NECK LUMPS

1
NECK LUMPS

• John Waldron
• 15 October 2008

2
Neck lumps - assumptions

• Reasonable experience
• Concern about missing cancer/serious disease
• Manage common conditions with confidence
• Simple guidelines
• Doctor Ive got a lump in my throat

3
(No Transcript)
4
Neck lumps

• History
• Examination
• Investigation

5
Neck lumps - history

• lt 3 weeks
• gt 1cm progressive?

• Dysphagia/voice change/ulceration/pain/odynophagia
  
• Other lumps
• B symptoms
• Age
• Smoking/Drinking

6
Neck lumps - examination

• Size gt 1cm
• General feel hard/fixed
• Site midline/lateral/supraclavicular

7
Midline neck lumps

• Thyroid
• Thyroglossal cyst
• Lymph node
• Dermoid

8
Lateral neck lumps

• Lymph node
• Branchial cyst
• Submandibular gland
• Parotid
• Glomus tumours
• Carotid body tumours

9
Supraclavicular lumps

• Lymph nodes
• Usually from below the clavicle

10
Investigation of neck lumps

• Examination of the mouth/neck/skin/scalp
• FNA
• ?examination for other nodes
• ?examination of breast/abdomen
• ?CXR

11
Urgent referral

• Hard/fixed mass
• Progressive increase in size gt 3weeks
• Associated Weight loss / dysphagia / voice
  change / other nodes
• B symptoms
• Anyone where your clinical suspicion is aroused

12
Globus pharyngeous

• lump in throat
• feeling of something there
• Phlegm/particle of food stuck there
• uncomfortable
• pressure on front of neck

13
Globus pharyngeous

• Symptoms improved by eating/drinking
• No dysphagia
• No weight loss
• No odynophagia
• No neck lumps
• No significant voice change
• No pain/otalgia
• Usually midline

14
Urgent referral

• Dysphagia
• Odynophagia
• Weight loss
• Neck lump
• Unexplained pain/otalgia
• 3 week rule