2 weeks do not pass
The nodule lasts for 2 weeks or longer, does not decrease, and there was no infection before - or it is not known since when it was present.
CONDITION / JAWS, MOUTH AND NECK
Neoplasm on the neck.
A neoplasm on the neck is any lump or knot: an enlarged lymph node, a cyst, a tumor of a gland or soft tissues. In most cases, this is a reaction to an infection that goes away on its own. But in an adult, a thickening that does not go away should be examined to the end: it may be a metastasis of cancer in the lymph node.
CONCEPTUAL VISUALIZATION- What it is
- Any lump in the neck: enlarged lymph node, cyst, gland or soft tissue tumor.
- Most often
- Nodules enlarge due to a cold, sore throat, or ear and throat infection and decrease in 1-2 weeks.
- When to be careful
- A lump lasts 2 weeks or longer without infection or is firm, immovable, or larger than 1.5 cm.
- Who treats it
- Team: surgeon, oncologist, radiation therapist. The plan depends on what the biopsy shows.
01 / WHAT IS ITWhat is
What is
neoplasms on the neck.
There are many lymph nodes in the neck. They get bigger around the infection to help the body fight it, and usually get smaller on their own within 1-2 weeks. Therefore, a node that appeared during a cold or sore throat is a common thing.
In adults, it is different with seals that do not go away. According to the guidelines of the American Academy of Otolaryngology (AAO-HNSF), in children, most neck lumps are caused by infections, and in adults, persistent lumps are mostly tumors, and malignant ones are the most common. A painless lump may be the first and only noticeable sign of head and neck cancer — squamous cell carcinoma, lymphoma, thyroid or salivary gland cancer.
Metastasis to a lymph node is when cancer cells from another location, most often from the lining of the mouth, pharynx, or larynx, enter a node in the neck. It happens that the node is noticed earlier than the tumor itself. If the primary tumor cannot be found, doctors speak of a metastasis from an unknown primary focus.
Neck cysts, salivary gland tumors and chemodectoma have separate pages - links to them below.
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSWhen sealing
When sealing
needs examination.
The AAO-HNSF and NHS guidelines list the signs for which a lump in the neck should no longer be simply observed.
Solid and immovable
Dense to the touch and does not shift under the fingers, as if welded to the surrounding fabrics.
More than 1.5 cm
Size over 1.5 cm is one of the signs of higher risk according to the guidelines; also — an ulcer on the skin above the node.
Near the collarbone
An enlarged lymph node just above or below the collarbone is a reason to see a doctor.
Accompanying signs
Hoarseness that does not go away; mouth ulcer for more than 3 weeks; it is difficult or painful to swallow; night sweats, temperature for no reason, weight loss.
A cyst too
A cystic nodule in an adult is recommended to be examined prior to diagnosis, and not to be considered benign. In a cohort of 79 adults, 19 of 49 such nodules on the lateral and posterior surfaces of the neck and 1 of 30 on the anterior surface were malignant.
Lateral cyst of the neck03 / REASONSWhat can it do?
What can it do?
to be
There are many reasons. You can answer what exactly you have only after an examination, and often only after a biopsy.
Infection
The most common cause of enlarged nodes: cold, sore throat, ear and throat infections, viral infections.
Head and neck cancer metastasis
Cancer of the mouth and larynx is usually associated with smoking, alcohol, or both; pharyngeal cancer is increasingly common with the human papillomavirus (HPV), primarily type 16.
Lymphoma
Rarely, nodes become enlarged due to cancer of the lymphatic system. It can be indicated by night sweats, fever, itchy skin, and weight loss.
Thyroid gland
A lump in the front of the neck may be a goitre; an unexplained nodule of the thyroid gland also needs an urgent examination.
Salivary glands
A lump on the neck can be a tumor of the salivary gland, in particular, a malignant one.
Tumors of the parotid glandSoft tissues
A soft mobile seal is a lipoma; such that at first it does not hurt, and then it grows and begins to hurt - sometimes a sarcoma.
Sealing under the skin
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Sealing on the neck itself usually does not require an emergency. But if it persists, the examination should not be delayed: in a meta-analysis of 10 studies, delay in diagnosis was a moderate risk factor for death from head and neck cancer, although, according to the authors, some of the connection may be explained by other factors.
