Neck Masses

by Dr. Christopher Chang, last modified on 4/17/21.

Neck masses are something that affects people of all ages. Understandably, such masses are of great concern for patients. This webpage is to provide information on what some of the causes of various types of neck masses are. If you have only a sensation of a lump in your neck without actually being able to see or feel it with your fingers, click here for more information. If you have a bump or lesion inside your mouth, click here instead.

If the neck mass is in a child, click here for more specific information.

As a general rule of thumb, physicians do not consider a neck mass "significant" until it reaches at least 1.5cm in size. Neck masses <1.5cm are generally observed unless there are other findings that increase level of concern.

Regardless of size, there are three basic classes of neck masses and based on where the mass is located, can help guide a physician to a specific diagnosis. The three classes are:

Neoplastic (Cancer) • Benign Masses • Infectious

Based on physical exam findings, follow-up studies may be obtained including endoscopy, cultures, fine needle aspiration, ultrasound, CT/MRI scans, and/or bloodwork.

Watch Video on "How Long Do Biopsy Results Take"

Neck Masses Due to Cancer

When a neck mass pops up due to cancer, it almost always is due to spread from some other location such as the tonsil, throat, tongue, lung, etc. The one exception is lymphoma which can pop up anywhere. Based on where the neck mass is, one can guess where the most likely location of the main cancer to be... and a vigorous search for the main cancer needs to be performed by your physician. Such a "vigorous search" may include endoscopy, CT/MRI scans, chest X-rays, bloodwork, etc. Some signs that suggest a neck mass may be due to cancer include pain, rock hard (indurated), fixed in position (immobile), adherent to surrounding tissues/muscles, and slowly enlarging. Biopsy is required for diagnosis.

Risk of cancer increases if you smoke, drink alcohol, suffer from reflux, etc. More info on risk factors here. Using a calculator, a specific risk of cancer can be calculated based on all symptoms present and physical attributes.

A: Cancer of the nasopharynx, parotid gland

B: Cancer involving the submandibular gland, anterior 2/3 of tongue, floor of mouth, gums, or oral cavity mucosa

C: Lip cancer

D: Cancer of the nasopharynx, posterior scalp, ear, temporal bone, skull base

E: Cancer of the oral cavity, pharynx, tonsil, base of tongue, larynx

F: Cancer of the thyroid, pyriform sinuses, upper esophagus, lung

G: Cancer of the thyroid

Neck Masses Due to Benign Masses

There are some benign (non-cancerous) masses that can occur literally ANYWHERE in the neck. Such benign masses include cysts, inflamed lymph nodes, and lipomas and as such are not listed below. In kids, other benign masses that can occur anywhere include lymphatic or vascular malformations. However, other kinds of benign masses generally occur within certain well-delineated areas of the neck. Biopsy can confirm diagnosis.

A: Parotid gland tumors (ie, pleomorphic adenoma, Warthin's tumor)

B: Parotid gland tumors (ie, pleomorphic adenoma, Warthin's tumor), glomus jugulare (paraganglioma)

C: Submandibular gland tumors (ie, pleomorphic adenoma, Warthin's tumor)

D: Lymphadenitis

E: Branchial cleft anomalies, carotid body tumors (paraganglioma), schwannomas

F: Thyroglossal duct cysts, laryngocele

G: Thyroid cysts, goiter

Neck Masses Due to Infection

The vast majority of infectious causes of neck masses is due lymphadenitis, otherwise known as inflamed lymph nodes due to infection somewhere else in the head and neck region. Lymphadenitis can occur ANYWHERE in the neck. If the lymphadenitis gets bad enough, a neck mass may turn into a neck abscess. However, other underlying infectious processes may be going on contributing to a typically painful neck mass with overlying skin that is red and tender in certain discrete areas of the neck. Each of these processes may also turn into an abscess if it gets bad enough. Biopsy is usually not necessary.

A: Mastoiditis

B: Parotitis

C: Submandibular sialadenitis

D: Branchial cleft anomaly infection

E: Infected thyroglossal duct cyst

F: Thyroiditis

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Neck Masses

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