A pain in the neck

It is not uncommon that at some point in life an individual might find a lump in their neck. While it can be caused by any number of factors, it is always important to seek a specialist consultation for further investigation and diagnosis if the lump persists, says Professor Christopher Goh, senior consultant ear, nose and throat surgeon at Novena ENT – Head and Neck Surgery Specialist Centre.

The presence of thyroid and other neck lumps

According to Professor Goh, tumours of the head and neck are one of the most common reasons why patients come to see him. “Tumours can occur in the thyroid gland, salivary gland, oral cavity, throat, vocal cords, gullet and the nasopharynx, and most patients come to me when they discover a lump in their neck,” he says. “There can be several causes of neck lumps. The most common cause of a neck lump would be an enlarged lymph node, which has resulted from an infection or other inflammatory cause. However, a neck lump could also be due to a tumour or it might be a congenital lump, which can occur during the development of the foetus or at birth.”

When Professor Goh has a patient who comes in with a nodule in the neck or on the thyroid, the first step he takes is to diagnose the problem. “There are three investigations that I do for a patient with a thyroid nodule. The first is a thyroid function test, which is a blood test. Next is an ultrasound, which is followed by a fine needle aspiration, where we aspirate cells from the lump and look at them under the microscope,” Professor Goh explains. “Looking at these cells can tell us, or at least give us a clue about whether we’re dealing with a cancer or not.”

Treatment options for thyroid lumps

There are several possible causes of thyroid swelling or nodules and they include tumours, cysts, inflammatory conditions like thyroiditis, multinodular goitres or iodine deficiencies. The thyroid gland can also have functional problems, like being overactive in hyperthyroidism or not producing sufficient thyroid hormone as in hypothyroidism, Professor Goh says.

The majority of thyroid tumours are benign but it can be difficult to differentiate a benign thyroid nodule from one that is cancerous. Both benign and malignant thyroid tumours are best treated by surgery. However, for advanced thyroid cancers, both thyroid lobes may need to be removed and this is usually followed by radioactive iodine therapy a few weeks after the surgery.

The first line of treatment for patients with functional thyroid problems is medication to correct the deficit or bring down the excess thyroid hormone produced. “Patients who are hyperthyroid and for whom medical treatment fails, surgery or the use of radioactive iodine therapy can be considered,” Professor Goh explains. “Patients who have had a total thyroidectomy, where there is total removal of the thyroid gland, will require replacement with thyroxine (thyroid hormone) for life. Similarly, patients with hypothyroidism will require thyroxine replacement or else they might experience excessive weight gain, fatigue, weakness and sensitivity to cold.”

Besides surgery, most common head and neck cancers do respond to radiation therapy as well as chemotherapy. Radiation therapy is therefore often given a few weeks after surgery is done, as part of the treatment for advanced head and neck cancers. Radiotherapy can also be given in conjunction with chemotherapy to treat these cancers, with the aim of eliminating the need for surgery, Professor Goh says. "There have been recent advances in technology which allows for greater accuracy in the delivery of radiation therapy. Known as Intensity-Modulated Radiation Therapy (IMRT), it is a highly accurate form of radiotherapy where the volume of treatment is very precisely targeted so that the side-effects from collateral damage of surrounding cells is very much reduced."

When should you consult a doctor?

Professor Goh suggests that anyone with a persistent neck lump should seek medical attention. “A person who has a neck lump that has been there for more than two weeks should, at least, seek medical consultation. And if the neck lump grows bigger, patients should see a doctor as soon as possible.”

Professor Christopher Goh is an Ear, Nose, Throat (ENT) surgeon with more than 20 years' experience in the field. He provides specialised care for patients with head and neck conditions through his advance surgical techniques. Prior to his move to private practice, Professor Goh was the Head of Department and Senior Consultant of Otolaryngology at Singapore General Hospital, where he remains a visiting consultant.

Novena ENT – Head & Neck Surgery Specialist Centre
Main Clinic:
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #04-21/22/34
Singapore 329563
Tel: +65 6933 0451
Email: enquiry.mnh@novena-ent.com

Satellite Clinic:
Parkway East Medical Centre
319 Joo Chiat Place #03-07
Singapore 427989
Tel: +65 6346 7761
Email: enquiry_peh@novena-ent.com
www.novena-ent.com