Neck lump
Neck lump
This section contains information on the following:
1. Causes
2. Investigations
3. Treatment of benign lump
4. Origin of a malignant lump
5. Treatment of malignant lump
6. Types of neck dissection
7. Complications of neck dissection
1. What are the causes of a neck lump?
Neck lumps are usually caused by benign conditions such as lymph node enlargement due to infection, cyst (fluid filled structure), lipoma (collection of fat), tumors arising from covering of nerves (nerve sheath tumors) or carotid body (arising from carotid artery) tumors. Sometimes, neck lumps may be caused by involvement of lymph nodes by malignancy.
2. How do I find out if my neck lump is benign or malignant?
Lymph node enlargement due to bacterial infection usually responds to antibiotics within 2 weeks. In general, two tests are done to find out the nature of the neck lump – a CT scan and a needle sample (biopsy) from the lump. These would help determine if the lump is benign or malignant.
3. How is a benign lump treated?
Generally it is treated by surgical removal which is quite safe. Left untreated, benign tumors also tend to grow and can cause pressure symptoms and become more difficult to remove at a later stage.
4. If the lump is malignant, where does it come from?
Malignant growth in the neck is usually due to spread from a cancer elsewhere in the head and neck region. The possible sites of origin are thyroid, mouth, throat, voice box, parotid and sinuses.
5. How is the malignant lump treated?
It is generally treated by a neck dissection, wherein not only the malignant lump, but also the surrounding lymph nodes of the “at-risk” levels (compartments) are removed. This is because even though only one node may be apparently involved, the nearby nodes are also at risk of seeding by the tumor, which may not be readily visible to the naked eye or picked up by the scan.
In general, for thyroid cancer, levels 2,3,4,5 are dissected, along with central compartment neck dissection. For mouth cancer, levels 1,2,3 and if indicated level 4, are dissected. For throat and voice box cancers, levels 2,3,4 and if indicated, level 5 are dissected. Having said all of this however, if chemoradiation is chosen as the primary treatment for throat or voice box cancer, there is no need for a primary (upfront) neck dissection. Instead, it is done as a planned or salvage (for recurrence) procedure following completion of chemoradiation.
6. What are the types of neck dissection?
When at least one neck level is spared and the neck dissection selectively targets only the involved or “at-risk” nodal levels, it is called a selective neck dissection (SND). All procedures outlined in the previous paragraph are SND procedures. SND involves a much smaller incision which is cosmetically more appealing, preserves anatomy and function, causes considerably less pain, reduces complications and leads to much faster recovery. This is an innovative, relatively new and minimally invasive technique and Dr. M. Dhiwakar has published extensively on this topic. However, for advanced neck malignancy, traditional procedures such as radical or modified radical neck dissection are still required.
7. What are the complications of neck dissection?
Neck dissection is a major operation, but in expert hands it is straightforward and safe. The risks are infection, bleeding, chyle leak (milky fluid from the gut leaks out from the neck wound) and nerve injury causing shoulder pain and weakness, weakness of one half of the tongue muscles and weakness of the corner of the mouth. However in expert and experienced hands that undertake careful and meticulous dissection, these risks are negligible.