Neck

Growths in the neck can be divided into the following categories: 1) Lymph nodes, 2) Thyroid, 3) Salivary Glands and 4) Other. The other category includes many different benign and malignant solid tumors as well as infectious abscesses which can originate from primary infections of the throat or the teeth. Congenital cysts which are remnants from the in-utero phase of life which can persist and cause problems with swelling and infection also occur in the neck.

Lymph Nodes

Lymph nodes are found all over the body and are very numerous in the neck. They are the 'factories' of the immune system. When the body is fighting infections and other illnesses the lymph nodes swell up and begin to produce antibodies. This is normal. The 'swollen glands' of the child who has a lot of tonsil infections are like lymph nodes. Typically after the infection has resolved they shrink back down to the point where you cannot feel them. Occasionally the lymph nodes can remain at their large size. These are called reactive lymph nodes.

Lymph nodes can also swell due to the presence of cancer. For cancers of the head and neck like throat or larynx (voice box) cancer, the lymph nodes of the neck are the first region that it spreads to. Lymphoma, which is a cancer of the immune system, also may lead to lymph node enlargement. Lymph nodes that are suspicious for cancer are firm, generally not tender, and do not fluctuate in size.

Evaluation of enlarged lymph nodes can include a trial of antibiotic therapy to see if they will decrease in size, CT scan to determine how many nodes are enlarged, or Fine Needle Aspiration biopsy. In some cases open lymph node biopsy is necessary.

Salivary Gland Obstruction

Salivary gland obstruction can be caused by stones (like kidney stones), or by swelling from acute or chronic infection, or by scarring. Within the salivary gland, saliva is produced in small cell sacs and is passed through larger and larger ducts combining together until the saliva passes through the main duct into the mouth. When blockage of this duct system occurs from whatever cause, the saliva cannot pass. The typical history is of pain and swelling of the involved glandular area with salivation. This is most commonly occurs during oral intake or even with the aroma of food.

Treatment includes antibiotics, increased water intake, duct dilation for stone removal, and in cases where medical treatments do not control the problem, surgical removal of the gland

Salivary Gland Tumors

There are a number of different types of solid tumors that can affect the salivary glands. The most common ones are benign (not cancer). There are several types of malignant (cancerous) tumors that can occur. Solid tumors are generally not painful. They generally do not cause duct obstruction. They are usually firm to the touch and over time increase in size, although not rapidly.

There are a number of diagnostic tests that can be performed including Fine Needle Aspiration (FNA) biopsy, and imaging studies. These studies can either increase or decrease our suspicion that there is a cancer present. In some cases the FNA will diagnose that a cancer is present and then the treatment for cancer begins. Usually the FNA will report whether the cells look normal or abnormal which can either increase or decrease our suspicion for malignancy. Ultimately the only way to be 100% certain whether cancer is present or not is to surgically remove the gland and have it examined in the laboratory.

Salivary Glands

There are three pairs of major salivary glands, the Parotid gland which is located in the side of the face just in front of the ear, and the Submandibular gland which is located behind the chin along the inner aspect of the mandible (jaw bone), and sublingual glands, which are located under the tongue.

There are two types of problems that can affect the salivary glands: obstruction and tumors.

Thyroid

The thyroid gland is located at the base of the neck, just above the collar bone. It is shaped like a bow-tie and produces thyroid hormone. Thyroid hormone functions to regulate the rate at which biochemical reactions take place in the body. The most common form of thyroid hormone in the blood stream has a long half-life; If the thyroid gland were to suddenly disappear, it would take 3-4 weeks for the person to feel any symptoms. If the thyroid gland produces too much hormone there is a hyperthyroid condition, if it produces too little hormone there is a hypothyroid condition.

Nodules can develop in the thyroid gland. These nodules do not generally affect the level of thyroid hormone. However, occasionally there can be a nodule that produces excessive amounts of thyroid hormone, and thus cause a hyperthyroid state.

Thyroid cancer cannot be diagnosed with a blood test. Thyroid nodules are much more common in women than in men. Most thyroid nodules, approximately 85%, are benign Cancer occurs about 15% of the time.

The evaluation includes ultrasound of the thyroid, thyroid uptake and scan, and Fine Needle Aspiration (FNA) of the thyroid gland. In most cases these results will either increase or decrease our suspicion that there is cancer present. There are various options on how to manage these nodules. The unique plan for each patient includes the following: level of suspicion of cancer (including family history, imaging/biopsy characteristics, etc.), patient condition, and patient preferences (different people have different tolerance levels for undergoing surgery vs. observation). Thorough discussion and communication between doctor and patient is key in coming up with a plan. In general, the only way to be 100% certain about the diagnosis is to have an open biopsy of the gland and remove the affected lobe to allow for detailed pathological analysis.

If the FNA result is positive for cancer, then we proceed with the treatment for cancer which is surgical removal of the entire thyroid gland, and possibly the surrounding lymph nodes.