103 immediately if:
- it is very difficult to breathe - a person suffocates, wheezes or cannot utter words;
- the neck or floor of the mouth quickly swells, and it becomes difficult to breathe or swallow;
- bleeding from a wound after biopsy or surgery does not stop, even if you press the wound;
- the blood spurts, bright red and hard to stop.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after neck surgery, pain or swelling in the wound area increases, and it is not difficult to breathe and swallow. On the same day: shortness of breath is stronger than usual; very difficult to swallow; you feel unwell or have a fever after a biopsy or surgery. In the coming days: the node is growing or has not decreased in a week; it is solid and does not shift; an enlarged node above or below the collarbone; there are night sweats or a high temperature without signs of a cold; hoarseness that does not go away; mouth ulcer for more than 3 weeks. A child or young person under the age of 24 with an enlarged nodule for no apparent reason should see a doctor as soon as possible: British NICE guidance advises to consider referral to a specialist within 48 hours. After inspection: if the doctor suspects cancer, do not delay the examination: in the UK, the standard is to confirm or rule out cancer within 28 days of referral.
05 / DIAGNOSTICSAs it turns out,
As it turns out,
what kind of node is this?
- Conversation and examination of the neck
How long has the node been there, has it changed, was there an infection; smoking and alcohol, voice, swallowing, weight. The doctor feels the node and the entire neck.
- Examination of the throat and larynx
If the risk of a tumor is increased, the mucous membrane of the larynx, the root of the tongue, and the pharynx are examined.
- CT or MRI with contrast
The guideline strongly advises CT (or MRI) of the neck with contrast if the risk of the tumor is increased. Ultrasound can also be prescribed.
- Puncture or needle biopsy
Fine-needle puncture instead of open biopsy. Core needle biopsy yields a column of tissue for histology.
- If there is no diagnosis
Examination of the throat under anesthesia with biopsies - even before the open biopsy of the node. If cancer is found in the node, but the source is not visible, PET-CT of the whole body.
06 / TREATMENTHow we treat
How we treat
neoplasm of the neck.
Treatment depends on what the biopsy shows: the plan is different for lymphoma, thyroid or salivary gland cancer, metastatic squamous cell carcinoma, or a soft tissue tumor. One thing in common is an accurate diagnosis first, then a treatment plan.
01
First, the diagnosis
As the instructions advise to examine the seal in an adult.
- No antibiotics "just in case"
- The AAO-HNSF guideline does not recommend antibiotics for neck lumps unless there is evidence of a bacterial infection.
- A needle, not an incision
- Fine needle aspiration is recommended instead of open biopsy when the diagnosis is unclear.
- Biopsy with a thick needle
- In a review of 16 studies (1,267 patients), it detected head and neck malignancies with 96% accuracy, but was not ideal for the thyroid gland. For lymphoma, in a meta-analysis of 22 studies (1120 patients), it provided a diagnosis sufficient to initiate treatment in 82.45% of cases.
02
If it is a cancer metastasis
Treatment of the neck is planned together with the treatment of the primary tumor.
- Finding the primary tumor
- If the source is not visible, British guidelines advise PET-CT, examination under anesthesia with targeted biopsies and removal of both palatine tonsils.
- Cervical dissection
- Surgery to remove groups of lymph nodes in the neck. Selective dissection, when only part of the groups are removed, is as effective as a wider modified radical for the neck without visible metastases.
- Irradiation and chemotherapy
- After surgery, due to unfavorable signs in histology, irradiation is added; when the tumor extends beyond the capsule of the node or the cut edge is not clean — chemoradiotherapy. Cancer of the pharynx and larynx is usually treated primarily with chemotherapy.
- Supervision at an unknown fire
- At least every 2 months for the first 2 years, then every 3-6 months, for a total of at least 5 years.
03
After neck surgery
- Shoulder and neck
- In a review of 75 articles, shoulder pain after selective dissection in various studies was experienced by 9–25% of patients, after radical the proportion was slightly higher; neck movement was limited in 1–13%. Preservation of the accessory nerve reduces this risk, but does not eliminate it.
- Rehabilitation
- The authors of the review advise explaining to the patient before the operation that such problems with the shoulder and neck are possible.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
At Dr. Valikhnovskyi's Institute of Surgery, soft tissue tumors of the neck are examined and removed in the "Soft tissue oncology" department. Cancer of the mouth, pharynx, larynx, thyroid gland and lymphoma is treated by a specialist oncologist: the clinic is responsible for its part - diagnosis, removal of soft tissue tumors and tissue restoration, and the treatment plan is drawn up together with the oncologist.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- MRI and biopsy with a thick needle — first MRI, then biopsy with histology; surgery is planned only after diagnosis.
- Consilium — the surgeon, oncologist, and radiation therapist decide whether preoperative treatment is necessary.
