Why is there a lump in my neck?

Neck lumps are surprisingly common but they aren’t necessarily a cause for concern. We asked celebrated ENT surgeon Mr John Watkinson why neck lumps occur, which ones you can remove yourself, and when you might need surgery.

Why is there a lump in my neck?

Lumps in the neck are common. Cancer is thankfully uncommon. This means that most lumps within the neck are benign, and are usually infective or inflammatory in origin when the cervical lymph nodes are involved.

Otherwise they occur in named organs such as:

• the parotid gland
• submandibular gland
• the thyroid.

Swellings in these latter organs are usually non-cancerous.

A lump in the neck is usually investigated with a full clinical history and examination to include flexible nasopharyngoscopy. Usually further tests on a neck lump will include ultrasound plus or minus fine needle aspiration cytology (FNAC).

Occasionally blood tests will be ordered or more complex imaging such as CT or MRI.

Can I remove the lump in my neck myself?

Many lumps in the neck particularly in the young resolve over time because they are often infective. However, concern should always be raised about neck swellings at the extremes of life.

If a swelling is cystic (contains fluid) it can be removed by aspiration and then left as long as it does not recur. Otherwise, surgery may be required to remove the lump.

What are my options to remove a lump in the neck?

Surgery for neck lumps can be required for a number of reasons. These include patient preference, concern about the cosmetic appearance of the lump, as well as both diagnostic and curative purposes.

Most lumps in the neck which require removal will be done by open surgery. The size of the incision and the extent of the operation is dictated by a number of factors which include:

• the size of the lump
• its location
• whether or not it is cancer or non-cancerous.

Some benign lesions can be removed through small incisions (minimally invasive surgery) or very occasionally a robot is employed. Some swellings which contain a lot of fluid can be aspirated without recourse to an open operation.

Malignant swellings in either the parotid, submandibular or the thyroid gland, will nearly always require surgery. This sometimes can be extensive and associated with neck dissection at the same time if the cancer has spread.