Symposium. ENT for nonspecialists. The patient has a lump in the neck.
When a patient presents with a hard, painless lump in the neck, one should assume that it is a cancer and that it is metastatic from a primary lesion located above the clavicle. A careful physical examination with the appropriate instruments most often will determine the site of the primary lesion. Laryngograms or lateral soft-tissue roentgenograms should not be used as a substitute for visual inspection and careful examination. Examination with the patient under anesthesia is not needed unless the office examination cannot be done or a specimen from the suspected region cannot be obtained and examined microscopically in the office. Taking blind biopsies from normal-appearing mucosa is seldom worthwhile. Excisional biopsy is usually done with the patient under general anesthesia; needle biopsy is seldom used. Pathologic diagnosis by examination of frozen section is mandatory. Definitive treatment depends on the surgical and pathologic findings.
D000768:Anesthesia, General; D001706:Biopsy; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005629:Frozen Sections; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis / Q000532:radiotherapy; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D009455:Neurofibroma / Q000175:diagnosis / Q000235:genetics; D010610:Pharyngeal Neoplasms / Q000175:diagnosis; D014062:Tongue Neoplasms / Q000175:diagnosis