NECK TUMORS


In 5 % of patients with tumor and 40 % of patients with cancer localized in the head and neck, neck lump is the first symptom of the disease. Therefore, each bump on the neck should first be diagnosed to exclude cancer.

 

The basis for diagnosis of tumors of the neck in addition to subjective and objective examination is ultrasound examination and fine needle aspiration biopsy of the tumor (thin needle puncture of the changes and receiving small amounts of material for pathological examination). In difficult cases, CT scan and magnetic resonance imaging is used. If you are not replying with fine needle aspiration biopsy is necessary to remove entire lymph node for pathological examination.

For diagnosis of vascular tumors vascular examination is used. If you have difficulty finding a primary focus of cancer examination is performed using positron emission tomography.

 

The neck has half of all human lymph nodes. The most common tumor of the neck is enlarged lymph node. Its enlargement can either have nature of :local change, generalized process, reactive process and metastasis. Therefore the differential diagnosis of tumors of the neck is to define the process leading to its enlargement.

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They can be:

 

  • inflammatory changes caused by nonspecific bacterial infection, specific bacterial infection (tuberculosis, syphilis, actinomycosis), viral infection. In these cases, the conservative treatment is sufficient.
  • primary and metastatic tumors. Primary are mostly different types of leukemia. In the case of the metastases the most common starting point of the cancer are organs located in the head and neck. Sometimes it is difficult to find a primary focus of proliferative process. In over 50 % of patients with primary tumors starting points reveal in 5-year observation. Sometimes the primary focus is not detected. Treatment of these processes is dependent on the form of the tumor and the stage of the process. The earlier the diagnosis the better the prognosis. In the case of cancer developing primarily in the lymphatic system, neck surgery is limited to a removal of the lymph node for pathological examination, which will answer the question what type of growth occurs in the patient. From this depends the method of treatment: chemotherapy, optionally combined with radiotherapy. This treatment is carried out by the oncologists. In the case of confirmation of tumor metastasis to lymph nodes in the neck, patient requires surgery to remove the neck lymphatic system completely, or requires modified surgeries. These operations may lead to a reduction of upper limb movements back and up and pain around the shoulder. It is associated with the necessity to cut the nerves coming into the brachial plexus. It may also occur disorders of the blood and lymph drainage from the head and neck, leading to edema as well as to headaches. Symptoms may occur with varying intensity for life. In addition to surgeries within the neck lymphatic system, treatment of an organ from which the cancer process spreaded is also necessary. The selected method of treatment depends on the location, the severity of the clinical staging and pathological examination. This may be simultaneous surgery, or radiation therapy, or combined surgery and radiation.
  • tumors of glandular origin(tumors of the thyroid and parathyroid glands), neurogenic (schwannoma ) and cervical glomus tumors, and tumors of vascular origin. In relation to these tumors surgery is preferred option. In the case of vascular tumors and tumors of cervical glomus surgery is preceded by a vascular examination combined with embolization.
  • congenital diseases in the form of thyroglossal duct cyst neck and branchial cleft cyst can appear at any age in the form of a tumor of neck. The treatment is surgical removal.

 

Patients after removal of a neck tumor which is not cancer is called for first follow up in policlinic after two weeks after operation. However, patients diagnosed with cancer are obliged to to check in outpatient clinic for life. At the beginning each month, for three years after surgery every 3 months and between 3 to 5 years after surgery evry 6 months, then every year.

Control tests are extremely important for the patient. They are supposed to exclude cancer recurrence, the appearance of metastases, as well as the occurrence of a second primary tumor.

 

dr med. Jagna Nyckowska