Lump in the neck: examination and surgery
A lump in the neck is benign in the vast majority of cases – often a lymph node reacting to an infection. If the lump persists, grows or appears without an obvious explanation, it should be examined. At Charlottenlund Private Hospital, lumps in the neck are assessed using ultrasound scanning and fine-needle biopsy, and benign lumps, cysts and glands can be removed surgically.
What can a lump in the neck be?
A lump in the neck may be an enlarged lymph node, a congenital cyst, a lump in a gland or a benign lump in fatty or connective tissue. According to a review article in Ugeskrift for Læger, a lump in younger adults can typically be explained by congenital causes, inflammation or infection. Lymph nodes can become enlarged with colds, throat infections and glandular fever and usually settle down again.
A lateral neck cyst is the most common congenital cause of swelling on the side of the neck, while a median neck cyst is located high in the midline. Thyroid nodules are very common – the Danish Endocrine Society [link:
https://endocrinology.dk/nbv/thyroideasygdomme/udredning-af-knuden-i-glandula-thyreoidea/] states that 38% of women aged 60–65 have a thyroid nodule larger than 1 cm, and the vast majority are benign. Other possible causes include lumps in the salivary glands and fatty lumps (lipomas), which grow slowly and do not spread into surrounding tissue.
What does the location of the lump mean?
The location can provide a clue, but it does not determine the diagnosis. A lump low down at the front of the neck that moves when you swallow often arises from the thyroid gland.
A swelling in front of or below the ear and beneath the jawline may arise from a salivary gland; in the case of salivary stones, the gland typically becomes swollen around mealtimes.
A soft, painless swelling on the side of the neck may be a lateral neck cyst, while a lump high in the midline that moves upwards when you swallow may be a median neck cyst.
Tender, mobile lumps along the sides of the neck are most often lymph nodes reacting to an infection. Ultrasound scanning shows which tissue the lump originates from.
When should you see a doctor about a lump in the neck?
A lump that does not disappear within a few weeks, or that cannot be explained by an infection, should be assessed by a doctor. The same applies to a lump that grows, feels hard or appears fixed to the underlying tissue.
According to Ugeskrift for Læger, age is one of the most important factors: in adults over the age of 40, a new lump in the neck should always be examined, and a lymph node measuring more than 1 cm on imaging is assessed further.
Hoarseness lasting more than two weeks, difficulty swallowing, pain radiating towards the ear, night sweats or unintentional weight loss together with a lump are signs that should be assessed promptly by your GP or an ear, nose and throat specialist. If there is a well-founded suspicion of malignant disease, the assessment takes place within a cancer pathway in the public hospital system.
How is a lump in the neck examined?
A lump in the neck is assessed through a consultation, an ear, nose and throat examination using an endoscope to examine the nose, pharynx and larynx, an ultrasound scan of the neck and often a fine-needle biopsy.
According to Ugeskrift for Læger, ultrasound scanning and fine-needle biopsy are the most important diagnostic tools, and in experienced hands the diagnostic accuracy of fine-needle biopsy is reported to exceed 90% in some studies.
During a fine-needle biopsy, cells are collected using a thin needle under ultrasound guidance, and the sample is then assessed by a pathologist. At Charlottenlund Private Hospital, ultrasound scanning and fine-needle biopsy are performed by the specialist during the initial examination. CT, MRI and PET scans are not performed at the hospital – patients are referred elsewhere if required.
When is a lump in the neck operated on?
A lump is operated on when it causes symptoms, when it grows or when a tissue sample cannot provide a clear diagnosis. Neck cysts are treated surgically by removing the entire cyst; many patients have previously had inflammation in the cyst.
Lumps in the salivary glands are generally removed because fine-needle biopsy cannot always determine the cell type. Thyroid nodules are operated on if they cause pressure symptoms or if the tissue sample is inconclusive, while fatty lumps are removed when they cause discomfort.
Many lumps do not require treatment and only need monitoring. Removed tissue is always sent for microscopic examination.
What neck operations are performed at Charlottenlund Privathospital?
Charlottenlund Private Hospital performs thyroid surgery (hemithyroidectomy), salivary gland surgery, surgery for lateral and median neck cysts and removal of fatty lumps from the neck.
Operations on the thyroid gland, salivary glands and neck cysts are performed under general anaesthesia, either as outpatient procedures or with one overnight stay depending on the procedure. Fatty lumps are removed under local or general anaesthesia depending on their size and location.
Removal of lymph nodes for diagnostic purposes and treatment of malignant lumps take place within cancer pathways in the public hospital system, and in adults over the age of 40, a cyst on the side of the neck is also investigated there.
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway begins with an initial examination, during which the specialist reviews your medical history, examines the neck, performs an ultrasound scan and, if necessary, takes a fine-needle biopsy.
Once the results are available, the next step is agreed: monitoring, surgery or referral to a public hospital. Any surgery is performed in the surgical department in Charlottenlund, and the microscopic examination results are reviewed at the subsequent follow-up.
The specialists are presented on the staff page.
Referral
Most patients at Charlottenlund Private Hospital attend through private health insurance; insurance companies typically require a referral from your GP and prior approval. No referral is required for self-paying patients, and prices are available in the price list.
Frequently asked questions
Is a lump in the neck dangerous?
Most lumps in the neck are benign, often lymph nodes reacting to an infection. A lump that persists, grows or appears after the age of 40 should be examined.
How long can a swollen lymph node last?
Lymph nodes that swell in response to an infection usually settle down again. If the lump does not go away within a few weeks, it should be assessed by a doctor.
How is a lump in the neck examined?
With an ear, nose and throat examination, an ultrasound scan and often a fine-needle biopsy, in which cells are collected using a thin needle and assessed by a pathologist.
Does a fine-needle biopsy hurt?
It feels like a blood test needle prick and takes a few minutes. The sample is taken under ultrasound guidance.
What is the difference between a lateral and a median neck cyst?
A lateral neck cyst is located on the side of the neck, while a midline neck cyst is located high in the middle. Both are congenital and are treated with surgery.
Can a fatty lump in the neck be removed?
Yes. Fatty lumps (lipomas) are benign and can be removed in a minor procedure under local or general anaesthesia if they cause discomfort.