19 July 2017
Professor John Watkinson, a Consultant ENT/Head and Neck and Thyroid Surgeon at Spire Parkway Hospital, has published on all aspects of Head and Neck surgery, as well as having been the President of the British Association of Endocrine and Thyroid Surgeons (BAETS) from 2011 to 2013.
Here he answers questions on what you should do if you notice a lump in the neck or throat area.
Q: Are all lumps in the neck or throat area dangerous?
The majority of lumps in the neck and thyroid areas are benign (non-cancerous). However, it is best to exclude serious pathology which would begin with a history and clinical examination. If there was any cause for concern referral to an ENT surgeon would facilitate further investigation to include nasopharyngoscopy and, usually, some form of imaging (ultra-sound plus or minus fine needle aspiration cytology (FNAC), CT or MRI scans.
Q: What parts of the neck and throat are most affected?
Commonly within the upper aero-digestive tract, the mouth, pharynx and the larynx (voicebox) are the areas commonly affected. Within the neck swellings usually occur in named organs such as the parotid, submandibular and thyroid glands together with lymph node swellings.
Q: Should I always visit my GP on noticing such a lump?
Any persistent symptom such and hoarseness, a sore throat or a neck swelling that has been present for more than a month would warrant a visit to your GP. This would be particularly so in the presence of other symptoms such as weight loss, night sweats, or any difficulty with breathing or swallowing.
Q: What are common causes of such lumps?
There are a number of risk factors associated with neck lumps and it is important to remember that the majority are benign. Infection is a common cause within cervical lymph nodes and the majority of swellings within the organs mentioned above are usually benign. Risk factors for malignancy include age, smoking, alcohol consumption, sunlight exposure and, more recently, exposure to the HPV virus which is currently the cause of the increased incidence of throat cancer in young people.
Q: What is the likelihood of them being cancerous?
Most swellings will turn out to be non-malignant with causes that include infection, benign and congenital abnormalities. Occasionally cancers are encountered when the incidence is between 10 and 20 percent.
Q: What age groups tend to be most affected?
The middle-aged and elderly but always be aware and concerned about swellings at the extremes of life.
Q: If they are cancerous what treatments are available?
Most tumours are amenable to primary surgery or irradiation depending on stage and site. Those with advanced stage are usually treated with primary surgery combined with post-operative radiotherapy, although some tumours have primary chemo-radiation up front, and in the case of most thyroid tumours, they have surgery with post-operative radio-iodine.
Q: How successful are these treatments?
Success depends on a number of factors which include stage at presentation, mode of treatment, treatment expertise and HPV status. Survival figures currently, for head and neck and thyroid malignancy, are very good, with the majority of patients achieving excellent five year survival rates and good quality of life.
Q: Are there any ‘breakthrough’ treatments being worked on at the moment?
More conservation surgery, together with transoral robotic surgery for primary tumours and primary and adjuvant chemo-radiation. Current research suggests immunotherapy is going to have an increasing role in the future.
Q: How is cancer treatment for the throat and neck likely to develop over the next ten years?
Earlier detection and awareness of risk factors, more conservation surgery with targeted chemo-radiation and HPV vaccination for boys.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.