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Vincent’s S.C.A.N.S 
Ear, Nose and Throat (ENT), Head and Neck Surgery
Specialist Clinic
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Last update:  4/1/16 
EDUCATION Head and Neck   Swellings,Lumps and Bumps
Part 1 - What ? How? Who ? Am I the One ?
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Continue to Head & Neck Lumps & Bumps Part 2 -Diagnosis & Treatment
Cervical   lymphadenitis    (inflammation   of   the   lymph   nodes   in   the   neck)   is   very   likely   the   most   common   cause of   an   inflammatory   mass   in   the   neck.   This   condition   is   characterized   by   painful   enlargement   of   normal   lymph nodes   in   response   to   infection   or   inflammation,   commonly   due   to   upper   respiratory   infection   such   as   a   cold   or sinus infection On   the   other   hand,   tumours   (known   as   'neoplasm'   from   a   medical   perspective)   can   be   benign   i.e   non- cancerous   or   malignant   i.e   cancerous.   Some   of   these   benign/non-cancerous   tumours   can   arise   spontaneously without   any   particular   triggering   factor.   On   the   other   hand,   malignant   tumours   are   what   is   commonly   known   as CANCERS.   Cancers   are   commoner   in   adult   (still   possible   in   younger   age   group   but   less   likely).   Benign tumours   are   more   commonly   slow-growing   while   cancerous   tumours   generally   grow   much   faster   and   may even   invade   the   skin. The   likelihood   of   the   lump   being   a   cancer   increases   as   adults   age,   particularly   for   people who smoke or drink significant amounts of alcohol. However, most lumps in adults are not cancers (fortunately) Common risk factor for cancer include: chronic smoking, betel nut chewing, tobacco chewing, chronic alcohol consumption immunodeficiency Human papilloma virus (HPV) viral infection poor dentition industrial or environmental exposures positive family history -first degree relatives with cancer .
Benign blood vessel tumour from the nose
Neck lymph node enlargement due to nasopharyngeal cancer
Benign tumour of fat cell origin next to the parotid gland
Benign tumour arising in the parotid gland
Benign tumour of nerve origin arising just next to the carotid artery
Benign growth of the thyroid gland - goitre.
Benign cyst of development origin in the upper neck.
Benign cyst arising from the skin layer in the face
Benign cyst arising from the skin layer in the upper neck
Cancerous growth in the voice box of a chronic smoker.
© Vincent Tan ENT
Head and Neck Swellings, Lumps & Bumps
A neglected ‘fungating’ neck mass implying cancer spread to the skin  © Vincent Tan ENT Smoking as the number 1 risk factor for head and neck cancers Environmental wood dust exposure as a risk factor for paransal sinus cancer © Vincent Tan ENT TB presenting as multiple nexk lymph node swelling in a young lady TB over the other parts of the body can present with or without typical chest X-ray TB changes © Vincent Tan ENT TB presenting as ulcerative neck lesion in another young lady
A   neck   lump   is   any   lump,   bump,   mass   or   swelling   in   the   neck.   It   is   something   that   commonly   brings   a   patient   to   his   doctor.   One   of   the   major concerns is : "DOCTOR,  IS THIS A CANCER?"   As such, all neck lumps in children and adults should be checked without undue delay .
Head   and   neck   masses   are   malignant,   or   cancerous,   if   they   spread   to   surrounding   tissue.   In   the   head   and   neck,   cancers   may   be   either   primary   or secondary.   Primary   cancers   originate   in   the   head   or   neck   itself,   including   the   thyroid,   throat,   larynx,   salivary   gland,   brain,   or   other   locations.   Primary cancers   of   the   head   and   neck   typically   spread   to   the   lymph   nodes   in   the   neck,   presenting   as   neck   swellings.   (to   complicate   matters,   these   swellings   as look   and   feel   just   like   a   node   swelling   due   to   an   infection   of   the   neck   !).   Your   doctor   may   call   these   neck   nodes   as   "metastatic"   or   "secondary"   neck nodes . Secondary   neck   nodes    can   also   less   commonly   have   spread   from   primary   cancers   in   other   parts   of   the   body   outside   the   head   or   neck   region   eg   lung, breast, kidney, or from the skin.
Congenital   head   and   neck   lumps   or   masses   can   arise   during   early   years   or   may   present   later   in   life.   These   include   embryological   remnants   since   'in utero' (while you are still in your mother's womb) eg. thyroglossal duct cyst, dermoid cyst or branchial anomalies among others. As   illustrated   in   the   picture   above,   the   head   and   neck   region   is   made   up   of   many   different   structures   and   many   of   these   structures   can   either   get   infected giving rise to a lump or grow into a tumour over time, whether cancerous or otherwise. Examples of these structures include: Skin Subcutaneous  tissue under the skin Lymph nodes or lymphatic tissue Nerves Vessels (veins or artery) Salivary glands (eg. parotid, submandibular gland) Thyroid gland Bones (eg jaw bone) Infection   can   arise   as   a   result   of   infection   by   viruses,   bacteria   or   fungus.   Occasionally,   the   lymph   node   becomes   necrotic,   and   an   abscess   forms.   In   our region,   tuberculosis   (TB),   due   to   infection   from   a   special   type   of   bacteria   known   as   mycobacterium,   is   also   quite   common   and   becoming   increasingly more   prevalent.   Besides   being   notoriously   difficult   to   detect,   it   can   masquerade   as   infection   in   any   parts   of   the   body,   commonly   in   the   lungs   and   the   neck lymph nodes.
(Please click on picture for larger view)
Secondary   cancer   spread   to   the   lungs   (red arrows) as seen on the chest X-ray
© Vincent Tan ENT
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Talks about NECK SWELLING on 2/1/15
The primary cancer discovered ‘sitting’ in the nasopharynx, the area at the back of the nose
The patient presenting  with a right neck lymph node swelling -Is this a primary cancer of the lymph node (lymphoma) or a sceondary metastasis from a primary somewhere else?
The primary cancer discovered ‘sitting’ in the nasopharynx, the area at the back of the nose
Primary vs Secondary Cancer
(Please click on picture for larger view)
(Please click on picture for larger view)
© Vincent Tan ENT
D R. V INCENT T AN Consultant Ear, Nose and Throat, Head and Neck Surgeon, MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore) Fellowship in Head and Neck Oncology & Surgery (Amsterdam)
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