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Neck lump - Management
What investigations should I request?

  • If there are features of head and neck malignancy, do not delay referral by undertaking investigations in primary care.
  • If glandular fever is suspected (typically fatigue, fever, lymphadenopathy, and sore throat in people younger than 40 years of age), consider a Monospot test during the second week of illness. For more information, see the CKS topic on Glandular fever.
  • If the person has unexplained lymphadenopathy, request a full blood count and blood film, and erythrocyte sedimentation rate, plasma viscosity, or C-reactive protein (according to local policy).
  • If the person has unexplained cervical and/or supraclavicular lymphadenopathy or any of the following unexplained symptoms and signs for more than 3 weeks, urgently refer for chest radiography (the result should be available within 5 days):
    • Chest and/or shoulder pain.
    • Dyspnoea.
    • Weight loss.
    • Chest signs.
    • Hoarseness.
    • Finger clubbing.
    • Cough, with or without any of the above.
    • Features suggestive of metastasis from lung cancer (for example in the brain, bone, liver, or skin).
  • If the person has a suspected thyroid lump and does not require immediate admission to hospital:
    • Refer to a centre with a multidisciplinary thyroid team if possible.
    • Consider doing thyroid function tests, but do not allow this to delay referral, particularly if the person has urgent referral criteria.
    • Do not request further investigations, such as ultrasonography or isotope scanning, in primary care.

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