A neck lump can be a frightening discovery. But not all neck swellings are dangerous. In this article, we’ll break down what a neck lump really means, what causes it, how doctors diagnose it, and what treatment you might need.
What Is a Neck Lump?
- Definition (clinical & layman)
- Location (anterior/posterior triangle of neck)
- When to seek medical help
Key Features of a Neck Lump
- Moves with swallowing → Thyroid
- Moves with tongue protrusion → Thyroglossal cyst
- Multiple → Likely lymph nodes
- Rock-hard → Suspicious for cancer
- Tender → More likely infection
Types of Neck Lumps Based on Origin
1. Thyroid Swellings
- Goitre
- Nodular thyroid (colloid, follicular, papillary, anaplastic)
- Cancerous signs: firm, non-tender, enlarged cervical lymph nodes
2. Lymph Node Enlargements
- Viral: tender, mobile
- Bacterial: tonsillitis, TB, mono
- Cancerous: lymphoma, metastases
3. Cystic Lumps
- Thyroglossal duct cyst (midline, moves with tongue)
- Branchial cyst (lateral neck, anterior to SCM)
- Cystic hygroma (childhood, transilluminant)
4. Neoplasms (Tumors)
- Metastatic carcinoma
- Salivary gland tumors
- Carotid body tumor
- Sternocleidomastoid tumor (Torticollis)
5. Inflammatory/Abscess
- Acute infective lymphadenitis
- Parotitis
- Collar stud abscess
6. Vascular Lumps
- Subclavian aneurysm
- Brachiocephalic ectasia
Differential Diagnosis by Age
Children
- Congenital or inflammatory
- Common: cystic hygroma, thyroglossal duct cyst
Young Adults
- Viral infections: mono, pharyngitis
- Papillary thyroid cancer
Adults Over 40
- Consider malignancy first
- 75% head/neck origin (thyroid, larynx)
- 25% from infraclavicular origin (lung, stomach)
- Primary vs. metastatic lymphadenopathy
Dysphagia: Causes, Symptoms & Diagnosis of Swallowing Difficulty
Clinical Evaluation of a Neck Lump
History Taking
- Duration, progression
- Pain, tenderness
- Fever, systemic symptoms
- Dysphagia, hoarseness
Physical Examination
- Location: midline vs lateral
- Mobility with swallowing
- Consistency: soft/cystic/hard
- Single vs multiple
- Skin changes, fixation
Neck Lump Diagnostic Workup
1. Blood Tests
- FBC (for all patients)
- Thyroid function test (if thyroid suspected)
2. Imaging
- Ultrasound: Solid vs cystic
- CT scan: Source of mass, metastasis
- CXR: If suspect infraclavicular primary
3. Endoscopy (if malignancy suspected)
- Laryngoscopy
- Nasopharyngoscopy
- Bronchoscopy
- Gastroscopy
4. FNAC
- For all solid lumps
- Diagnostic for: colloid nodule, papillary carcinoma, lymphoma
5. Biopsy
- For definitive histological diagnosis (esp. lymphomas)
Red Flags: When to Suspect Cancer
- Age >40
- Rock-hard consistency
- Rapid growth
- Non-tender and fixed
- Multiple nodes
- Voice changes, dysphagia
Treatment Options for Neck Lumps
Benign Lumps
- Observation (inflammatory)
- Surgical excision (cysts, goitre)
Infectious
- Antibiotics
- Incision and drainage for abscess
Neoplastic
- Surgery
- Chemotherapy (for lymphomas)
- Radiotherapy (head and neck cancers)
FAQs About Neck Lumps
Is a neck lump always cancer?
No. Most are benign or inflammatory, especially in children and young adults.
How do I know if a neck lump is serious?
Hard, fixed, painless, or rapidly growing lumps warrant urgent evaluation.
Do thyroid nodules need surgery?
Not always. Depends on FNAC result and symptoms.
What is FNAC?
Fine Needle Aspiration Cytology — a quick, minimally invasive test to assess cell type.
Can a neck lump go away on its own?
Yes, if caused by a viral infection. But persistent or enlarging lumps should be evaluated.
A neck lump might be nothing—or it might be something serious. Early evaluation by a healthcare provider, especially for lumps that are hard, growing, or not resolving, is key to timely diagnosis and management.
