A neck mass is an abnormal lump or bump in the neck. Neck masses can be any size—large enough to see and feel, or they can be very small. They can occur in any age group—from infants to the elderly. There are many causes of neck masses, and while many are benign (non-cancerous), cancers should not be overlooked. If any abnormal bump or lump persists for more than one month it is important to see a doctor. If a cancer is present, early detection provides the highest chance of successful treatment.
In general, neck masses in children are most commonly due to infection or congenital (meaning they were born with it—even if you have not noticed it since birth). In adults, while many neck masses are benign, there is a higher likelihood of cancer.
Causes of Neck Masses
There are numerous causes of head and neck masses:
- Enlarged lymph nodes--This is the most common cause of new neck mass. Lymph nodes are part of the immune system. They can enlarge when the body is fighting off an infection (sinus infection, ear infection, Strep throat, tooth or gum disease) or other source of inflammation. The swelling in the lymph node will often go down over the course of days to weeks.
- Thyroglossal duct cyst--This is the most common type of congenital (present from birth) neck mass and goes undetected until it becomes swollen and infected. It is a small pocket of fluid or mucus located in the midline of the neck.
- Branchial cleft cyst—This too is a congenital cyst. It may appear as a mass anywhere along the side of the neck and sometimes has an opening in the skin. These too can go undetected until they become infected.
- Skin cysts—Sebaceous and dermoid cysts are pockets or cavity under the skin that contains tissues normally present in the outer layers of the skin. These are benign
- Lipoma-Lipomas are slow growing benign lumps underneath the skin that arise due to an overgrowth of fat cells. They may occur anywhere in the body.
- Sialadenitis--This is an infection of the salivary glands that cause them to become inflamed. Please see the Salivary Glands section of our website for more information
- Thyroid nodules—This can be either a benign or malignant mass of the thyroid gland. The thyroid gland is located in the midline of the neck below the Adam’s apple. Thyroid nodules can occur in the middle of the neck or off to one side. They can range from so small that you cannot feel them or very large. Please see the Thyroid Disorders section of our website for more information.
- Benign tumors—These are noncancerous growths that cannot spread to other parts of the body.
- Cancers--In the head and neck, cancers may be either primary (originating from the head and neck) or secondary (having spread from tumors elsewhere in the body). Most head and neck cancers are caused by tobacco and alcohol use. However, they can be caused by the human papilloma virus (HPV) and prior radiation exposure.
What Are the Symptoms of a Neck Mass?
Neck masses may occur with no other associated symptoms. They can occur in the setting of a cold, flu, or allergies. If you are experiencing any of the following symptoms for more than two (2) weeks, if the neck mass is not associated with a cold, flu, other infection, or allergies you should see a physician:
- Change in your voice including hoarseness that persists more than two weeks.
- Growth in the mouth.
- Swollen tongue.
- Blood in the saliva or phlegm or coughing up blood.
- Swallowing problems.
- Persistent ear pain on the side of the mass
- Unexplained weight loss.
- Growth of the mass over time
How Are Neck Masses Evaluated?
Your doctor will ask about your medical history and examine your head and neck. They may perform (or recommend) an endoscopy, which is a procedure that inserts a small lighted tube with an attached camera through your nose to look inside your throat and voice box.
In addition, your doctor may order tests, such as a CT scans, MRIs, Ultrasounds, or biopsies.
Fine Needle Aspiration Biopsy (FNA): Currently, FNA is the standard of diagnosis for neck masses. A small needle is put into the mass and a sample is pulled out and given to a pathologist to examine under a microscope. Most FNAs are done using an ultrasound to guide the biopsy.
Open biopsy: On occasion a fine needle biopsy does not provide enough information and an open biopsy is required. An open biopsy is done in the operating room and you will need anesthesia. An open biopsy may remove only portion of the mass or the whole mass.
How are Neck Masses Treated?
Treatments are determined by the cause of the mass. Some neck masses will resolve on their own with time. However, some may require surgical removal, chemotherapy, or radiation. Your doctor will discuss treatment plans with you once the cause is identified.