Quick take: Is a neck swelling serious?

Many neck swellings are due to infections (reactive lymph nodes) and settle once the infection clears. But a lump that lasts more than 2–3 weeks, keeps growing, feels hard or fixed, or comes with red flag symptoms needs proper assessment by an ENT specialist. nhs.uk

Common causes of a neck swelling

• Swollen lymph nodes after a throat, nose, ear or dental infection
• Thyroid problems: nodules, goitre
• Salivary gland issues: stones (sialolithiasis), infection (sialadenitis)
• Benign lumps: lipoma, epidermal/dermoid cyst
• Congenital cysts (more in younger patients): thyroglossal duct or branchial cleft cyst
• Cancers: lymphoma and head & neck cancers (including nasopharyngeal carcinoma/NPC)

Tobacco and alcohol are major risk factors for head & neck cancers; in our region, betel quid/areca nut chewing also raises risk. CDCPubMed

In Malaysia, NPC is among the more common cancers, especially in Chinese and some indigenous groups—so a persistent, painless neck lump should be checked early. Ministry of Health Malaysia

Red flags you should not ignore

Seek urgent care (call 999 or go to the Emergency Department) if you have:

• Rapidly enlarging neck swelling with breathing difficulty, noisy breathing, or drooling
• Severe neck pain with high fever or feeling very unwell

Book an ENT appointment promptly if you notice:

• A lump that persists >2 weeks, enlarges, or feels hard/fixed
• Night sweats, unexplained fever, weight loss, or fatigue
• Persistent hoarseness, painful swallowing, ear pain without ear findings, nose block/bleeding (NPC clues)
  These features merit timely specialist assessment and sometimes urgent cancer pathways. nhs.ukNICE

What you can do now (before seeing us)

• Don’t squeeze or massage the lump.
• Note when it started, how it has changed, and any associated symptoms (sore throat, dental pain, fever, weight change).
• Gather recent blood tests, scans, medicine list, and dental records if available.
• Simple measures for suspected viral illness: rest, fluids, paracetamol as needed (avoid NSAIDs if advised otherwise).
• Avoid starting leftover antibiotics—they may blur findings and delay diagnosis.

What to expect when you visit The ENT Doctor

1) Focused history & head–neck examination

We’ll map the lump’s location, size and feel, and check your mouth, nose, throat, ears, thyroid and salivary glands. We also examine for risk factors (tobacco, alcohol, betel quid) and systemic signs. CDC

2) Flexible nasoendoscopy (scope) – usually same visit

A thin, flexible camera is passed through the nose after numbing spray. It takes a few minutes and helps us view the nasopharynx, back of nose, voice box and throat—critical when investigating an unexplained neck lump in adults. Ministry of Health Malaysia

3) Neck ultrasound

A quick, radiation-free scan that characterises thyroid, salivary glands and lymph nodes. It also guides fine needle aspiration cytology (FNAC) when needed. This step is recommended by international neck mass guidelines for efficient, accurate work-up. PubMed

4) FNAC (needle test)

A very fine needle samples cells from the lump; most patients tolerate this well without stitches. It helps distinguish reactive nodes from lymphoma or metastasis, and guides next steps. PubMed

5) Blood tests and imaging (when indicated)

Depending on findings, we may order thyroid bloods, infection screens, or CT/MRI for deeper mapping—especially if cancer is suspected so treatment isn’t delayed. rcot.org

6) Clear plan & follow-up

We’ll explain results, likely diagnosis, and treatment options. If cancer is suspected, we fast-track you through a multidisciplinary pathway for timely biopsy, staging and oncology care, consistent with best-practice referral guidance. NICE

How we treat neck swellings (depends on the cause)

• Infections: targeted antibiotics only when bacterial; source control (e.g., dental treatment).
• Salivary gland stones: hydration, gland massage, sialogogues (sour sweets), sometimes minimally invasive stone removal.
• Thyroid nodules/goitre: observation, thyroid medication, FNAC, or surgery depending on risk.
• Benign cysts/lipomas: minor surgery if symptomatic or enlarging.
• Suspected cancer (e.g., NPC, metastatic node, lymphoma): urgent ENT–oncology pathway for biopsy, imaging and combined treatment (surgery, radiotherapy, chemotherapy) according to guidelines. Ministry of Health MalaysiaPubMed

When to see an ENT (rule of thumb)

• Any neck swelling lasting >2 weeks
• Hard, fixed, painless lumps
• Lumps with B symptoms (fever, night sweats, weight loss)
• Persistent hoarseness, difficulty swallowing, ear pain with normal ear exam, or one-sided nose block/bleeding
• History of tobacco, alcohol, or betel quid use
  These scenarios meet common referral triggers used to detect cancers early. nhs.ukNICE

FAQs

Is a painless lump more worrying than a painful one?
Often yes. Painless, hard, persistent lumps raise more concern than tender, mobile lumps after infection. Please get assessed. nhs.uk

I’m Chinese and have a neck lump—should I worry about NPC?
NPC is relatively common among Malaysians overall and particularly among Chinese and some East Malaysian groups. Early ENT evaluation is wise if a neck lump persists. Ministry of Health Malaysia

Can I wait for antibiotics to “work” first?
Not if red flags are present or the lump has persisted beyond 2 weeks. Early assessment avoids delays if something serious is found. nhs.uk

Trusted resources

• NHS – When to seek help for lumps and swollen glands. nhs.uk+1
• AAO-HNSF Clinical Practice Guideline: Evaluation of the Neck Mass in Adults – diagnostic pathway and tests. PubMedrcot.org
• NICE NG12 – Suspected cancer: recognition and referral. NICENCBI
• MOH Malaysia (CPG NPC) – Malaysian context for nasopharyngeal carcinoma. Ministry of Health Malaysia
• CDC – Head and neck cancer basics and risk factors (tobacco, alcohol, HPV). CDC
• Evidence on betel quid and head & neck cancer risk. PubMed

A gentle next step

If you’ve found a neck swelling—especially one that’s persistent or painless—let’s check it properly. Early diagnosis leads to simpler treatment and peace of mind.

Book an appointment with Dr Julius Goh (ENT)
Klang Valley • Same-day scopes available • Multidisciplinary pathway if needed

Disclaimer: This article provides general information and is not a substitute for medical advice. If you have worrying symptoms, please seek medical care promptly.