- 3D modeling — MRI and CT data are combined into a three-dimensional model to see the tumor in relation to blood vessels, nerves and bones.
- Single block deletion — the tumor of the soft tissues of the neck is removed together with a layer of healthy tissues; the edges are checked by a pathologist.
- A tumor near blood vessels and nerves — the affected vessel is replaced with a prosthesis or own vein, the nerve is plasticized if possible.
- Closure of the defect with a flap — if the wound cannot be simply sewn up, it is closed with a flap, often in the same operation.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Materials onlineSend the results of ultrasound, CT or MRI, puncture or biopsy and discharge - the doctor will pre-evaluate the situation.
- ConsultationExamination, examination plan: MRI, biopsy, if necessary, examination by a head and neck oncologist.
- Consilium and planThe surgeon, oncologist and radiation therapist determine what to do and in what order.
- SurgeryRemoval of the tumor and closure of the defect — according to indications, often in one operation.
- SupervisionHistology of the edges, if necessary - radiation or chemotherapy at the oncologist, regular examinations and pictures.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is an enlarged lymph node in the neck cancer?
Most of the time, no: the nodules get bigger because of a cold, sore throat, or other infection and go away in 1-2 weeks. But in an adult, a seal that does not go away, the instruction advises to consider it as a possible tumor, until the examination shows otherwise.
How long can you wait for the node to pass?
If it appeared during a cold - 1-2 weeks. If it grows, does not decrease in a week, or persists for more than 2 weeks, is firm or stationary, see a doctor. If the doctor suspects cancer, do not delay the examination: the British standard is to confirm or rule out cancer within 28 days.
Is it possible to drink antibiotics and see?
Only if there are signs of a bacterial infection. The AAO-HNSF guideline advises against prescribing antibiotics for unexplained neck lumps.
Why not just cut the knot?
The guideline advises first a puncture with a needle, and if there is no diagnosis, an examination of the throat under anesthesia with biopsies, and only then an open biopsy.
What is a metastasis from an unknown primary focus?
This is when cancer is found in a neck node, and the tumor from which it originates is not visible. They are looking for it with PET-CT, examination under anesthesia with biopsies and removal of tonsils.
What is a cervical dissection?
Surgery to remove groups of lymph nodes in the neck. After it, pain and limitation of movements in the shoulder are possible; nerve preservation reduces this risk.
Who will treat: a surgeon or an oncologist?
Usually together. A surgeon is responsible for biopsy, tissue removal and repair, and an oncologist and radiation therapist is responsible for chemotherapy and radiation therapy. The plan is made together.
Sources
16 sources · AAO-HNSF, ASCO, UK and NICE guidelines, reviews, NHSshowCollapse
- Clinical Practice Guideline: Evaluation of the Neck Mass in AdultsOtolaryngology–Head and Neck Surgery, 2017doi:10.1177/0194599817722550 ↗
- Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO GuidelineJournal of Clinical Oncology, 2020doi:10.1200/JCO.20.00275 ↗
- Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology, 2016doi:10.1017/S0022215116000591 ↗
- Management of neck metastases in head and neck cancer: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology, 2016doi:10.1017/S002221511600058X ↗
- Head and neck squamous cell carcinomaNature Reviews Disease Primers, 2020doi:10.1038/s41572-020-00224-3 ↗
- Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: A meta-analysis and systematic review of the literatureHead & Neck, 2012doi:10.1002/hed.21821 ↗
- Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta-analysisHead & Neck, 2020doi:10.1002/hed.26381 ↗
- Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysisClinical Otolaryngology, 2012doi:10.1111/j.1749-4486.2012.02464.x ↗
- Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic reviewEuropean Journal of Surgical Oncology, 2017doi:10.1016/j.ejso.2016.10.026 ↗
- Malignancy and “Violated Neck” Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck MassJournal of Craniofacial Surgery, 2024doi:10.1097/SCS.0000000000010122 ↗
- Suspected cancer: recognition and referral (NG12) — Recommendations organised by site of cancerNICE, 2026nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer ↗
- Suspected cancer: recognition and referral (NG12) — Terms used in this guidelineNICE, 2026nice.org.uk/guidance/ng12/chapter/Terms-used-in-this-guideline ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Swollen glandsNHS, 2023nhs.uk/symptoms/swollen-glands ↗
- Laryngeal cancer: SymptomsNHS, 2025nhs.uk/conditions/laryngeal-cancer/symptoms ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
Sealing on the neck
does not pass?
Send the results of ultrasound, CT or MRI, puncture or biopsy. The doctor will tell you what tests are missing and where to start.