The lump in the neck

Abstract

A “lump in the neck” is usually the first symptom of nasopharyngeal cancer, and any of the lymph chains of the head and neck may be the site of the metastatic spread of a malignant neoplasm arising in the head and neck area. When a patient presents with an asymmetric “lump in the neck,” the examiner should immediately suspect metastatic cancer since only a small proportion of neck cancer is primary in the neck structures. Most probably the primary lesion is in the oral cavity, pharynx, or skin. Occasionally, the primary lesion may be below the clavicle. Asymmetric cervical enlargement in children is less likely to be metastatic than it would be in the adult. A knowledge of these chains and the areas that they drain (Fig. 1) is indispensable to the dentist or physician interested in early detection when he is confronted by a patient with such a node. 1 The most serious error that can be made is an excision biopsy which, although proving the presence of malignant disease, does not indicate the primary lesion and contributes only to a poor prognosis by delaying treatment and by scarring a surgical field where radical dissection may be contemplated. Unless the mass is known to be a cyst, lipoma, or thyroid adenoma, biopsy of the node should be the last resort in a series of diagnostic steps which start. with a meticulous examination of the mouth, tongue, larynx, and pharynx.