Neck Lumps & Head-Neck Cancer Care

A lymph node that has enlarged from a bacterial infection usually settles with a short course of antibiotics. If a lump doesn't resolve, imaging (typically an ultrasound or CT scan) and a needle biopsy of the swelling are used to determine whether it is benign or malignant.

Surgical removal is generally safe and effective. Because benign lumps can continue to enlarge and become harder to remove over time, early surgical treatment is usually recommended once diagnosed.

A cancerous lymph node in the neck is most often secondary — meaning the cancer has spread there from a primary site elsewhere in the head and neck, such as the thyroid, mouth, throat, voice box, salivary glands or sinuses.

A neck dissection removes the cancer-affected lymph node together with the surrounding "at-risk" nodal groups, since nearby nodes can harbour microscopic disease that isn't visible on scans. Which nodal levels are removed depends on where the primary cancer is located (for example, thyroid cancer and mouth cancer involve different nodal groups). When at least one level of the neck is preserved and only the at-risk levels are targeted, this is called a selective neck dissection — a smaller, more cosmetically favourable operation with a quicker recovery than the traditional radical neck dissection, which is still used for more advanced disease.

As with any major surgery, risks include infection, bleeding, a chyle leak (leakage of lymphatic fluid), and nerve-related effects such as shoulder weakness or altered movement of the tongue or mouth. In experienced hands, careful surgical technique keeps these risks low.

A persistent lump or swelling in the neck, a sore throat or mouth ulcer that does not heal, difficulty or pain on swallowing, a change or hoarseness in the voice lasting more than a few weeks, unexplained ear pain, nasal blockage or bleeding on one side, and unexplained weight loss are all reasons to seek an ENT evaluation. Tobacco use (smoked or chewed), heavy alcohol use, and certain HPV infections are recognised risk factors for several head and neck cancers, so people with these risk factors should be especially attentive to persistent symptoms.