Nav: Home

Neck mass in adults: Guideline for evaluation provides framework for timely diagnosis

September 10, 2017

CHICAGO, IL --With the development of the Clinical Practice Guideline: Evaluation of the Neck Mass in Adults, published today in Otolaryngology-Head and Neck Surgery and presented at the AAO-HNSF 2017 Annual Meeting & OTO Experience in Chicago, IL, the appropriate testing and physical examination of an adult with a neck mass is addressed, with a specific goal to reduce delays in diagnosis of malignant disease and to optimize outcomes.

"Neck masses are common in adults, but the underlying cause is not always easily identified. This guideline is an important instrument for the early diagnosis and treatment of potentially malignant growths, especially with the rise of HPV-related head and neck cancer. A neck mass may indicate a serious medical problem. It does not mean the patient has cancer, but it does mean they need more medical evaluation to make a diagnosis," said M. Boyd Gillespie, MD, MSc, guideline development group assistant chair.

Most persistent neck masses in adults are neoplasms, new and abnormal growths, and malignant growths far exceed any other. While the traditional patient profile for neck mass was an older adult, younger people infected with HPV are changing that expectation. If current trends continue, the incidence of HPV oropharyngeal (tonsil and base of tongue) head and neck squamous cell carcinoma will surpass HPV-positive cancer of the uterine cervix by 2020.

Forty years ago, patients with a neck mass experienced an average of a five- to six-month delay from the time of initial presentation to the diagnosis of malignancy. Today, studies continue to report delays as long as three to six months. The information in this guideline is targeted at anyone who may be the first clinician a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists.

"In addition to crafting a set of actionable statements relevant to diagnostic decisions in the workup of an adult patient with a neck mass, the guideline also seeks to promote high quality and cost-effective care as well as educate patients about seeking medical attention when a neck mass presents," said Dr. Gillespie. The accompanying materials provide and patient information for adults with a neck mass.

The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) guideline is endorsed to date by American Academy of Physician Assistants (AAPA), American Academy of Emergency Medicine (AAEM), American Association of Oral and Maxillofacial Surgeons (AAOMS), American College of Radiology (ACR), American Head and Neck Society (AHNS), American Society for Clinical Pathology (ASCP), Head and Neck Cancer Alliance, Society of Otorhinolaryngology Head-Neck Nurses (SOHN), and Triological Society.

The guideline was chaired by Melissa A. Pynnonen, MD, with M. Boyd Gillespie, MD, MSc, and Benjamin R. Roman, MD, MSHP, serving as assistant Chair, and Richard M. Rosenfeld, MD, MPH, as the methodologist, and David E. Tunkel, MD, as methodologist-in-training.
Members of the media who wish to obtain a copy of the guideline or request an interview should contact: Tina Maggio at 703-535-3762, or Upon release, the guideline can be found at

--------------FACT SHEET---------------------------

What is the purpose of this guideline?

The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include:
  • Reducing delays in diagnosis of head and neck cancer
  • Promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies
  • Reducing inappropriate testing
  • Promoting appropriate physical examination when cancer is suspected
What is a neck mass?

A neck mass is an abnormal lump in the neck. Neck lumps or masses may be any size. They can be large enough to see or feel or very small. They can be a sign of an infection or something more serious, such as cancer.

What causes a neck mass?

Neck masses are common in adults and can occur for many reasons. Adults may develop a neck mass due to a viral or bacterial infection. Ear or sinus infection, dental infection, strep throat, mumps, or a goiter may cause a neck mass. If a neck mass is from an infection, it should go away completely when the infection goes away. A neck mass could also be caused by a benign (noncancerous) tumor or a cancerous tumor. Cancerous, or malignant, neck masses in adults are most often due to head and neck squamous cell carcinoma. Other cancers such as lymphoma, thyroid or salivary gland cancer, skin cancer, or cancer that has spread from somewhere else in the body, may also cause a neck mass.

