Lumps and Swellings
Lumps / Swellings
A common presenting symptom is of noticing a lump in the neck. Due to the complicated nature of the anatomy of the neck (see Head and Neck Structure and Function) there are numerous possible structures that a lump could arise from. The lump could be benign (not cancer) or malignant (cancer).
Ultrasound is an excellent way of investigating neck lumps and looking at the thyroid gland. The cause of the lump and the site it has arisen from can usually be identified.
The scan is similar to pregnancy scans and is entirely painless. A gel is placed onto the skin and a doctor moves the probe across the skin while looking at the images on a monitor. On occasions the doctor may decide that a fine needle aspiration is necessary to obtain more information (see below)
Computed tomography (CT) is a medical imaging method using X-ray tomography created by computer processing. It provides important diagnostic information in various anatomical planes. The main advantage over MRI scanning is that it demonstrates bone as well as soft tissue features. A temporal bone CT scan will therefore show details of sinus and jaw bone problems. Airway problems and head and neck cancers are well demonstrated on CT scanning.
The scanning technique involves lying still with the head in a medical “hair-dryer” capsule for approximately 20 minutes. It is a completely painless procedure.
Sometimes it is necessary to take a tissue sample from a skin lesion or lesion in the mouth or throat.
This can often be done in clinic, but occasionally a hospital admission with general anaesthetic is required. If it is performed in clinic, local anaesthetic is first injected to numb the area. Then a sample is taken with either a small punch or forceps. There may be a small amount of bleeding which usually settles quickly. The sample has to be processed and then carefully examined by a doctor called a histologist afterwards. This means the result may take several days to come back.
Fine Needle Aspiration (FNA) Biopsy
Neck and thyroid lumps may be easily palpated and seen on scans, but frequently it is necessary to take a sample of cells from the lump to determine its exact nature. FNA can often distinguish between benign and malignant neck lumps and cysts.
FNA is often performed with ultrasound guidance to ensure that an accurate sample is taken. Local anaesthetic is usually injected to numb the skin, and then a thin needle is inserted through the skin into the lump. The needle may need to be moved in and out of the lump 3-4 times to obtain an adequate sample and is then withdrawn from the skin. A small amount of bleeding can occur briefly afterwards and occasionally some tenderness or bruising can last a few days. The sample has to be processed and then carefully examined by a doctor called a cytologist afterwards. This means the result may take several days to come back. Occasionally the sample may be inadequate and a repeat sample may be required. This occurs in less than 10% of samples.
There are numerous tests that can be performed on a single blood sample to diagnose many diseases.
Despite a large number of tests being requested, usually only one sample of blood is required. A very small needle is used to draw a few mls of blood from a vein just under the skin. Usually this is taken from the arm. Anaesthetic cream can be used first if requested but is not generally required. Depending on the tests the results may take from a few hours to several days to be processed.Book Appointment