Neck Lumps

Question 1

What are the red flags associated symptoms for neck lumps

Answer 1

• Hoarseness of voice
• Weight loss
• Ulceration of mouth
• Painless neck lump
• Lymphadenopathy – enlarged supraclavicular nodes are the most concerning for malignancy of the cervical lump nodes (can be caused by malignancy in chest or abdomen)
• Night sweats (e.g. indicating lymphoma)
• Fevers
• Fatigue
• Symptoms >3 weeks
• Risk factors – FH, age, smoking status

Question 2

What 4 categories can lymphadenopathy be generally grouped into?

Answer 2

• Reactive
• Infected
• Inflammatory
• Malignancy

Question 3

Give some examples of reactive lymph nodes

Answer 3

• swelling caused by viral URTIs
• dental infections
• tonsillitis

Question 4

What are reactive lymph nodes?

Answer 4

Reactive lymphadenopathy is when lymph glands respond to infection by becoming swollen.

Question 5

What are infective lymph nodes?

Answer 5

Lymphadenitis is an infection in one or more lymph nodes.

Question 6

Give some examples of infected lymph nodes

Answer 6

TB, HIV, infectious mononucleosis

Question 7

What are some inflammatory conditions can cause lymphadenopathy

Answer 7

SLE, sarcoidosis

Question 8

What malignancies can cause lymphadenopathy?

Answer 8

Leukaemia, lymphoma, metastasis

Question 9

What are the 6 S’s of examining any neck lump?

Answer 9

• Size
• Shape
• Smoothness
• Surface
• Surroundings

Question 10

Gives some red flag features of a neck lump

Answer 10

• Unexplained (e.g. no infection)
• Persistently enlarged (particularly >3cm in diameter)
• Abnormal shape (normally oval shape where the length is more than double the width)
• Hard or ‘rubbery’
• Non-tender
• Tethered or fixed to skin or underlying tissues
• Associated symptoms e.g. night sweats, weight loss, fatigue, fevers

Question 11

What should you always remember to examine in a neck lump examination

Answer 11

Oral cavity!

Question 12

What is the urgent 2 week referral criteria for a neck lump?

Answer 12

2 week wait referral for:

• An unexplained neck lump in someone aged 45 or above
• A persistent unexplained neck lump at any age

Question 13

What is the urgent ultrasound referral criteria for a neck lump?

Answer 13

A lump that is growing in size:

• Within 2 weeks in patients 25 and older
• Within 48 hours in patients under 25

Question 14

Give some blood tests indicated in a neck lump

Answer 14

• FBC & blood film → leukaemia, infection
• HIV test
• Monospot test or EBV antibodies → for infectious mononucleosis
• TFTs → for goitre or thyroid nodules
• Antinuclear antibodies (ANA)
• Lactate dehydrogenase

Question 15

What do ANAs indicate?

Answer 15

SLE

Question 16

What is LDH a non-specific tumour marker for?

Answer 16

Hodgkin’s lymphoma

Question 17

What is the 1st line imaging investigation in a neck lump?

Answer 17

US

Question 18

What is fine needle aspiration cytology?

Answer 18

Aspirating cells from lump using a needle and then analyse under microscope

Question 19

What is a core biopsy?

Answer 19

taking a sample of tissue with a thicker needle

Question 20

What is an incision biopsy?

Answer 20

cutting out a tissue sample with a scalpel

Question 21

What are the 3 possible locations of a neck lump?

Answer 21

1. Anterior triangle
2. Posterior triangle
3. Midline

Question 22

What separates the anterior and posterior triangles of the neck?

Answer 22

Sternocleidomastoid muscle

Question 23

What are the borders of the anterior triangle?

Answer 23

anterior → midline of neck

superior → mandible

lateral → sternocleidomastoid

Question 24

What are the borders of the posterior triangle?

Answer 24

inferior → clavicle

posterior → trapezius

lateral → sternocleidomastoid