What is the prevalence of head and neck cancer?
  • Head and neck squamous cell carcinoma has a worldwide annual incidence of 550,000 cases, representing five percent of all newly diagnosed cancers.
  • From 1988 to 2004, the U.S. population experienced a 225 percent increase in HPV positive oropharyngeal (tonsil and base of tongue) head and neck squamous cell carcinoma.
  • If current trends continue, the incidence of HPV-positive oropharyngeal (tonsil and base of tongue) head and neck squamous cell carcinoma will surpass that of HPV positive cancer of the uterine cervix by 2020 and constitute 50% percent of all head and neck cancer by 2030.
What are the common symptoms in patients with a neck mass at high risk for cancer?
  • The mass lasts longer than two to three weeks
  • The mass gets larger
  • The mass gets smaller but does not completely go away
  • Voice changes
  • Trouble or pain with swallowing
  • Trouble hearing or ear pain on the same side as the neck mass
  • Neck or throat pain
  • Unexplained weight loss
  • Fever > 101 degrees Fahrenheit
Why is the guideline for evaluation of neck mass in adults important?

Currently, there is only one evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes. The information in this guideline is targeted at anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses.


1. Avoidance of Antibiotic Therapy
Clinicians should not routinely prescribe antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.

2a. Stand-alone Suspicious History
Clinicians should identify patients with a neck mass who are at increased risk for malignancy because the patient lacks a history of infectious etiology and the mass has been present for two weeks or greater without significant fluctuation or the mass is of uncertain duration.

2b. Stand-alone Suspicious Physical Examination
Clinicians should identify patients with a neck mass who are at increased risk for malignancy based on one or more of these physical examination characteristics: fixation to adjacent tissues, firm consistency, size greater than 1.5 cm, and/or ulceration of overlying skin.

2c. Additional Suspicious Signs and Symptoms
Clinicians should conduct an initial history and physical examination for adults with a neck mass to identify those patients with other suspicious findings that represent an increased risk for malignancy.

3. Follow Up of the Patient Not at Increased Risk
For patients with a neck mass who are not at increased risk for malignancy, clinicians or the designees should advise patients of criteria that would trigger the need for additional evaluation. Clinicians or their designees should also document a plan for follow up to assess resolution or final diagnosis.

4. Patient Education
For patients with a neck mass who are deemed at increased risk for malignancy, clinicians or their designees should explain to the patient the significance of being at increased risk and explain any recommended diagnostic tests.

5. Targeted Physical Examination
Clinicians should perform, or refer the patient to a clinician who can perform, a targeted physical examination (including visualizing the mucosa of the larynx, base of tongue, and pharynx) for patients with a neck mass deemed at increased risk for malignancy.

6. Imaging
Clinicians should order a neck computed tomography (or magnetic resonance imaging) with contrast for patients with a neck mass deemed at increased risk for malignancy.

7. Fine Needle Aspiration (FNA)
Clinicians should perform FNA instead of open biopsy, or refer the patient to someone who can perform FNA, for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain.

8. Cystic Masses
For patients with a neck mass deemed at increased risk for malignancy, clinicians should continue evaluation of patients with a cystic neck mass, as determined by FNA or imaging studies, until a diagnosis is obtained and should not assume the mass is benign.

9. Ancillary Tests
Clinician should obtain additional ancillary tests based on the patient's history and physical examination when a patient with a neck mass is at increased risk for malignancy and/or does not have a diagnosis after FNA and imaging.

10. Examination under Anesthesia of the Upper Aerodigestive Tract before Open Biopsy
Clinicians should recommend examination of the upper aerodigestive tract under anesthesia, before open biopsy, for patients with a neck mass who are at increased risk for malignancy and without a diagnosis or primary site identified with FNA, imaging, and/or ancillary tests.

Where can I get more information?

Patients and health care providers should discuss all evaluation, testing, and follow-up options and find the best approach for the patient. There are printable patient handouts and materials that further explain neck mass evaluation in adults that can help with discussions between patients and providers. For more information on evaluation of the neck mass in adults, visit

About the AAO-HNS/F

The American Academy of Otolaryngology--Head and Neck Surgery, one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."

American Academy of Otolaryngology - Head and Neck Surgery

Related Cancer Articles:

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.
Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.
Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at