Neck Lumps and Bumps Rapid Fire Session: Update Course 2015
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about neoplasm
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What the experts said
Neck masses are developmental, inflammatory and reactive, or neoplastic.
Palpable nodes in children are very common and most of them are benign.
Reactive nodes tend to be small or fluctuate in size.
A cervical node that decreases in size will be extraordinarily unlikely to be neoplastic.
Symptoms of fever, weight loss, or splenomegaly may be indicators of neoplasia, but the duration and consistency of symptoms are not good indications that it's a neoplasm.
The diagnostic utility of a chest X-ray in children with enlarged nodes is actually unknown; some people do it routinely, but the diagnostic yield appears to be very minimal.
Seeing nothing on chest X-ray doesn't tell you anything really about the lymph nodes.
In patients with enlarged nodes, whether malignant or not, abnormalities of the complete blood counts are very uncommon.
The utility of fine needle biopsy in pediatric population for evaluation of lymph nodes is unclear.
Even when suspicious, most enlarged lymph nodes are not malignant in children.
Enlarged nodes persistent for greater than 6 weeks are considered indications for surgery.
Enlarged lymph nodes in this context means greater than 2 centimeters.
If you have an enlarged lymph node greater than 2 centimeters that has not changed in 6 weeks, it is reasonable to consider operation.
If the patient has night sweats or any B-type symptoms, the threshold for intervention is lower.
Parental anxiety and family history of lymphoma influence the practical decision of when to operate.
By the time patients see the surgeon, it's probably been 3 or 4 weeks at least because they've seen their pediatrician at least once, maybe twice.
Another indication to operate is if the size of the lymph node increases while on antibiotic treatment.
For cat scratch disease, you don't have to be scratched; children can be licked by a cat and then rub their eye.
A history of cat scratch or a history of conjunctivitis a couple weeks beforehand are very indicative of cat scratch disease.
If a child has already had a Z-Pak (azithromycin), that should effectively treat cat scratch disease if it was present.
A firm rubbery node greater than 2 centimeters is an indication for biopsy.
A hard immobile mass is an indication for biopsy.
A mass located in the supraclavicular area is completely abnormal and not associated with anything inflammatory as a rule, and needs to be biopsied.
A thyroid mass is an indication for biopsy.
Fine needle biopsy has good diagnostic yield in adults according to several papers.
Oncologists say to wait 6 weeks for enlarged nodes.