignant. If FNA results are inconclusive, or if lymphoma is suspected, a core biopsy or an open surgical biopsy may be required to obtain a larger tissue sample for confirmed diagnosis.