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* What features suggest a neck lump needs referral?
* How can the GP differentiate between the various types of lumps seen in or related to the thyroid gland?
* What behaviours predispose to head and neck cancers?
A patient presenting with a mass in the neck can be a diagnostic challenge to the GP. The differential diagnosis of a neck mass is extensive, encompassing all the intricate neck structures.
Furthermore, the aetiologies range from benign, self-limiting processes to life-threatening malignancies, and it is therefore important to be able to recognise the warning symptoms and signs of a dangerous disorder to ensure prompt diagnosis and reduce morbidity.
* Epidemiology A `neck lump' is a common clinical finding, and in practice is usually the result of inflammation caused by a self- limiting bacterial or viral infection, which resolves within weeks.
The most serious causes, the head and neck cancers, are frequently related to smoking and alcohol consumption.
There is evidence to suggest that alcohol and smoking are synergistic risk factors. Dietary factors, occupational causes (such as hardwood furniture and nasal fossa adenocarcinoma) and viruses have also been implicated. There is a 10:1 male: female ratio in carcinoma of the larynx, and 2:1 in other sites with a slight female preponderance in post-cricoid carcinoma.
* Clinical approach A careful history and physical examination is essential, along with a basic understanding of the normal neck anatomy. It is important to recognise the location of major neck structures along with the lymphatic drainage, which helps in differentiating normal from abnormal structures.
Unless it is obvious that the mass is inflammatory and associated with a throat or upper respiratory tract infection, all neck masses should be documented by their position, size, tenderness, fixation, compressibility, displacement, consistency and the presence of bruit and thrills. A thorough examination of all the mucosal surfaces of the upper aero-digestive tract is important.
* Differential diagnosis of a neck mass It is often helpful to consider a differential diagnosis based on the age of the patient and location of the mass.
The vast majority of children presenting with a `neck mass' are found to have cervical adenitis. If an isolated mass is identified, it is often a result of inflammation or a congenital cause.
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