While showering or looking in the mirror, you might unexpectedly feel a small lump in your neck. Most people dismiss it thinking, "Maybe I'm just tired lately" or "It'll probably go away in a few days," but a newly developed neck lump in an adult requires more careful observation.
In fact, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) explicitly states that for any newly developed neck lump in an adult that "persists for more than 2 weeks or gradually increases in size, a medical evaluation is absolutely necessary." This is because a neck lump could be a simple inflammatory reaction, but it could also be an early signal of various diseases such as thyroid, salivary gland, lymph node, or head and neck tumors.
Lumps felt in the neck are largely divided into four causes. First, reactive lymph node hypertrophy that temporarily increases due to inflammatory reactions such as colds, pharyngitis, or tonsillitis. This often changes in size within a few days and is accompanied by pain. Second, lumps due to thyroid nodules or goiters. These are commonly found on ultrasound, and some may be a form of thyroid cancer, requiring Fine Needle Aspiration (FNA). Third, salivary gland diseases. This is when a hard lump is felt in the area of the parotid gland (under the ear) or submandibular gland (under the jaw), with various causes ranging from benign salivary gland tumors to rarely malignant ones. Fourth, it could be an early signal of a head and neck tumor, i.e., a malignant tumor occurring in the neck, jaw, tonsils, or base of the tongue. In particular, firm lumps that are painless and gradually increase in size must be evaluated.
▲ Dr. Jung Kwang-yoon (Photo provided by Min Hospital)
Let's look at a case that demonstrates the danger of not taking a neck lump seriously. A, a man in his 50s, felt a lump under his right jaw a month ago but dismissed it because there was no pain. He thought it had occurred due to a cold and would disappear over time. However, as result of an ultrasound examination during a health checkup, a possibility of a salivary gland tumor was seen, and it was confirmed as a benign salivary gland tumor through Ultrasound-Guided Fine Needle Aspiration (FNA).
Like this, lumps felt in the submandibular or parotid gland area in most adults can show lesions such as salivary gland tumors in addition to simple lymph node hypertrophy. In fact, an international multicenter study published in the journal 'Head and Neck Pathology' in 2022 also mentioned that while about 60-70% of salivary gland tumors are benign, salivary gland cancer also occurs rarely. This patient was fortunately discovered early and was able to recover without problems through surgical treatment, but if he had delayed any longer, it could have increased in size or invaded surrounding nerves and tissues.
One cannot be relieved just because a lump doesn't hurt. Inflammatory lumps usually involve pain and tend to change in size within a few days, but malignant tumors are often firm and grow gradually without pain. However, judgment cannot be made based on the presence of pain alone, and systemic symptoms such as location, firmness, mobility, size change, fatigue, and weight loss must be evaluated together.
The two most important tests for an accurate diagnosis are neck ultrasound and Fine Needle Aspiration (FNA). Ultrasound is very useful in the first evaluation as it can check the size, blood flow, and tissue characteristics of the lump in real-time. FNA is a test that extracts cells with a thin needle to check for cancer, and it is highly accurate and has little pain, so it can be safely performed even in outpatient settings.
So, in what cases should you definitely visit a hospital? If a lump is felt for more than 2 weeks, if the size is gradually increasing, if a firm lump has appeared without pain, if other symptoms such as voice changes, swallowing discomfort, or weight loss are accompanied, and for adults with a history of smoking and drinking, a medical exam is absolutely necessary.
Dr. Jung Kwang-yoon, medical director of Min Hospital, explained, "Lumps felt in the neck are common, but their causes are so diverse that it is difficult to judge for oneself. Ultrasound and Fine Needle Aspiration are essential tests for an accurate diagnosis, and as malignant tumors can be discovered in some cases, early diagnosis is important."
He added, "Dismissing a small lump can be the cause of missing the treatment timing. A lump in the neck can be the starting point for various diseases, from simple inflammatory reactions to thyroid, salivary gland, and parotid gland tumors, and even the first signal of head and neck cancer. If an accurate diagnosis is made early, it helps reduce unnecessary anxiety and decide on necessary treatment at a more appropriate time."