Enlarged Neck Node

Please visit

https://www.sleepclinc.com.au

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

Epidemiology

> 40 Yr neck node is a malignancy Unless proven otherwise, M>F

>40 Yr Cystic mass in the neck is a degenerated cancer node, not a branchial cyst until proven otherwise

In the young -Inflammatory more likely, if cystic- branchial cyst

Aetiology

Most common mets are SCC > others ie thyroid/ adeno Ca/ melanoma

SCC=Primary sites nasopharynx > tonsil > retromolar trigone > tongue base > piriform sinus Then outside head and neck

Primary lymphoma-less common

Inflammatory; bacterial/ viral/ TB should be considered)

Signs and Symptoms

Hx suggestive more of an inflammatory node are : acute onset, painful, resolving, younger patient

Hx suggestive of a neoplasm- progressive enlargement, generally non tender, SCC hard, may get cystic degeneration Lymphoma rubbery.

Ask about symptoms of a possible primary site;  
                                                                                                      -upper aerodigestive tract: Dysphagia, Otalgia due to referred pain 
-Skin CA
-Thyroid cancer/risk of cancer

Examination

Node or nodes: what is the consistency, is it very tender(inflammatory)

Look for a primary site (oral cavity, oropharynx, Flexible scope: nsopharynx, Hypopharynx, larynx, skin, thyroid, melanoma)

If a low neck node look for a primary breast/ chest/ GI/ testicular origin

Investigation

If acute onset may observe/ do blood work up check for EBV, CMV etc

US guided FNAC: (if any possibility of neoplasm) : do all the stains-Cytokeration-SCC, Lukocyte antigens-lymphoma, HMB45, s 100-melanoma, Thyroid AB

Also consider TB culture on FNA

If non diagnostic need and excisional biopsy and through look for a primary site i.e. Panendoscopy & blind biopsies of nasopharynx, tongue base, tonsillectomy (wide resection)

Cystic mets have poor FNA diagnostic yield and do need excisional biopsy (cyltic node in an adult is a cancer unless proven otherwise;NOT a branchial cyst!)

If low cervical nodes/ adeno CA on FNA: work up for non head and neck primary (chest/ prostate/ renal/ GI/ breast)

Treatment

Metastatic SCC; Neck dissection, treatment of the primary site and XRT +/- Chemotherapy

If Thyroid: need total thyroidectomy, neck dissection and post op radioactive treatment

if Lymphoma -CHOP etc