Neck lumps

A neck lump is any swelling or lump you can feel in your neck, which can range from pea-sized to much larger. Most neck lumps are harmless, often caused by an infection, and settle down on their own within a few weeks.

What causes neck lumps?

• Infection (the most common cause) – colds, tonsillitis, ear or chest infections, dental infections and abscesses, glandular fever, and other viral or bacterial infections can all cause nearby lymph nodes to swell.
• Salivary gland problems – a blocked duct (often from a small stone) can cause swelling that comes and goes, especially around mealtimes; infections such as mumps can also cause swelling.
• Thyroid gland problems – such as a goitre (enlarged thyroid), thyroid nodules or cysts.
• Skin problems – such as a sebaceous cyst, a boil or abscess, or a skin tag.
• Non-cancerous (benign) growths – such as a lipoma (a soft fatty lump) or a cyst you were born with, such as a thyroglossal or branchial cyst.
• Cancer – a less common cause, including lymphoma, leukaemia, thyroid cancer, or cancer that has spread from elsewhere, such as the mouth or throat.

Are there different types of neck lumps?

Neck lumps can feel and behave differently depending on their cause and where they sit in the neck. This can offer clues, though a doctor's examination is needed to be sure.

• Swollen lymph node – often pea- to grape-sized, rubbery and able to move under your fingers, sometimes with pain, heat or redness.
• Salivary gland swelling – tends to come and go, often swelling up around meals.
• Thyroid lump – sits at the front, lower part of your neck, and moves up and down when you swallow.
• Thyroglossal cyst – present from birth, and moves when you stick out your tongue.
• A hard, painless, craggy lump that has grown steadily over a few weeks – needs checking, as this pattern is more often linked to something more serious.

How are neck lumps diagnosed?

Your doctor will ask about the lump: how long you've had it, whether it came on suddenly, and whether you have other symptoms, such as tiredness, night sweats, unexplained weight loss or bruising, or recent travel. They'll then examine the lump and its location, and may ask you to swallow or stick out your tongue, since some types of lump move in a characteristic way.

The following investigations may be considered:

• Blood tests – to check your thyroid function, or to look for infections such as glandular fever, or for lymphoma or leukaemia
• Ultrasound scan – to look at the structure of the lump in more detail
• Biopsy – a small sample of tissue or cells is taken and checked under a microscope, if there's any concern the lump could be cancer
• Chest X-ray – sometimes used, depending on what's suspected.

Not every lump needs tests. If the cause seems clear, such as a soft, reactive lymph node alongside a cold, your doctor may simply advise waiting to see if it settles on its own.

How are neck lumps treated?

Treatment depends completely on the cause, so there's no single answer.

• Reactive lymph nodes (from an infection) – usually need no treatment themselves and settle once the infection clears; the infection itself may need treating, for example with antibiotics.
• An underactive thyroid – treated with a replacement thyroid hormone called thyroxine.
• A blocked salivary gland – the stone or blockage can be removed to relieve the swelling.
• An abscess – drained, often alongside antibiotics.
• Some benign lumps, such as large lipomas or skin growths – may be removed with a minor operation, though small ones causing no problems don't necessarily need removing.
• Cancer – treatment depends on the type, and may include surgery, chemotherapy or radiotherapy (high-energy rays that destroy cancer cells).

When should you see a doctor?

See a doctor about any neck lump that doesn't settle down within about 4 weeks. See a doctor sooner if the lump:

• Feels hard, solid or craggy, rather than soft and squashy
• Doesn't move freely when you press on it
• Has been growing steadily
• Is greater than 1cm in diameter
• Is not painful or tender (painless lumps are sometimes more of a concern than painful ones).

See a doctor as soon as possible if a neck lump comes with any of the following:

• Losing weight without trying to
• A hoarse voice for more than 3 weeks
• Night sweats
• Difficulty swallowing
• Feeling out of breath, or coughing up blood
• Persistent tiredness or bruises you can't explain
• A lump just above your collarbone, particularly on the left side.