History (neck swellings)

The history should take into account the following points:

• the most significant predictors of neoplasia are: (1)
  • age
    • this is the most important predictor
    • the risk of malignancy is greater with increasing age
  • size
  • duration of the mass
  • other features in the history suggestive of a neoplasm include (1)
    • anorexia and weight loss
    • smoking
    • heavy alcohol intake
    • past history of radiotherapy
• an infective or inflammatory cause may be indicated by (1)
  • fever and rigors
  • contact history of infectious disease
  • recent travel
  • injury to the head and neck
  • insect bites
  • exposure to pets or farm animals
• onset of symptoms is also significant (1)
  • acute symptoms
    • e.g.fever, sore throat, and cough
    • these suggest lymphadenopathy due to an upper respiratory tract infection
  • chronic symptoms
    • e.g. sore throat, dysphagia, hoarseness
    • these suggest anatomic or functional changes in the pharynx or larynx
• symptomps may be further grouped as
  • symptoms of systemic illness
  • specific head and neck symptoms
• the commonest cause of a neck swelling is an enlarged lymph node. In turn, the commonest causes of an enlarged lymph node are infection or tumour. In both of these cases systemic features are important.

Reference:

• (1) Schwetschenau E. The Adult Neck Mass, American Family Physician 2002;66:831-8.