SYMPTOMS

What is a neck mass?

A neck mass primarily refers to abnormal swelling of lymph nodes in the neck or the appearance of unusual lumps. It is not a disease itself but rather a common sign caused by various conditions, which may or may not be accompanied by pain.

The clinical manifestations of a neck mass vary depending on its specific location, size, and whether it is benign or malignant. Additionally, the underlying diseases associated with the mass differ based on its location. Each case should be analyzed individually.

TREATMENT

How to treat neck masses caused by inflammation?

• Acute or chronic inflammatory neck masses are often caused by bacterial infections and can be treated with antibiotics. For viral infections, antiviral therapy may also be appropriate.

• If an abscess forms, incision and drainage may be performed.

• For tuberculous lymphadenitis, anti-tuberculosis treatment can be considered.

How to treat benign neck masses?

Small benign tumors or congenital neck masses without obvious symptoms may not require immediate treatment. However, surgical removal may be considered if the mass causes symptoms, shows malignant potential, or causes patient anxiety. If infection is present, it should be controlled before surgery.

What to do if a neck mass is diagnosed as malignant?

• For primary malignant neck tumors: Treatment varies by pathological type. Lymphomas are often treated with chemotherapy or chemoradiotherapy, while thyroid cancer, parotid cancer, and soft tissue sarcomas typically require surgery. Neck lymph node metastases from nasopharyngeal cancer are usually treated with radiotherapy.

• For metastatic neck lymph node cancer: If originating from head and neck tumors, treatment involves neck dissection or radiotherapy based on pathology. For metastases from distant organs (e.g., chest or abdomen), radiotherapy or chemotherapy is chosen depending on the primary tumor.

• Besides surgery and chemoradiotherapy, targeted therapy may also be used for certain tumor types.

Is radiotherapy necessary for malignant neck masses?

Depending on the pathological type, radiotherapy may be considered for radiation-sensitive malignancies (e.g., lymph node metastases from nasopharyngeal or oropharyngeal cancer). However, radiotherapy is generally unnecessary for radiation-insensitive tumors like differentiated thyroid cancer. Radiotherapy can also be part of multimodal therapy for some malignant neck masses.

Is chemotherapy necessary for malignant neck masses?

Except for lymphomas, most malignant neck tumors are not highly responsive to chemotherapy. However, chemotherapy may still serve as an adjunct treatment for some advanced cases.

DIAGNOSIS

Should a neck lump require medical attention? Which department should I visit?

After discovering a neck lump, regardless of whether it is accompanied by other symptoms, you should seek medical attention promptly for diagnosis to avoid delaying the condition. Many patients actively seek medical care when they notice a neck lump accompanied by symptoms such as pain, redness, swelling, itching, or ulceration. However, if the lump is painless and not itchy, with no other discomfort, it is often overlooked.

Clinically, a painless neck lump often suggests the possibility of a malignant tumor. Therefore, any abnormal neck lump should prompt consultation with relevant medical departments, such as otolaryngology-head and neck surgery, general surgery, or oncology.

POTENTIAL DISEASES

What diseases can cause neck masses?

The neck has a complex structure, so neck masses can be caused by many diseases. Based on etiology, they are generally classified into three categories:

• Congenital neck masses: Congenital neck masses are usually present at birth but can occur at any age. They are the most common non-inflammatory neck masses in children.

  • Nearly 20% of pediatric neck masses are branchial cleft cysts, which are often discovered in late childhood or early adulthood due to infection of a previously unnoticed cyst. Only a small number of branchial cleft cysts are diagnosed in adulthood.

  • Thyroglossal duct cyst: Presents as a midline mass in the anterior neck. Patients are usually asymptomatic until an upper respiratory tract infection involves the cyst. Thyroglossal duct cysts are typically diagnosed in childhood, but up to 40% may appear after the age of 20.

  • Vascular anomalies: Can be divided into vascular tumors and vascular malformations. Both can manifest as neck masses. Hemangiomas are the most common vascular tumors, while lymphatic malformations are the most frequent cause of neck masses among vascular malformations.

• Inflammatory neck masses: Inflammatory masses are usually associated with enlarged lymph nodes. Lymphadenopathy can be caused by infections or inflammatory non-infectious diseases. For details, see the entry on "Cervical Lymphadenopathy."

• Neoplastic neck masses: Both benign and malignant tumors can occur in the neck. In adult patients, masses should be treated as malignant until malignancy is ruled out. Tonsillar cancer, base-of-tongue cancer, and thyroid cancer can present as cystic neck masses and may be misdiagnosed as benign lesions during initial evaluation.

How can neck masses be distinguished based on onset time? Does rapid growth indicate higher malignancy?

Growth speed alone cannot simply determine malignancy. Generally, masses lasting a few days are usually inflammatory; those lasting months are more likely malignant; and those lasting years are typically benign tumors or congenital masses.