Neck Masses: When to Seek Further Evaluation

Neck mass

Hello doctor, I discovered a lump below my neck, above the clavicle, in June.
Initially, a CT scan showed one lump measuring 0.3 cm and another 0.6 cm.
However, by September, an ultrasound revealed one lump measuring 3 cm and two others measuring 2 cm, all of which are hard and painless.
The doctor performed a fine needle aspiration during the ultrasound and said there were no cells, advising me not to worry.
Now, the 3 cm lump has developed a softer lump next to it, both located above the clavicle and below the neck.
Previous abdominal CT scans and ultrasounds were normal.
Should I be concerned about this, or is it acceptable to wait? Should I consider a biopsy, especially since there is a family history of cancer, with many relatives on my parents' side having passed away from cancer? I'm quite worried.

fire ex, 20~29 year old female. Ask Date: 2015/11/18

Dr. Zheng Jueyi reply Otolaryngology

Hello, if there are changes in size, you can discuss with your clinician whether a biopsy is necessary to confirm the diagnosis, or if continued monitoring is sufficient.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/11/18

More Info

When it comes to understanding neck masses, particularly in the context of your situation, it's crucial to approach the matter with caution and thorough evaluation. The presence of a neck mass, especially one that has changed in size or characteristics, warrants careful consideration and often further investigation.

In your case, you initially discovered a mass in the supraclavicular region, which has since increased in size from 0.3 cm and 0.6 cm to 3 cm and 2 cm. The fact that these masses are described as hard and non-tender is significant. Hard masses in the neck can sometimes indicate lymphadenopathy, which may be reactive (due to infection or inflammation) or indicative of more serious conditions, including malignancy.

The ultrasound-guided fine needle aspiration (FNA) biopsy you underwent, which yielded no cellular material, is a common first step in evaluating neck masses. However, the absence of cells does not always rule out pathology, especially if the mass is solid and has characteristics that raise suspicion. The emergence of a new, softer mass adjacent to the previously identified hard mass is particularly concerning and should not be overlooked.

Given your family history of cancer, it is understandable that you are feeling anxious about these findings. Family history can play a significant role in the risk of developing malignancies, and it is essential to communicate this information to your healthcare provider.
In general, the following factors should prompt further evaluation of a neck mass:
1. Size and Growth: A mass that is larger than 1 cm, particularly if it is growing, should be evaluated further.

2. Consistency: Hard, fixed masses that do not move with swallowing or are associated with other symptoms (like weight loss, night sweats, or fever) are concerning.

3. Duration: Masses that persist for more than two weeks without improvement should be investigated.

4. Associated Symptoms: Symptoms such as difficulty swallowing, changes in voice, or unexplained weight loss should raise red flags.

In your case, the increase in size and the appearance of a new mass, combined with your family history, suggest that further evaluation is warranted. A repeat imaging study, such as a CT scan or MRI, may provide more detailed information about the masses' characteristics and their relationship to surrounding structures. Additionally, a surgical consultation may be beneficial to discuss the possibility of an excisional biopsy, which can provide a definitive diagnosis.

In conclusion, while your physician may have initially deemed the masses as non-concerning, the changes you have described warrant a second opinion or further evaluation. It is always better to err on the side of caution, especially with a family history of cancer. Do not hesitate to advocate for your health and seek further testing to ensure that any potential issues are addressed promptly.

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