Why lumps appear
The neck contains many lymph nodes, small glands that are part of the body’s defence against infection. They swell when they are working: after a cold, a sore throat, tonsillitis, a dental abscess or an infected spot on the scalp or face. These lumps are often tender, and usually shrink over two to three weeks as the infection clears.
Other common causes include cysts that have been present since birth and swell later, often after an infection; swellings of the thyroid gland in the front of the neck; lumps in the salivary glands under the jaw or in front of the ear; and lumps in the skin, such as cysts and fatty lumps.
When a lump needs a specialist
The simplest rule is three weeks. A lump in the neck that is still there after three weeks should be examined by an ENT surgeon, even if it is painless and even if you feel well.
See someone sooner if the lump is growing or feels hard or fixed; if your voice has been hoarse for more than three weeks; if swallowing is difficult or painful, or food sticks; if you have pain in one ear without an ear problem; if there is a sore, or a white or red patch, in the mouth that does not heal; if you cough or spit blood; or if you have unexplained weight loss, fevers or night sweats.
Go to an emergency unit if a swelling in the neck makes it difficult to breathe or to swallow your saliva.
Who is at higher risk
Cancers of the mouth, throat and voice box are more common in people who smoke or chew tobacco and in people who drink alcohol regularly, and the risk is higher still with both. Some cancers of the throat, particularly of the tonsils and the base of the tongue, are linked to the human papillomavirus (HPV) and can occur in younger people who have never smoked. Lymphoma and thyroid cancer can occur at any age.
A lump in the neck may be the first and only sign of these cancers. That is why a lump that persists in an adult deserves an examination, rather than one course of antibiotics after another.
What happens at the appointment
Dr Kana asks how long the lump has been there, whether it has changed, and about your general health, smoking and drinking. He examines the neck, mouth and throat, and usually looks at the back of the nose, the throat and the voice box with a thin flexible endoscope. This is done in the rooms with a local anaesthetic spray and takes a few minutes.
The next step is usually an ultrasound of the neck with a fine needle aspiration (FNA), in which a thin needle takes a small sample of cells for the laboratory. A CT or MRI scan may be arranged to show the lump and the structures around it. If a biopsy is needed from the throat or voice box, it is taken under a short general anaesthetic.
A lump in the neck should not be cut out ‘to see what it is’ before this assessment is complete. If it turns out to be a cancer, an operation done without a plan can make later treatment more complicated.
If it is cancer
Most results are reassuring. If the tests show a cancer, treatment depends on the type, where it started and how far it has spread. It may involve surgery, radiotherapy, chemotherapy or a combination. The plan is agreed with oncologists, radiologists and other specialists, so that you hear one recommendation and understand the reasons for it.
Speech therapists who share the rooms help with voice and swallowing during and after treatment. Head and neck cancers found early are generally simpler to treat, which is the main reason not to wait.
If you live outside South Africa
If you have already had an ultrasound, a scan or a biopsy at home, send the reports and images with your enquiry. They help Dr Kana advise you on what still needs to be done, and can shorten your stay. Please say in your enquiry that you have a neck lump and how long it has been there; these enquiries are given priority.
This page is general information, not medical advice for your situation.
