Thyroid lumps (nodules)
What are Thyroid lumps (nodules) ?
The thyroid gland is a butterfly or wing-shaped organ that sits in front of the windpipe (trachea) in the neck (Figure 1). It produces thyroid hormones that regulate your body’s metabolism (the way your body uses energy). Thyroid nodules (Figure 2) can occur in any part of the thyroid gland. Up to 8% of women and 2% of men has clinically palpable thyroid nodules (detectable by physical examination – Figure 3). With the availability of modern imaging such as ultrasound, MRI and CT scans, thyroid nodules are increasingly detected incidentally. Up to 30% of women may have thyroid nodules detectable by an ultrasound scan.
Although thyroid nodules are common, 90% of the time, they are benign (non-cancerous).
The presence of a family history of thyroid cancer, exposure to radiation and some suspicious features on physical examination and ultrasound scan can increase the likelihood of thyroid cancer in a thyroid nodule. Assessments for thyroid nodules include a full ENT, head & neck history and physical examination, blood tests (to check thyroid hormone level), imaging scan (usually an ultrasound scan) and fine needle aspiration and cytology (FNAC – Figure 4) of the thyroid nodule.
Salivary gland lumps
What are Salivary gland lumps ?
The major salivary glands are the parotid, submandibular and sublingual glands (Figure 1). They produce saliva that is important in food digestion, keeping your mouth moist, fighting bacteria and keeping your teeth and gums healthy. Lumps or growths can occur in the salivary glands (Figure 2a and 2b). The likelihood of a lump being benign (non-cancerous) is about 80% in the parotid gland, 50% in the submandibular gland and 20% in the sublingual gland.
Thyroid SpecialistThe investigation of a salivary gland lump includes a fine needle aspiration and cytology (FNAC) or biopsy of the lump as well as an imaging scan (usually a CT scan of the neck with intravenous contrast). Treatment of salivary gland lumps depends on the nature of the lump (benign vs malignant). Most of the time, surgical removal of the salivary gland (either partial or total) will be recommended. As there are important structures close to the salivary gland, you should have an in-depth discussion with your doctor on the risks involved in surgical removal of the salivary glands.
Salivary gland and duct stones
What are Salivary gland and duct stones ?
The chemicals in the saliva can sometimes crystalise to form stones. These stones can block the salivary gland and ducts. Why some people have stones in their salivary gland or ducts is still unknown. Majority of stones occur in the submandibular gland. When stone blocks up the salivary duct system, saliva backs up into the gland. This causes pain and swelling in the gland which is worse during meals. In some cases, the gland can be infected, resulting in fever, pain as well as redness and tenderness over the gland. The assessment for a salivary gland stone involves a thorough clinical history, physical examination and likely an imaging scan (usually a CT scan of the neck region). Treatment of salivary duct or gland stones depends on the size and location of the stone. Small stones ( <5mm) can be observed and may pass out on its own by stimulating production of saliva (e.g. taking sour sweet or food). Larger submandibular stones can be removed either through a small cut in the mouth (Figure 1a-d), by a minimally invasive procedure called sialendoscopy (Figure 2a-c) or by removing the salivary gland.
Enlarged lymph nodes (Cervical lymphadenopathy)
What are Enlarged lymph nodes (Cervical lymphadenopathy) ?
Lymph nodes are kidney bean-sized small glands that are a part of the body’s immune system. They are located throughout the body including in the back. They can become swollen and enlarged (Figure 1) when your immune system is responding to a threat in your body such as an inflammation, infection or cancer. In most cases, swollen lymph nodes are a result of an infection and usually become smaller once the infection has settled. Doctors will assess patients with enlarged or swollen lymph nodes in the neck with a comprehensive clinical history, physical exam and possibly, nasoendoscopy.
If the lymph node doesn’t go away or display worrying signs such as hard or rubbery consistency, not moving easily, skin over them is warm, red or irritated, located above the collar bone, bigger than the usual inflammatory lymph node, your doctor may carry out a fine-needle aspiration cytology (FNAC). In this procedure, a needle will be inserted into the lump to collect sample cells from the lymph node for investigation. If the test result is inconclusive, your doctor may recommended a biopsy to remove some tissues of the lymph node or complete removal. Most of the time, lymph node biopsy can be done under local anaesthesia.
What are Mouth lesions?
The oral cavity can have many lesions, ranging from ulcers to large growths. It is best to consult a doctor if you have a mouth lesion that you are worried about.
What is a Nose cancer ?
The area behind the nose is called nasopharynx (Figure 1). Cancer in this region is called nasopharyngeal carcinoma (often just called nose cancer). NPC is not so common in the West. It is more common in Southern China, Hong Kong, Vietnam, Singapore and Malaysia. In Singapore, NPC is the 8th most common cancer in men.
Risk factors for NPC include family history of NPC, dietary habit (consumption of preserved and salt-cured fish or meat) and Epstein Barr Virus (EBV) infection. Due to the location of the tumour, majority of the time, patients with early NPC may not have any symptoms. The most common symptom of NPC is a lump in the neck (when the cancer has spread to the lymph node in the neck). Other symptoms include blocked ear (due to fluid collecting in the middle ear – Figure 2), blood-stained nasal discharge or saliva and blocked nose.
Assessment of a patient suspected of NPC includes a clinical history, physical examination and nasoendoscopy. If a growth or mass is found in the nasopharynx (Figure 3), a biopsy (removal of a small sample of tissue for analysis) is performed. If NPC is confirmed, staging investigations (scans of the neck and other parts of the body) will be required to determine the extent of the disease. NPC is treated by radiotherapy with or without chemotherapy, depending on the stage of the disease. An oncologist (a doctor specializing in giving radiation therapy or chemotherapy) will plan the treatment for patients with NPC. Surgery is usually reserved for recurrent cases of NPC.
Other head & neck lumps & bumps
What are the other head & neck lumps & bumps
The head and neck region can have many different types of lumps and bumps ranging from small benign cyst, fat overgrowth (lipoma), skin lesions that can be benign (non-cancerous) or malignant (cancerous), to large growths like thyroglossal duct cyst, vascular tumours (e.g. carotid body tumour) or nerve tumours (Schwannomas). It is best to consult an ENT Specialist to have these lumps assessed.