Patient information · ENT
Lump in the neck
most are harmless, and three weeks is the threshold
Most neck lumps are enlarged lymph nodes reacting to an infection, and they settle within a few weeks. The ones that matter are those that persist, and the rule that catches them is simple: an unexplained neck lump lasting more than three weeks needs examining, regardless of how well you feel.
Arrange urgent assessment if the lump is
- present for more than three weeks without an obvious explanation
- hard, fixed and painless, rather than soft and mobile
- growing, or larger than about 2cm
- accompanied by a hoarse voice, difficulty swallowing or persistent earache with a normal ear
- accompanied by unexplained weight loss, night sweats or fever
- accompanied by a mouth ulcer or red or white patch that has not healed in three weeks
A persistent neck lump can be the first sign of head and neck cancer or lymphoma, both of which are far more treatable when found early. Risk is higher with smoking, chewing tobacco, betel quid or paan, and heavy alcohol use. In an emergency — airway difficulty or rapid swelling — call 999.
The common harmless causes
- Reactive lymph nodes — small, tender, mobile, appearing with a sore throat, cold, dental infection or skin infection. They shrink over two to four weeks. The commonest cause by far.
- Sebaceous or epidermoid cysts — in the skin, sometimes with a central punctum.
- Lipoma — soft, doughy, mobile, slow-growing.
- Thyroid nodules and goitre — in the midline, moving up when you swallow.
- Salivary gland swelling — in front of or below the ear, sometimes worse before meals if a stone is blocking the duct.
- Branchial cysts and thyroglossal cysts — congenital, usually presenting in younger people.
Where it is tells you a lot
A lump that moves up when you swallow is thyroid. A lump in front of the ear is usually parotid gland. Lumps along the front edge of the neck muscle are commonly lymph nodes. A lump above the collarbone, particularly on the left, is taken especially seriously and always needs investigating. Tender lumps that appeared with an infection are usually reactive; painless hard lumps that appeared for no reason are the ones to act on.
What investigation involves
- Examination of the neck, mouth, throat, thyroid, skin and scalp — the source is often found somewhere obvious.
- Blood tests — full blood count, inflammatory markers, LDH, thyroid function, and tests for glandular fever, HIV or TB where relevant.
- Ultrasound — the first-line imaging test, distinguishing cystic from solid and assessing the characteristics of nodes and thyroid nodules.
- Fine needle aspiration under ultrasound where a sample is needed.
- Flexible nasendoscopy to examine the throat and voice box, particularly with hoarseness or swallowing difficulty.
- CT or MRI where further mapping is required.
In children
Small, mobile neck nodes are extremely common in children and usually reflect frequent viral infections — many healthy children have palpable nodes most of the time. Assessment is warranted for a node larger than 2cm, one that is growing, hard or fixed, one above the collarbone, or any node with fever, weight loss, night sweats or unusual bruising.
What not to do
Do
- Note when you first felt it, and whether it has changed
- Photograph it beside a coin for scale, to track size
- Mention smoking, alcohol, paan or betel quid use honestly — it changes the assessment
- Get it examined at three weeks even if you feel completely well
- Report any hoarseness, swallowing difficulty or ear pain
Do not
- Do not squeeze, press or repeatedly prod it — this makes nodes more tender and no smaller
- Do not assume painless means harmless — it is often the opposite
- Do not accept a second course of antibiotics for a lump that has not responded to the first
- Do not wait for it to become painful before seeking help
- Do not rely on a normal blood test alone
Why come to us. Three weeks is the threshold, and waiting for appointments can double that. We can examine you within days, take blood count, inflammatory markers, LDH, thyroid function and infection screening in-house with results the same visit, and perform ultrasound of the neck on site in the same appointment. Our ENT team can carry out flexible nasendoscopy in clinic, and we refer urgently through our CQC-registered partners where anything needs it.
Examined and scanned in one visit
Neck ultrasound and bloods on site, ENT nasendoscopy in clinic.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.