Modern Management of Neck Lumps
University College Hospital London, The Harley Street Clinic
Head and neck cancer affects between 8 and 15 people out of every 100,000 of the UK population, although there are considerable regional variations. There is good evidence that early detection of head and neck cancer improves the chances of surviving this disease, but unfortunately many of the initial symptoms are often very general and not just specific to cancer. One of these symptoms is a neck lump, which can be an extremely common and completely benignNot dangerous, usually applied to a tumour that is not malignant. (not dangerous) symptom but which can also indicate the presence of head and neck cancer. As a result of this the modern day Rapid Access Neck Lump Clinic has evolved.
A Rapid Access Neck Lump Clinic allows the immediate assessment of patients with a neck lump to take place. The benefit of this is that it enables those patients whose neck lump is benign to be reassured whilst also allowing for patients with a malignantDescribes a tumour resulting from uncontrolled cell division that can invade other tissues and may spread to distant parts of the body. lump to be swiftly diagnosed so that the appropriate treatment can be rapidly commenced. In addition to this a person who does have a benign neck lump that nevertheless requires surgical input will be seen and managed by a surgeon who specialises in neck surgery.
I see in excess of 400 patients each year in a Rapid Access Neck Lump Clinic and thankfully, looking at the statistics from this clinic demonstrates that only 9% of these patients have a malignant diagnosis. The patients that do have a malignant lump are rapidly managed with further imaging, biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. and then the commencement of their definitive cancer treatment. Importantly the 91% who have a benign diagnosis are reassured of this very quickly.
A Rapid Access Neck Lump Clinic does not just involve surgeons. It is a clinic that requires a team approach. As the ENTThe abbreviation for ear, nose and throat. / Head and Neck Surgeon I will see the patient first and take a careful clinical history. This guides my thoughts as to what the neck lump might be. Following this I will then examine the patient thoroughly. I look of course at the neck lump but I also carry out a thorough oral examination and I evaluate the nasalRelating to the nose space and upper airways and the upper respiratory and digestive tracts using an endoscopeA tube-like viewing instrument that is inserted into a body cavity to investigate or treat disorders. (a special viewing instrument), seeking a cause of the neck lump. Following my history and examination, an Ultrasound of the neck lump is the bare minimum investigation performed by the second member of the team, the Radiologist. In order to offer a first class service, the radiologistA doctor specializing in the interpretation of imaging techniques for the diagnosis and assessment of disease. I work with is a specific Head and Neck radiologist rather than a general radiologist. If appropriate, cells from the lump will be taken under ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. guidance and they will be examined by a third member of the team, the Cytopathologist. Cytopathologists again are super-specialists in their field and their interpretation of the small sample of cells from a neck lump can be invaluable in the diagnosis.
The combination of three super-specialist consultants (surgeon, radiologist and cytopathologist) in Head and Neck Lumps offers the patient the best and most accurate management of a neck lump.