Feel a Neck Lump? See Your Doctor

Terminal cancer patient releases his first public service announcement (PSA) aimed at encouraging faster diagnosis of head and neck cancer.

It was November 25th, 2015, the day before Thanksgiving and I was working from home. After responding to some emails that morning, I got ready and tiptoed gingerly up and down the cold white tiles of our bathroom floor, waiting for the shower water to heat up.

In the mirror’s reflection, I suddenly noticed something different about the right side of my neck. Placing my hand there, I could feel a solid lump just under my jawline that was about 3 centimeters in diameter (see Figure 1). The left side of my neck appeared normal.

The bulge wasn’t there the day before, or I would have felt it while shaving. It was a solid mass and wasn’t sore at all to the touch. It didn’t feel warm and seemed tethered to its location.

Putting my shower on hold, I threw my sweatpants and t-shirt back on and hurried back to my computer to do a quick search on the medical literature website PubMed from the U.S. National Library of Medicine. I quickly came across one medical journal article that contained a startling statistic: More than 75% of lateral (side) neck masses in patients older than 40 years are caused by malignant tumors.

The same article continued with guidance that “in the absence of overt signs of infection, a lateral neck mass is metastatic squamous cell carcinoma or lymphoma until proved otherwise.” The results made me nervous enough to reach for the phone and call our family physician for an appointment that day.

The most common cause for enlargement of the lymph nodes is infection or inflammation. However, such lymph nodes are often swollen, tender, and mobile. They can also exhibit abnormal redness of the surrounding skin and feel warm to the touch. Other than being swollen, my enlarged lymph node didn’t have any of these other symptoms.

My physician prescribed an antibiotic and instructed me to follow up with an Ear, Nose, and Throat (ENT) specialist if the lymph node didn’t decrease in size or got worse after the weekend. Unfortunately, there was no change in the size of my lymph node and subsequent testing confirmed the diagnosis of advanced oropharyngeal squamous cell carcinoma (OPSCC).

I’m thankful that my physician gave me a short course of antibiotic treatment. An article from the American Family Physician suggests a 2-week trial of antibiotics and then referring the patient for a biopsy if no resolution. However, every delay of 1 week in the referral of an OPSCC patient to secondary care correlates with a more advanced cancer stage at presentation and is associated with poorer survival. Specifically, researchers estimate that for every 1 week of delay in referral, the stage of presentation will progress by 0.045 of ‘a stage’.

Call to action: Men and women over the age of 40 who discover a suspicious lump or mass on either side of their neck shouldn’t delay in seeking medical attention. Many patients should also avoid being treated by courses of antibiotics for weeks or months, as this causes a delay in referral to secondary care, generally to an ENT specialist. Don’t delay — get a suspicious neck lump checked out today!

Disclaimer: Michael Becker is not a doctor and does not have formal medical training. His commentary should not be construed as recommendations, endorsements, or medical advice.

Image
Figure 1: Self-portrait showing the neck mass (blue side) is visible


6 thoughts on “Feel a Neck Lump? See Your Doctor”

  1. Thank you, Michael, for your PSA. I will be posting it to facebook and twitter. I found my own lump in precisely the same way that you did, but my primary care physician jumped on it and sent me for imaging immediately. You know the story after that.

    I hope that you are comfortable these days and as pain-free as possible. I’m still sending you healing vibes since healing comes in so many different ways.

  2. Thank you, Michael, for all you do to keep awareness of HPV cancer. Sending warm thoughts and vibes your way. Bless you, Humphrey and your beautiful family.

  3. David had surgery the day after Thanksgiving Day to remove lymph nodes and mass at base of tongue. In spite of….it was present in lymph nodes of lungs six months later. Six more months, give or take…a seizure found it in brain. David left us in Dec. After severe reaction to 5fu which left him unable to eat.

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