Neck Pain and Lumps: When to Consider Surgery

Ultrasound of the neck has been performed?

Hello, Doctor.
On June 1st, I suddenly experienced severe pain in my neck and felt a lump that was oval-shaped and soft, resembling a gummy candy.
I visited a clinic where the doctor prescribed antibiotics for a week, but after finishing the medication, the lump did not decrease in size.
On the 12th, I went to a larger hospital for further examination.
The doctor performed a physical exam and suggested that surgery might not be necessary, recommending regular follow-up and monitoring instead.
They scheduled an ultrasound for a week later and a follow-up appointment in two weeks.
However, the pain suddenly became unbearable and the lump increased slightly in size, so I decided not to wait that long and went to another hospital on the 19th.
After taking antibiotics for over a week, the ultrasound on the 22nd showed some pain but the lump had slightly decreased in size; however, it still resembled a round gummy candy.
During the follow-up, after reviewing the ultrasound and blood test results, the ultrasound revealed numerous lymph nodes in the right side of my neck, and the blood test indicated low white blood cell count and poor immune function.
When I asked the doctor about the findings, they were uncertain about the cause.
I inquired if it could be cancer, and the doctor suggested it might be, but they were not sure.
Due to the number of lymph nodes, they recommended surgery to remove one for further testing.
I would like to consult Dr.
Ji regarding whether surgery is truly necessary in my case and if my situation genuinely resembles cancer.

Lily, 20~29 year old female. Ask Date: 2020/06/29

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, it is most likely that the cervical lymphadenopathy is accompanied by inflammation, which is often treated with medication, including antibiotics if necessary.
However, if the swelling in the neck continues to progress and leads to a deep neck infection, antibiotics and other medications must be administered.
If the neck mass does not resolve, a nasopharyngolaryngoscopy may be performed to rule out tumors, along with a neck ultrasound, and sometimes fine needle aspiration may be combined.
If a definitive diagnosis cannot be made, surgery may be arranged to excise the mass for pathological examination.
Typically, at this stage, the cause can be almost completely diagnosed.
It is advisable to consult an otolaryngologist to arrange appropriate examinations as needed.
Wishing you peace and good health.
Ministry of Health and Welfare Taichung Hospital.

Reply Date: 2020/06/29

More Info

When it comes to neck pain and the presence of lumps, particularly in the context of swollen lymph nodes, it is essential to approach the situation with careful consideration and a thorough understanding of the potential underlying causes. Your symptoms, including the sudden onset of neck pain and the discovery of a soft, gummy-like lump, warrant a detailed evaluation, especially given the subsequent findings of multiple swollen lymph nodes and low white blood cell counts.

Initially, the treatment with antibiotics suggests that your healthcare provider was considering a possible infectious etiology, such as a viral or bacterial infection that could cause lymphadenopathy (swollen lymph nodes). The fact that the lump did not resolve with antibiotics indicates that the cause may not be purely infectious. The persistence of the lump, along with the increase in size and the associated pain, raises concerns that necessitate further investigation.

The ultrasound findings revealing multiple lymph nodes in the neck are significant. Lymphadenopathy can occur due to various reasons, including infections, inflammatory conditions, and malignancies. The low white blood cell count and the physician's uncertainty regarding a potential cancer diagnosis add another layer of complexity to your case. While the presence of swollen lymph nodes can be associated with cancer, it is important to note that not all lymphadenopathy is indicative of malignancy. Conditions such as autoimmune diseases, chronic infections, or benign reactive lymphadenopathy can also lead to similar findings.

Regarding the recommendation for surgical intervention, the decision to proceed with surgery to remove a lymph node for biopsy is often based on several factors, including the size of the lymph node, its characteristics on imaging studies, the duration of symptoms, and the overall clinical picture. A biopsy can provide definitive information about the nature of the lymph node, helping to rule out or confirm malignancy.
In your case, given the persistence of symptoms, the increase in size of the lump, and the concerning laboratory findings, it may be prudent to consider the surgical option. A biopsy can help clarify the diagnosis and guide further management. If the biopsy indicates a benign process, you may be reassured and managed conservatively. Conversely, if malignancy is confirmed, early intervention can be crucial for effective treatment.

It is understandable to feel anxious about the possibility of cancer, especially when faced with such symptoms. However, it is essential to remember that many conditions can cause similar presentations, and a definitive diagnosis can only be made through appropriate testing. Engaging in open discussions with your healthcare provider about your concerns, the rationale for surgery, and the potential outcomes can help alleviate some of the anxiety associated with this situation.

In summary, while surgery may seem daunting, it is often a necessary step in diagnosing the underlying cause of persistent lymphadenopathy and neck pain. The information gained from a biopsy can be invaluable in determining the appropriate course of action, whether that involves further treatment or reassurance. It is crucial to follow up with your healthcare provider, adhere to their recommendations, and ensure that you receive the necessary care and support during this challenging time.

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