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Neck lump - Management
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How should I manage a lump when the cause is unknown?
- Admit immediately if the person has symptoms such as difficulty breathing (stridor), or signs of superior vena cava obstruction (swelling of the face and/or neck with fixed elevation of jugular venous pressure). Also consider admission if the person has absolute dysphagia, general symptoms of sepsis, or signs of aspiration (hoarse voice with coughing or chest infection).
- Refer urgently if the person has:
- An unexplained lump in the neck which has recently appeared, or
- A lump which has not been diagnosed before that has changed over a period of 3–6 weeks.
Basis for recommendation
These recommendations are based on a referral guideline for suspected cancer from the National Institute for Health and Clinical Excellence [NICE, 2005a], expert opinion in a narrative review [Prakash and Hanna, 2002], and the opinion of CKS expert reviewers.
The need for urgent referral of an unexplained neck lump is because of the risk of malignancy, especially in adults. Experts in a narrative review take the view that 'a lateral neck mass is metastatic squamous cell carcinoma or lymphoma until proved otherwise' [Gleeson et al, 2000].
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