GP section

neck lumps

The aim of management is to diagnose every neck lump and therefore to determine which are detrimental to the patient and should be treated.

• age of presentation is very important. Patients under 30 generally have inflammatory or congenital lesions while malignancy increases from the 4th decade.
• aim to determine what tissue is involved eg skin, subcutaneous, node, salivary, thyroid.
• midline lumps include benign lesions such as dermoid, thyroglossal cysts, plunging ranulae, and thyroid masses.....but malignancy is still possible eg. thyroid cancer, or metastases to midline nodes from skin, lip, oral cavity,
• most lumps at the angle of the jaw are in the parotid. In younger patients they usually represent a benign parotid tumour (surgery required) but parotid nodal metastasis from a facial skin cancer is very common in this country and increases in incidence from the 5th decade onwards.

Multiple lumps of recent duration:

blood tests

• in young patients (<40) - likely inflammatory.
  • FBC ESR
  • serology for glandular fever (usually obvious)
  • toxoplasma titres - see toxoplasmosis in patient section. I see at least 5 of these each year presenting with nodes only.
  • CMV titres - I see 1-2 per year.
  • cat scratch titres - 1-2 per year
  • possibly rubella titres - seldom see
• In older patients (>40) -malignancy increases yet the tests above may still be relevant.
  • multiple lumps when malignant may reflect lymphoma (ask re "B" symptoms), metastatic carcinoma from oral/throat/skin/thyroid primary. Ask re skin lesions, throat symptoms (soreness, otalgia, lump. hoarseness, dysphagia, blocked ear, blocked nose, epistaxis).

If blood tests do not indicate diagnosis then consider ultrasound to determine what tissue is involved and to determine whether FNA cytology required. However, also consider whether there is likely to be a delay and whether referral is preferable.