I have a neck mass! Help, what should I do?
A patient came into my clinic today exclaiming “Doctor, I have lymphoma, until when do I have to live?!” He is not the only anxious patient that I have come in with a neck mass in the ENT clinic. Hopefully, this blog helps alleviate that anxiety. So, what are you supposed to do when you have a neck mass, neck swelling or head and neck tumor?
What your ENT doctor will check
First, don’t panic. For most patients, searching Google about their symptoms makes them feel empowered. However, there is a certain percentage that end up feeling like they have cancer. Of course, corollary to saying “don’t panic”, I have to emphasize that you should not be too relaxed either. When you feel swelling up your neck, the best action would still be to see a good head and neck doctor.
Your doctor will be able to tell you if your neck mass is infectious, inflammatory, congenital, traumatic, benign, or it is from a malignant neoplasm.
History is very important during your ENT clinic consult for a head and neck tumor. It is important that you help us with that. Your ENT doctor will ask for recent bouts of sinusitis or dental pain. Dental or mouth problems, scalp, sinus, or ear problems are also checked. These may lead to enlarged lymph nodes in the neck. Your ENT doctor will also check the location of the swelling or tumor, whether it is on the side of the neck (lateral neck) or in front ( anterior neck). The neck masses are also checked if superficial or deep to the muscles.
Typically, 2 weeks is our golden period for management of neck masses. Anything less than 2 weeks may be attributed to infectious or inflammatory causes. Your ENT doctor may start a trial of antibiotics, warm compress or both, if the neck swelling is recent (within 2 weeks) and WITHOUT signs of head and neck tumor/ malignancy or risk factors, we may start a trial of antibiotics, warm compress or both.
When will your neck surgeon suspect cancer?
During history taking, your ENT doctor will note of exposure to radiation, occupational hazards, smoking history or alcohol intake. he or she will ask for history of cancer, family history of cancer or head and neck tumor. If you answer yes, we may have a higher clinical suspicion of a malignancy. A hard fixed neck mass, any skin changes, ulceration, or any neck tumor more than 1cm will alert your ENT doctor to have a more aggressive approach.
What your ENT doctor will test
Diagnostic tests may be recommended if your ENT doctor (Palawan) deems you at an increased risk for malignancy. These may include doing an ultrasound, CAT scan, or MRI and a possible endoscopy procedure of the throat. However, if the mass is assessed to be benign, we may begin proper medical treatment, or just observe for 2 weeks and subsequent follow up.
Based on this blog, consult with an ENT doctor is crucial when you have a neck mass. Your ENT doctor will also be able to assess whether the neck mass is benign or malignant, and request further tests to be able to start treatment.
It is important not to delay consultation as early management still enables prompt treatment, especially when considering head and neck cancers. Early consultation also enables you to have peace of mind, especially if the mass is deemed benign by your ENT doctor.
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