A lump in the neck -old

A lump in the neck -old

What’s that lump in the neck? If it moves as you swallow, it might be a thyroid nodule.

The thyroid gland normally produces the thyroid hormone which affects our heart rate, body temperature and energy level (basal metabolic rate). In addition, special cells within the thyroid gland known as C cells make calcitonin which controls the level of calcium in the blood. Most thyroid nodules (more than 90%) are thankfully benign. Thyroid cancer is however the second commonest cancer among young women after breast cancer and is 3 times more common in women than in men. However because the incidence of thyroid nodules are a lot more common in women, we worry more about cancer when a man develops a thyroid nodule.

We worry more about thyroid cancer when there is a strong family history of thyroid cancer, in elderly women with a fast growing lump and if there is a previous history of radiation exposure either from radiation treatment or exposure to radiation fallout. Certain races have a higher incidence and insufficient iodine in our diet has been associated with thyroid cancer. We are also concerned if the patient also has enlarged lymph nodes, lumps which don’t move with swallowing. Rarely, thyroid cancer presents with symptoms of spread like hoarseness, swallowing problems, breathing problems and throat pain.

The ENT doctor will carefully examine your neck to determine if the lump is a lymph node, thyroid nodule or some other lump. He will usually insert an endoscope through the nose to look for a growth if it is a lymph node. With the endoscope, he can also check for the movement of the vocal cords which may be affected with thyroid cancer. He may do blood tests to check the thyroid function, ultrasound scan and do a fine needle biopsy to exclude cancer. If in doubt, he will recommend surgery (removing half the gland) with frozen section while the patient is asleep (under anaesthesia) to exclude cancer. He will usually proceed to removing the entire gland if it is proved to be cancerous. Sometimes a neck dissection is carried out to remove lymph nodes

Thankfully thyroid cancer is usually one of the easier to control cancers, especially in young patients. While there are usually 4 stages of cancer, in young patients, there is only stage 1 and 2. Even with distant spread, it is only stage 2, thanks to the availability of radio-iodine, a ‘magic bullet’ which can be used to specifically target distant spread of cancer. In older patients, there are the usual 4 stages to reflect poorer prognosis with advanced cancer.

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