Lymph nodes, part of the immune system, can swell as white blood cells in the lymphatic fluid attack invasive cells. Typically, there are other symptoms, such as fever, that would suggest an infection is causing the swelling. Infections will also often cause painful swelling of the neck. 

If you have a painless lump on the side of your neck, you shouldn’t take the condition lightly. But it’s important to remember that the cause of the lump is often something other than cancer.

As people age, especially those who use tobacco — including cigarettes, cigars, chew or snuff — or who drink alcohol excessively are at higher risk of developing head and neck cancer.

“Benign causes of a painless mass or neck swelling can include thyroid nodules, swelling of a saliva gland, or a reactive lymph node,” said Mia Jusufbegovic, M.D., head and neck surgical oncologist with the Norton Cancer Institute Head & Neck Tumor Program. “However, it is important to rule out cancer as a cause, especially as HPV associated cancers, which are seen in younger patients, are becoming more common. Any persistent neck swelling should be taken seriously and discussed with your primary care provider or ENT.”

As the incidence of HPV related oropharyngeal cancers increases, it is important to eliminate this as a source of a new neck mass, and this often involves performing a biopsy. These cancers are caused the human papillomavirus and frequently present with primary sites in the tonsil or back of the tongue that stay very small and are only noticed after a neck mass begins to grow. HPV related head and neck cancers are not associated with a smoking or drinking history.

Other causes of lymph node swelling can be cancers that start in the lymphatic system, known as lymphomas .These can be divided into Hodgkin lymphoma, which often is curable, or non-Hodgkin lymphoma, which has varying prognoses depending on the type.

Thyroid nodules can be solid or filled with fluid. The thyroid gland is located at the base of the throat near the windpipe. Thyroid nodules can be large enough to form a visible lump or cause difficulty breathing or swallowing.

Few thyroid nodules are cancerous, but you should see your primary care physician or ENT for this condition. Risk factors for thyroid cancer include being assigned female gender at birth, between the ages of 25 and 65 years old and radiation exposure.

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Some head and neck cancers even can form without symptoms.

Mia Jusufbegovic, M.D., head and neck surgical oncologist with Norton Cancer Institute Head & Neck Tumor Program, encourages people to check for symptoms, and seek medical care if something doesn’t feel normal.

“We should have a low threshold for speaking up if we feel like something is not right,” Dr. Jusufbegovic said. “Head and neck cancers can really affect anybody. If you’re having a sore throat that won’t go away, or you notice a little bump on your neck, or you’re feeling hoarse, speak up for yourself.”

Cancers of the head and neck are rare and do not receive the attention other cancers do, but when they occur they often metastasize without notice.

According to the American Academy of Otolaryngology-Head and Neck Surgery, roughly 110,000 people are diagnosed with oral or head and neck cancer every year in the United States, accounting for 6% of all cancers in the U.S.

Two-thirds of the time, head and neck cancers will be found as late as Stage 3 and 4, meaning the cancer has spread at least to adjacent tissue and possibly to other organs. The goal has become finding and diagnosing the cancers early, since early detection is key to successful treatment.

Head and neck cancer typically refers to cancers of the upper aerodigestive tract, meaning the nose, mouth, throat, voice box, trachea and esophagus. However, head and neck cancer also can refer to cancer that forms in other parts of the head and neck, including the thyroid and salivary glands.

According to Dr. Jusufbegovic, these types of cancers often can be disruptive to daily life, since they can affect breathing, eating and swallowing.

“Head and neck cancer really affects the things that make us, us and define the things that we do every day and we take for granted every day,” she said. “It may get to the point where you can’t breathe on your own, or eating may be difficult. To tell someone, ‘your swallowing is not safe anymore, and eating poses a risk to you right now’ is difficult to tell people.”

Head and neck cancer causes

Tobacco and alcohol use are the leading causes of mouth and voice box cancers. Smokers are 15 times more likely to develop head and neck cancer compared with nonsmokers, according to the American Academy of Otolaryngology-Head and Neck Surgery. People who use both tobacco and alcohol regularly are at greater risk than people who use only one or the other.

Recently, another cause of head and neck cancer related to oral sex has revealed itself.

Annually in the U.S., 10,000 new cases of head and neck cancer can be attributed to a particular strain of HPV found more often in younger nonsmokers.

In 2018, HPV-related throat cancer moved ahead of cervical cancer as the most common HPV-related cancer in the country, according to the Head and Neck Cancer Alliance.

According to Dr. Jusufbegovic, receiving the HPV vaccine can help prevent these forms of cancers.

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HPV can cause cancer

HPV is a virus that spreads by coming into contact with the mucous membranes of an infected person. Typically this happens during sexual contact, including vaginal, anal and oral sex. Most people with HPV have no symptoms. A healthy immune system normally will rid the body of HPV without treatment. Some types of HPV cause warts on the skin, genitals or mouth. Some types of high-risk HPV can cause cancer.

