Swelling in Neck : What to do ?

Dr. K.K. PANDEY Senior Vascular & Thoracic Surgeon Indraprastha Apollo Hospitals Sarita Vihar, New D

During your childhood or at young age, you would have noticed a protruding swelling or solid tumour like growth that persisted for a week or two and then suddenly the growth disappeared. You would have also noticed that along with the growth you also suffered from cough, cold and fever. No sooner than cold and cough ended, the swelling too disappeared. Sometimes swelling in the neck never subsides whatever you do even after taking a full course of antibiotic and other supportive medications. Sometimes the swelling in the neck start increasing in size gradually. If your protruding neck swelling persist as such for months or start increasing in size gradually, you should not ignore it and immediately consult a doctor, otherwise your life may be at risk.

Why does a temporary swelling form in the neck?

In a medical term, such temporary neck swellings are called lymphadenopathy or in simple words it can be called increased size of lymph node. These type of swellings that persist for few days in the neck are generally caused by infection of the organs in the neck specially of teeth or ear. Sometimes, infection of tonsil inside the neck becomes the cause of neck swelling (enlarged lymph node). In some cases, infection in nasal sinus ( sinusitis) too causes small protuberances in neck. These type of swelling in neck are very peculiar in the sense that they disappear as soon as infection is eradicated. The temporary emergence of these neck swelling during infection acts as a safety shield that prevents the infection of neck from spreading to other parts of a human body. That’s why these lymph nodes disappear after infection is controlled.

Be alert, if a neck swelling neither reduces in size nor disappears

If a neck swelling has been persisting for the last two to three weeks, you should be alarmed. This type of neck swelling or growth generally indicates towards tubercular infection specially in our Indian subcontinent. Tubercular infection of either lung or back bone of neck, happens to be the most important cause of neck swelling in our country. Sometimes salivary gland situated underneath your jaws that emits saliva during chewing of food, if exposed to a tubercular infection will lead to emergence of small swelling in the upper part of the neck. This problem is prevalent among children living in rural areas where children drink raw milk without pasteurisation or boiling. If a cattle (cow, buffalo or goat) suffers from tubercular infection, it is immediately transmitted to children through raw milk without having been boiled or properly treated. This tubercular infection transmitted to children though infected milk is called in medical terms as Bovine Tuberculosis.

If neck swelling is increasing in size

If swelling in the neck, instead of decreasing in size, becomes permanent or slowly start increasing in size or if there is an increase in numbers of swellings in the neck, do not take it lightly. In majority of the cases, it indicates the possibility of cancer of either of lung or of wind pipe. Appearance of neck swelling means a  primary cancer has been silently developing inside the neck for a few months without any significant complaint or symptom. Generally adults after age of fifty years suffer from cancer of lung or wind pipe. This means if you are in your fifties and you have a permanent or slowly growing swelling in your neck, you should promptly take doctor’s advice. Sometimes, in ladies having breast cancer, neck swellings are also visible.

Other reasons of neck swelling   

Sometimes tumour in thyroid gland is also reason for neck swelling. If neck swelling moves up and down on swallowing a spit, it indicates the possibility of swelling in the thyroid. Sometimes due to previous injury in neck, a neck swelling is visible or palpable.

Lymphoma also an important cause of swelling in neck

In our body exists a network of lymphatic channels and lymph nodes. In these lymphatic channels flows a liquid like substance called lymph which is circulating through these channels which are spread throughout the whole body. The function of lymph node is to restrict the infection and confine it to the affected part only so that it should not spread to the other parts of body. But in a few cases, happens a sudden and rapid structural change in the pattern of  lymphatic channels and lymphatic nodes, a tumour like growth then appears in the neck and continue to grow in size. This type of tumour is called in medical terms as lymphoma which is commonly found in the neck. This lymphoma is of two types. One is called Hodgkin’s lymphoma and another one called Non Hodgkin’s lymphoma. These lymphomas can be placed in the category of half cancer. Sometimes, cancerous changes do appear in theses lymphomas, it is called then as lymphatic carcinomas.

Tumour of blood pipes in the neck

In some people there is a tumour like growth in the blood pipes of neck. These blood pipe tumours though very small in size are present since birth. At the time of birth, these growths are too tiny to be visible to onlookers, but as the child progresses, the size of tumour also shows progression. These tumours are of two types. One is called venous or lymphovenous malformation. These venous tumours are inert, slow growing and has no pulsations. If tumour has pulsations or if you feel the regular sound of “tick- tick” after putting your hand on the swelling, it means the tumour is either attached to the wall of a blood pipe carrying pure blood {artery} or the tumour itself is originating from the wall of  blood pipe. This tumour is situated in the large sized main blood pipe called Carotid artery that carries pure blood from the heart to the brain. This tumour in medical terms called Carotid Body Tumour. If you ever find a pulsating protuberance or tumour in any part of the neck, immediately consult a vascular surgeon. Never undergo for investigation purposes any needle biopsy (FNAC) or Tru- cut biopsy, otherwise disaster may happen.

If you have swelling in the neck, where to go?

If you have a neck swelling, consult a vascular surgeon. The advantage of consulting a vascular surgeon in this case is immediate diagnosis of any vascular tumour in the neck and thus avoiding any inadvertent attempt at needle (FNAC) or conventional biopsy as putting a needle in such vascular tumour will lead to torrential haemorrhage and jeopardise the life. Even if the tumour is not vascular, nevertheless he will get needle biopsy done. All the more  if a non vascular neck tumour were to be removed or biopsied,  the procedure would be safer in the hands of a vascular surgeon because there would be lesser chance of damage to the nearby blood pipes and will help determining the further course treatment in consultation with other specialists after  biopsy result.    

Important Investigations required in a neck swelling

The most important investigation in neck swelling of a non vascular origin is the needle or injection biopsy that is called in medical terms Fine Needle Aspiration Biopsy (FNAC). In this procedure, a very tiny piece of tumour is taken out with the help of a needle and sent for detailed study and making diagnosis. A treatment strategy is formulated depending upon the biopsy outcome. Some other investigations like X-ray of neck and chest, CT and MRI are required. Sometimes Bronchoscopy is also required. In some special circumstances, angiography may be needed. Always remember, never allow any needle or any biopsy in a suspected neck tumour arising from a blood pipe (Artery)

Modalities of Treatment

If biopsy of neck swelling reveals infection of tuberculosis, medicines to control tuberculosis are started. If along with lung infection, there is collection of water or pus in the chest, surgery is required. If the lung is partially or completely destroyed or there is a lung cancer of early stage, consult a thoracic or a chest surgeon for prompt surgical removal of diseased lung or lung tumour. Always choose a hospital where in all modern investigatory facilities are available to help arrive a correct diagnosis of the cause of neck swelling, because incorrect diagnosis of neck swelling will lead to an incorrect treatment resulting into a loss of money ,time and harm to the patient.