Why Do I Have a Lump in My Neck?

According to Dr. Cannon, most reasons for a lump in your neck are not life-threatening. The most common cause is swollen lymph nodes due to a virus or an infection like tonsillitis or strep throat. This is a standard immune system response that occurs when your body works to fight off sickness. A recent or active fever points to this as the culprit. Other possibilities include thyroid nodules, cysts, or benign (non-cancerous) tumors or other growths such as fluid-filled sacs called lymphangiomas or hemangiomas, vascular birthmarks comprised of extra blood vessels.

“In terms of potential red flags, we’re looking for lumps that have been present for more than two weeks and are not associated with signs or symptoms of infection,” Dr. Cannon said. “There’s also a higher risk if you’re older than 40, the lump is bigger than 1.5 centimeters (about the width of your index finger) in diameter, you have multiple lumps, the lump has skin changes or ulcers, or if a lump is attached to surrounding tissues.”

Certain types of cancer can cause a lump in your neck. These include:

• Laryngeal (voice box) cancer
• Lymphoma
• Oral cancer
• Oropharyngeal cancer
• Salivary gland cancer
• Skin cancer (melanoma and non-melanoma)
• Thyroid cancer

If the lump in your neck hasn’t gone away in a few days, make an appointment with your primary care doctor or visit an urgent care. Tell them about any recent cold symptoms, contact with sick people, Covid exposures, drenching night sweats, difficulty swallowing or speaking, breathing problems, pain in your ears or throat, and unanticipated weight loss. This information can help your doctor identify the underlying cause, Dr. Cannon said. 

Your primary care doctor may prescribe antibiotics to treat a bacterial infection that could be causing your lymph nodes to swell. However, if the lump persists after one round of antibiotics, it’s critical to make an appointment with an ear, nose, and throat doctor (ENT) who specializes in head and neck surgery, ideally within two weeks, Dr. Cannon said. This is especially important if you’re over 40, smoke or use other tobacco products, or drink alcohol, since these factors increase your risk of head and neck cancer.

An ENT may recommend a needle biopsy to diagnose the lump. During this procedure, your doctor uses a syringe to collect cells from your lump or a nearby lymph node. The sample is tested in a laboratory for the presence of cancer. 

An ENT may recommend surgery to remove the lump in your neck, but not until after performing a thorough exam and testing to determine exactly what the lump is and the best approach to treatment.

Be wary of doctors who suggest surgery without an established diagnosis. “If your doctor wants to cut the lump out to make a diagnosis, that's not appropriate, just in case it is cancer,” Dr. Cannon said. Doing so makes it more difficult to stage the cancer, meaning how advanced it is and whether it has spread. Premature surgery can also make treatment more complex and increase your risk of complications, including spreading the disease, and could disqualify you from participating in clinical trials.

If your neck mass persists and is associated with worrisome signs and symptoms, it is important to seek care from a specialist who sees and treats a lot of neck masses. “It is important to follow certain steps in the diagnosis and treatment of neck masses,” Dr. Cannon said. “You can be certain that the head and neck surgeons at Duke are qualified to give you the best advice and care.”