Neck masses in the adult can be benign or malignant (cancerous). One of the most commonly diagnosed benign neck masses is an enlarged lymph node. Lymph nodes help to fight infection, so they will often swell up during an upper respiratory infection. Usually, these “swollen glands” are tender during the course of the infection. Most of the time, they will shrink down as the infection resolves. On occasion, enlarged lymph node(s) can become an abscess (collection of pus) which requires intravenous antibiotics and surgery.
Another common adult neck mass is a cyst, which is filled with fluid. Many cysts in the head and neck are congenital, that is, they have been present since birth. Despite their presence in the neck, an actual lump may not appear until much later in life. In fact, some congenital neck cysts do not get diagnosed until adulthood.
The most common benign neck masses are branchial cleft cysts, thyroglossal duct cysts, epidermoid cysts, dermoid cysts, lymphangiomas, and hemangiomas. These masses can cause a cosmetic deformity, as they bulge out from the neck. In addition, many neck masses cause symptoms, especially if they get infected. For this reason, surgical removal is generally recommended for most neck masses.
Malignant (cancerous) neck masses are obviously a greater concern for patients. Malignant neck masses tend to grow more quickly than benign ones, and may be tender or non-tender. Sometimes, a malignant neck mass is a cancer arising from one of the structures in the neck such as the thyroid gland or a salivary gland. In other cases, it can be a metastasis (distant spread) from a cancer that started elsewhere in the body. Some cancers (lymphomas) actually arise from a lymph node in the neck.
A needle biopsy of the neck mass may be done in the office. Your physician may also order some imaging studies (CT scan or MRI) to assess the extent of the mass. Depending on the type and severity of the cancer, your physician may recommend surgery or other modalities such as radiation therapy or chemotherapy. Cancer of the head and neck is usually treated in a team approach with other specialists including a radiation oncologist or a medical oncologist.