READ MORE: What to do if you have a painless lump on the side of your neck

HPV-related cancers include:

• Cervical cancer
• Oropharyngeal cancers: Most of these cancers, which develop in the throat (usually the tonsils or the back of the tongue), are caused by HPV (70% of those in the United States). The number of new cases is increasing each year, and oropharyngeal cancers are now the most common HPV-related cancer in the United States.
• Anal cancer: Over 90% of anal cancers are caused by HPV. The number of new cases and deaths from anal cancer are increasing each year. Anal cancer is nearly twice as common in women as in men.

There are rare HPV-related cancers of the vulva, vagina and penis.

READ MORE: What’s the right age to start getting Pap smear tests?

Symptoms and treatment

“Some HPV infections have no symptoms, such as those in the cervix,” said Paul A. Tennant, M.D., head and neck surgical oncologist with Norton Cancer Institute Head and Neck Tumor Program. “That’s why routine cervical screenings are important for people who have a cervix.”

Other signs of HPV can be warts or itching.

“There is no cure for HPV right now,” Dr. Tennant said. “That is why vaccination is so important.”

The Centers for Disease Control and Prevention (CDC) recommends children, teens and young adults get the HPV vaccine as soon as they are eligible.

Cancer symptoms in the head and neck range from mild to severe and can include:

• Changes in the voice, such as hoarseness or difficulty speaking
• Ear pain
• Lumps or swelling in the throat or neck
• Sore throat
• Difficulty swallowing
• Some difficulty breathing
• Pain in the side of the neck

If you have new, persistent or worsening symptoms, call a health care provider.

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Rarely, pain in the front of your neck beside the windpipe can be a sign of a heart attack. It’s important to get emergency help for heart attack symptoms like chest pain (though not always); a squeezing feeling in your chest; pain in the neck, back or abdomen; pain in at least one arm; shortness of breath; cold sweat; and nausea.

Infrequently, tenderness in one of the carotid arteries can become painful.

If the pain is accompanied by a mass on the side of the neck — usually a swollen lymph node — and hoarseness, a cough, difficulty swallowing and squeaky noises when breathing, it’s worth making an appointment with your physician.

Tobacco use is the most important risk factor for head and neck cancers, including throat cancer. Adding moderate or heavy alcohol use to smoking cigarettes, pipes, cigars and other tobacco products increases your risk of head and neck cancer.

READ MORE: What to do if you have a painless lump on the side of your neck

“While cigarettes and alcohol are both risk factors for laryngeal cancer, evidence shows that using the two together may create a synergy, as heavy consumption of alcohol and cigarettes has been shown to multiply the risk of cancer in the larynx. Furthermore, we know there is an increase of throat cancers caused by viruses in the past 10 years.” said Aaron C. Spalding, M.D., Ph.D., a radiation oncologist and medical director of the Norton Cancer Institute Head and Neck Tumor Program.

Age is also a risk factor, as throat cancers tend to grow slowly over time.

Related: Does HPV cause throat cancer?

The larynx, vocal cords or voice box all refer to the front part of your throat that allows speaking and plays a role in breathing and swallowing. The first sign of laryngeal cancer is often a swollen lymph node.

The pharynx is a passageway at the back of the throat that connects the nasal cavity to the esophagus. Symptoms of pharyngeal cancer can resemble cancer in the larynx with soreness on one side, a lump, ear pain and difficulty swallowing.

Cancer in the nasopharynx — the top part of the throat closer to the nasal cavity — often is noticed first as a swollen lymph node in the neck and can cause a stuffy nose, nosebleeds and hearing loss.

At the bottom of the throat, the hypopharynx moves food from the throat to the esophagus. Cancer in this area can cause difficulty swallowing.

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Completion is planned for February 2020, with two downtown campus locations getting a makeover.

Norton Cancer Institute – Downtown (676 S. Floyd St.)

• New clinics will serve patients with urgent care needs related to cancer, hepatitis C and sickle cell disease.
• Advanced radiation therapy services will continue to anchor the first floor.
• New multidisciplinary care space will be created for the Head, Neck and Skin Cancer Program and Comprehensive Lung Center.
• Current skin cancer resources will be expanded to include innovative new technology.
• A state-of-the-art oncology pharmacy and an expanded chemotherapy and infusion suite are being added to the third floor.

Norton Cancer Institute Women’s Cancer Center (234 E. Gray St.)

• The new women’s center on the first floor will include offices for gynecologic oncologist Lynn Parker, M.D. along with six large gynecologic oncology exam rooms.
• A new expressive art and music therapy suite will be located on the first floor.
• Offices for Norton Cancer Institute’s research program will occupy part of the second floor.
• A new central call and scheduling center, plus space for the financial services team, will be on floors five and six.
• Additional plans include a multidisciplinary breast health clinic led by medical oncologist Laila S. Agrawal, M.D.
• A designated pull-in valet area will facilitate quick service for those visiting for outpatient blood tests.

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