A doctor explains neck lumps!

Found a lump in your neck? Even if it doesn’t hurt, it may be worth getting it checked out. DR REYAZ SINGAPOREWALLA of Ace Specialist Surgery & Endoscopy answers a couple of our questions on neck lumps, from what causes them and when to see a specialist, to what happens if it turns out to be a thyroid nodule or thyroid cancer.

I’ve noticed a neck lump that is not causing me any pain or discomfort. Should I get it checked by a doctor?

A lump that does not hurt is easy to dismiss. We are wired to worry about pain, not the absence of it. So a painless swelling in the neck often gets watched quietly for weeks, sometimes months, before anyone brings it up with a doctor. Yet painless neck lumps are one of the most common reasons patients are eventually referred for a specialist opinion. The absence of discomfort is rarely a useful clue either way.

Neck lumps can arise from several structures. Some are reactive lymph nodes that flare up after a cold or minor infection and settle down on their own. Others originate from the thyroid gland, the salivary glands, or deeper tissues in the neck. What matters more than pain is behaviour – how long the lump has been present, whether it is growing, and whether it feels firm or soft.

A useful rule of thumb is this: anything that lingers beyond two to three weeks, or continues to enlarge, deserves a proper assessment. This usually begins with a clinical examination and an ultrasound scan, which is quick and painless. Depending on the findings, a fine needle biopsy may follow to give a clearer diagnosis. Blood tests may also be added if a thyroid or salivary gland cause is suspected.

While most neck lumps turn out to be benign, some do need further treatment and a proper management plan. Taking that first step to understand the nature of the lump may be the right path to discovering your wellness with confidence.

Could the lump on my neck be a thyroid nodule or thyroid cancer? How are they diagnosed and treated?

Certain neck lump features, such as a hard, fixed or rapidly growing lump or one that causes hoarseness, difficulty swallowing or swollen lymph nodes nearby, require your attention. These lumps could be thyroid nodules. According to the American Thyroid Association, most are benign, with around five to 15 percent turning out to be cancerous. Many early thyroid cancers, however, cause no symptoms and have no clinical signs at all. They are often picked up incidentally during an ultrasound scan of the neck.

Diagnosis usually starts with an ultrasound to assess the nodule’s size and characteristics. If certain features are present, a fine needle biopsy samples the cells directly, allowing most nodules to be classified as low or higher risk. The needle biopsy under ultrasound guidance remains the gold standard in diagnosing thyroid cancers early when they can be easily treated with minimal disruption to everyday life.

Once diagnosed, surgery remains the main treatment for most fit patients. This removes part or all of the thyroid gland depending on the cancer’s size and type. Thyroid surgery today is very safe and precise, and many patients go home within a day or two.

Occasionally, tiny thyroid cancers under 1cm may be suitable for close observation alone. In practice though, eligible patients rarely choose this route, preferring to remove the cancer and gain closure.

For patients with symptomatic non-cancerous nodular goitres, a total endoscopic trans-axillary thyroidectomy, a scarless procedure, may be an option to discuss with your surgeon. This specific procedure utilises a small incision hidden in the armpit using endoscopic instruments to approach the thyroid and avoids any visible neck scar.

About the doctor

Dr Reyaz Singaporewalla is the Senior Consultant Endocrine-Head Neck Surgeon at Ace Specialist Surgery & Endoscopy with over 25 years of experience in the field. He set up Khoo Teck Puat Hospital’s Endocrine-Head Neck Surgical Service in 2011 and served as Deputy Head of the Department of Surgery from 2019 to 2020.

Ace Specialist Surgery & Endoscopy
#15-14 Mount Elizabeth Hospital, 3 Mount Elizabeth
#05-02 Gleneagles Medical Centre, 6 Napier Road
9645 5900 | acesurgery.sg | [email protected] | FB & IG @acesurgery.sg

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