Finding a New Neck Mass
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Dr. Peter Vosler is currently an Assistant Professor in Head and Neck Surgical Oncology and Microvascular Reconstruction in the Department of Otolaryngology—Head & Neck Surgery at Sarasota Memorial Hospital. Prior to medical school Peter served in the U.S. Army as a helicopter mechanic and an intelligence analyst, performing... more
Management of a Neck Mass in an Adult
Introduction
It’s common to develop lumps or bumps in the neck, often after a cold or flu, caused by swollen lymph nodes fighting infection. While most of these lumps disappear within a week or two, a neck mass that persists longer can be a sign of something more serious. In adults, a neck mass that doesn’t resolve within 1-2 weeks should be considered cancerous until proven otherwise. This cautious approach is crucial because of the increasing prevalence of HPV (Human Papilloma Virus)-related cancers, especially those affecting the tonsils or base of the tongue, known as oropharyngeal cancers.
HPV-related cancers can develop decades after initial exposure to the virus. Most people who contract HPV clear it from their bodies without any issues, but a small percentage—about 1.7% of men and 0.7% of women—do not. Over time, this can lead to cancer developing in the tonsil tissue at the back of the throat. Unfortunately, these cancers often present as a painless lump in the neck, which is a result of cancer cells traveling from the tonsils to the lymph nodes. Because the tumors in the throat are often small and symptomless, many people are unaware they have a problem until the cancer has already spread to their neck.
When to Seek Medical Help
If you notice a painless lump in your neck that does not go away within 1-2 weeks, it’s essential to seek medical attention promptly. In many cases, patients are given antibiotics, assuming the lump is due to an infection. However, when the lump persists despite treatment, a more thorough evaluation by an otolaryngologist (ENT specialist) is necessary.
At the Jellison Cancer Institute at Sarasota Memorial Hospital, Dr. Peter Vosler specializes in diagnosing and treating head and neck cancers. His expertise in this field ensures that patients receive a comprehensive evaluation, starting with a detailed examination of the head and neck area. During this exam, Dr. Vosler will check for abnormalities in your tonsils and tongue base and may use a flexible scope passed through the nose to view the back of the throat—an area that can’t be seen just by looking into the mouth.
If a suspicious mass is found, Dr. Vosler may perform a biopsy right in the clinic. Alternatively, if the neck lump is not visibly connected to a tumor in the throat, he may use ultrasound-guided fine needle aspiration to take a sample from the neck mass for further analysis. This step is critical in determining whether the neck mass is cancerous and, if so, identifying the type of cancer involved.
Diagnostic Steps
Once an initial exam and biopsy have been completed, additional imaging tests are usually ordered to get a clearer picture of what’s happening inside your neck. These tests may include a CT scan with contrast or a PET scan. A PET scan is especially useful for identifying the primary tumor in the tonsils or base of the tongue, detecting additional affected lymph nodes, and determining whether the cancer has spread to other parts of the body, such as the lungs.
At Sarasota Memorial Hospital, patients also benefit from an advanced blood test called NavDx, which detects markers of HPV-related cancer in the bloodstream. This innovative test helps confirm the diagnosis and provides valuable information on whether the cancer has been fully treated after therapy.
In some cases, even with imaging, the exact source of the neck mass may not be immediately apparent. To ensure accurate diagnosis, your otolaryngologist may recommend an examination under anesthesia, during which a more detailed biopsy of the base of the tongue or tonsil can be performed. This procedure helps confirm the cancer type and guides the development of your treatment plan. It’s essential to determine whether the cancer is HPV-related, as this type of cancer responds better to treatment than other forms of throat cancer.
If the tumor is not easily visible on scans or during the initial exam, Dr. Vosler may suggest a minimally invasive procedure called transoral robotic surgery. This allows him to remove suspicious tissue from the base of the tongue or tonsils using robotic assistance for enhanced precision. At Sarasota Memorial Hospital, Dr. Vosler leads the head and neck surgical oncology program, offering cutting-edge robotic surgeries that improve outcomes for patients with difficult-to-detect cancers.
Treatment Options
Once the diagnosis is confirmed, the next step is to discuss treatment options. HPV-related squamous cell carcinoma of the oropharynx is typically treated through one of two main approaches: surgery or a combination of radiation and chemotherapy.
For small tumors—those less than 4 centimeters in size—and cases where cancer has affected only one lymph node, surgery may be sufficient. In these instances, Dr. Vosler uses robotic-assisted surgery to remove the cancerous tissue from the tonsils or base of the tongue. He also performs a neck dissection to remove lymph nodes on the affected side of the neck. If the cancer is confined to one side and the margins around the tumor are clear, patients may be cured with surgery alone.
Unfortunately, many patients present with larger or more complex tumors, or have multiple lymph nodes involved. In these cases, a combination of radiation and chemotherapy is typically recommended. At the Jellison Cancer Institute, Dr. Vosler works closely with a team of radiation oncologists and medical oncologists from Sarasota, Manatee, and Charlotte counties. Together, they ensure that each patient receives a tailored treatment plan designed for the best possible outcome. All cases are discussed during the hospital’s head and neck cancer tumor board meetings, which bring together experts from various specialties to reach a consensus on the best course of action.
Support Services
Head and neck cancer treatment can affect a patient’s ability to swallow, making speech therapy a vital part of the care plan. The Jellison Cancer Institute has specialized speech pathologists who work closely with patients undergoing treatment to help maintain their ability to eat and drink. This support is essential for both nutrition and quality of life during and after treatment.
Additionally, the institute offers the services of a dedicated Head and Neck Oncology Nurse Navigator. This professional helps coordinate appointments, assists patients with navigating the healthcare system, and provides access to valuable resources. Having someone to guide you through the complexities of cancer care can make a significant difference in managing your treatment and recovery.
Prognosis
The good news is that the prognosis for HPV-related squamous cell carcinoma of the oropharynx is excellent. Most people with this type of cancer are diagnosed at an early stage (Stage I-II), and survival rates are high. Treatment success rates typically range from 85-95%, depending on the extent of the disease and the treatment plan.
Post-Treatment Follow-Up
After treatment, follow-up care is crucial to ensure the cancer does not return. Patients will have regular visits with their otolaryngologist, radiation oncologist, medical oncologist, and speech pathologist. A PET scan is usually performed 12 weeks after treatment ends to check for any remaining signs of cancer. Additionally, the NavDx blood test can be used as a follow-up measure to ensure there is no recurrence.
Follow-up visits are typically scheduled every three months during the first two years after treatment and gradually become less frequent as time goes on. By maintaining close surveillance, doctors can catch any signs of recurrence early and take prompt action.
Conclusion
A neck mass that persists longer than 1-2 weeks should never be ignored. It’s important to seek evaluation by an experienced otolaryngologist to determine whether it may be cancerous. While this can be a frightening diagnosis, the expert team at the Jellison Cancer Institute at Sarasota Memorial Hospital, led by Dr. Peter Vosler, is here to help guide you through the process. From the initial evaluation to state-of-the-art treatment and compassionate follow-up care, you’ll receive the highest level of support every step of the way.