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NECK LUMPS

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NECK LUMPS

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    1. NECK LUMPS John Waldron 15 October 2008

    2. Neck lumps - assumptions Reasonable experience Concern about missing cancer/serious disease Manage common conditions with confidence Simple guidelines Doctor I’ve got a lump in my throat

    4. Neck lumps History Examination Investigation

    5. Neck lumps - history < 3 weeks > 1cm progressive? Dysphagia/voice change/ulceration/pain/odynophagia Other lumps B symptoms Age Smoking/Drinking

    6. Neck lumps - examination Size > 1cm General feel – hard/fixed Site – midline/lateral/supraclavicular

    7. Midline neck lumps Thyroid Thyroglossal cyst Lymph node Dermoid

    8. Lateral neck lumps Lymph node Branchial cyst Submandibular gland Parotid Glomus tumours Carotid body tumours

    9. Supraclavicular lumps Lymph nodes Usually from below the clavicle

    10. Investigation of neck lumps Examination of the mouth/neck/skin/scalp FNA ?examination for other nodes ?examination of breast/abdomen ?CXR

    11. Urgent referral Hard/fixed mass Progressive increase in size > 3weeks Associated – Weight loss / dysphagia / voice change / other nodes B symptoms Anyone where your clinical suspicion is aroused

    12. Globus pharyngeous “lump in throat” “feeling of something there” “Phlegm/particle of food stuck there” “uncomfortable” “pressure on front of neck”

    13. Globus pharyngeous Symptoms improved by eating/drinking No dysphagia No weight loss No odynophagia No neck lumps No significant voice change No pain/otalgia Usually midline

    14. Urgent referral Dysphagia Odynophagia Weight loss Neck lump Unexplained pain/otalgia 3 week rule

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