Conditions: Head and Neck Tumors (Growths, Lumps, Masses)

Tumors occurring in the mouth, throat, neck, or on the skin may be benign or malignant, but they create a scare either way. A full head and neck evaluation by a head and neck surgeon, including possibly looking in the nose and throat with a scope, and possible biopsy are the first steps that will allow diagnosis. You will have the opportunity to learn about various treatment options, whether surgical or otherwise, before deciding on a course of action.

Neck mass

Because of the wide variety of tissue types within the small space of the neck, the identity of a lump, fullness, or growth in the neck may not be immediately identifiable. Certain history and physical examination findings are very helpful in determining how to further evaluate and manage a neck mass.

Lymph node enlargement

Lymph node enlargement in the neck may simply be the result of inflammation, but persistence, lack of pain, and progressive growth over weeks or months in particular require evaluation for a more serious problem, such as cancer. Differentiating between an enlarged lymph node that is working properly in fighting germs (reactive inflammation), enlarged due to a problem in its functioning (such as with granulomatous disease including sarcoidosis), or containing cancer cells is a common task for the physician. If a lymph node persists for greater than about seven weeks, further evaluation may be necessary, such as examination, imaging and needle biopsy. Cancer in one or more lymph nodes may have spread from a primary cancer elsewhere in the body (such as tonsil cancer spreading to neck lymph nodes), or could represent a type of cancer starting in the lymph nodes (lymphoma).

Parathyroid adenomas and hyperparathyroidism

Skin growths

Skin swellings or growths have many causes, including benign and cancerous. Evaluation of new or changing skin growths is necessary to differentiate the dangerous from non-dangerous. Skin cancer is very common, and is the most common type of all cancers. The majority of skin cancers can be treated effectively or “cured” with surgery to remove the cancer, though other types of treatments are utilized in certain circumstances. The specific type of skin cancer generally predicts its behavior, and this information is used to guide treatment. Actinic keratosis, keratoacanthoma, basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma are some types skin tumors.

Oral (mouth) tumors

Throat (pharynx) tumors

larynx (voice box) tumors

Growths involving the voice box (larynx) range from areas of swelling (such as vocal nodules or vocal cord edema) to papillomas or other benign tumors to malignant (cancerous) tumors. Since the sound produced by the vocal cords may be altered by even small changes in their anatomy, a growth on the vocal cords themselves typically manifests early with hoarseness. In other areas, of the larynx, a growth may become quite large before showing itself by symptoms of difficulty in breathing or swallowing. For these reasons, hoarseness for greater than one month duration, difficulty swallowing or symptoms of blockage of the larynx airway are evaluated by physical exam by a specialist, often including office laryngoscopy—a safe and quick look at the throat and larynx anatomy. Further evaluation may involve biopsy or imaging, such as a neck CT scan. Some of the more common growths on the larynx include squamous papilloma, vocal nodule, and a cancer called squamous cell carcinoma.

branchial cleft cyst

A branchial cleft cyst is another benign condition that can arise at any time, can become infected, and requires definitive diagnosis to differentiate it from cancer. A branchial cleft cyst is a fluid filled swelling in the upper part of the side of the neck. It can, but does not usually have an opening to the skin surface, called a fistula. Branchial cleft cysts account for almost 20% of neck masses in children. Most branchial cleft cysts present in late childhood or early adulthood as a solitary, painless mass, which went previously unnoticed, that has now become infected (typically after an upper respiratory tract infection). A fistula, if present, is asymptomatic until infection arises. A branchial cleft cyst is the remnant of embryonic development and result from a failure of obliteration of one of the branchial clefts, which are homologous to the structures in fish that develop into gills. The diagnosis of branchial cleft cysts is typically made by history and physical exam due to their relatively consistent location in the neck, typically anterior to the sternocleidomastoid muscle. For masses presenting in adulthood, the presumption should be a malignancy until proven otherwise, since carcinomas of the tonsil, tongue base and thyroid may all present as cystic masses of the neck. Unlike a thyroglossal duct cyst, when swallowing, the mass should not move up or down.

lymphoma

Lymphoma is a cancer of the lymph nodes, and this sometimes shows up in the head and neck area, but also commonly in the arm pits or the groin. Persistently enlarged lymph node(s), especially those growing and non-tender are suspicious for some kind of tumor. A lymphoma may also cause fever and/or night sweats. Diagnosis is typically made by biopsy which is then analyzed by a technique called flow cytometry.

others

The list above is far from complete. Other types of neck tumors include carotid body tumors, glomus tumors, schwannomas, cancers that have spread to the neck from elsewhere, and others. After physical exam, biopsy is a mainstay in diagnosis, but this is often used in conjunction with radiographic imaging.