Neck mass

ENT specialists may perform certain endoscopic procedures if there is concern for certain cancers of the nose and throat. A laryngoscopy is a procedure in which a small, tube-shaped instrument called a laryngoscope is placed down the throat to see the voice box. This can usually be performed in an outpatient setting with a numbing spray, but less commonly could require general anesthesia (to put you to sleep temporarily) in a hospital setting. Biopsies may be taken during laryngoscopy and sent to a pathologist to evaluate for cancer cells. There are several types of laryngoscopies, including:

• Indirect laryngoscopy: The simplest of the laryngoscopy procedures, this test uses a laryngoscope in your throat combined with a light and a tiny mirror at the roof of your mouth to look down your throat. Your doctor typically performs this procedure in an outpatient setting with numbing spray while you are awake. This allows the ENT specialist to see your larynx in the mirror.
• Direct flexible laryngoscopy: This procedure uses a lighted fiber-optic laryngoscope that is placed in your nose and goes down into your throat to look at your throat and voice box. Your doctor typically performs this procedure in an outpatient setting with numbing spray while you are awake.
• Direct rigid laryngoscopy: This procedure is a complete exam of your throat and may be performed to also visualize the nasopharynx (nose and back of the mouth or throat). Specialists usually perform this procedure while you are under anesthesia in a hospital setting.
• Panendoscopy: A procedure that is typically done under general anesthesia and allows visualization of the larynx (voice box), esophagus (the feeding tube that connects your mouth to your stomach), and the trachea (windpipe).

A CT scan or MRI may be performed if you are at high risk for cancer, if the neck mass shows worrisome physical exam findings, or if the diagnosis is still unclear. These studies can help pinpoint exactly where the neck mass is located and how it could affect surrounding structures in the neck.

• Bone scan is a test that may only be performed if there is concern that the cancer has spread to the bones. During this imaging study, a radioactive substance is injected into a vein, which helps visualize abnormal areas of the bone.
• Chest X-ray may be performed to see if the cancer has spread to your lungs.
• CT scan, also called a computed tomography scan, uses an advanced X-ray and computer to take pictures of the head in cross-sections to visualize the neck mass and surrounding tissues.
• MRI, also called magnetic resonance imaging, is a noninvasive imaging study that does not use radiation. Instead, magnets and radio waves are used to take several pictures of the head in cross-sections in order to visualize the neck mass and surrounding tissues.
• PET scan, also called a positron emission tomography scan, is a noninvasive imaging study in which a radioactive tracer is injected through an IV to help evaluate the metabolic activity in your tissues prior to imaging, to help detect cancer. PET scans may be used if biopsy results show a cancerous neck mass. PET scans can help identify whether the cancer is localized or if it has spread to other parts of the body.
• Radioactive scan, or thyroid scan, uses a small amount of radioactive iodine that is swallowed by mouth or injected into a vein. This allows the provider to measure the amount of radioactivity in the tissues, which can help in the process of elimination while undergoing evaluation for thyroid cancer. You may be asked to avoid foods or medicines containing iodine for a few days prior to a radioactive thyroid scan as this could interfere with the test.
• Thyroid ultrasound, a noninvasive test that uses a wand and ultrasound to see the thyroid. This is also sometimes used to guide a biopsy if a nodule is present.

A biopsy removes tissue or cells from the neck mass to be checked by a pathologist under a microscope. Results from a biopsy help determine if cells are cancerous. Biopsies may be performed with imaging guidance.

• Bone marrow aspiration and biopsy may be performed for those with lymphoma to see if the cancer is in the bone marrow. Samples are taken after injecting a local anesthetic to numb the area over the bone (usually the pelvic or hip bone) prior to using a needle to remove some bone marrow fluid (in bone marrow aspiration) or a small piece of bone and marrow (in bone marrow biopsy).
• Core biopsy may be done instead of or following FNA. This technique uses a larger needle to take a larger piece of tissue to be evaluated by the pathologist for cancerous cells.
• Excisional biopsy may be performed for certain skin cancers. An injection of local anesthetic numbs the skin prior to surgically removing the portion of skin involved.
• Fine needle aspiration (FNA) is typically preferred over open biopsy, according to the American Academy of Otolaryngology-Head and Neck Surgery. FNA is performed by numbing the area and then inserting a needle into the neck mass to obtain a sample of fluid and cells for analysis.
• Open biopsy of the neck tumor may be performed in an operating room under anesthesia after evaluating other areas if the site where the cancer first started, also known as the primary site, has not yet been determined by other tests.

Ask your provider about your specific type of biopsy if this was recommended to learn more.

Patients will be contacted after a biopsy by a Markey team member to review results. Further management will be recommended at that time.

When you are diagnosed with a neck mass, it is common to feel a sense of urgency around starting treatment, particularly if it is cancerous. However, in most cases, there is time to do the needed research to ensure that your diagnosis is correct. That may include getting a second opinion.

Our team of experts works together to diagnose, treat and prevent cancers of the neck, with a focus on individualized patient care.

Markey is among the best cancer centers in the nation, according to U.S. News & World Report, when it comes to advanced treatment options, survival rates and experienced providers. As the first and only NCI-designated comprehensive cancer center in Kentucky, Markey is able to serve many patients each year with rare and common cancers, including neck masses.

Our specialized team is happy to work with your doctors and communicate to ensure confidence in your diagnosis.

Should I get a second opinion?

A second opinion can help to ensure that you will be getting the latest and most effective therapy for treating cancerous neck masses. The following are common reasons for seeking a second opinion after your initial diagnosis:

• You are having difficulty understanding your diagnosis.
• A dedicated team specialized in your cancer type may not be available in your area.
• There may be uncertainty around the stage of the cancerous neck mass.
• You may want to learn more about different treatment options, including clinical trials and advanced technologies only available at an advanced center like Markey.
• Your health insurance requires a second opinion before continuing toward treatment.

Questions to ask when getting a second opinion

After receiving a cancer diagnosis, you may have a lot on your mind. Here a few questions to keep in mind for your doctor when seeking a second opinion:

• Is there a chance that my medical problem could have a different diagnosis?
• Are there additional tests I should take before moving forward with treatment?
• Do you recommend any treatments at this time?
• What do you expect to happen if I wait or don't have the treatment?
• What are the side effects of treatment?
• How long are treatment recovery periods?

• American Academy of Otolaryngology
• American Cancer Society
• Centers for Disease Control and Prevention
• National Cancer Institute
• U.S. National Library of Medicine