Try as you may to bend your head forward or twist it from side to side, but no matter what you do, you will never be able to see your neck.
That is, until you take a selfie, says Arsenio Claro A. Cabungcal, MD, an Ear, Nose, and Throat (ENT) Specialist from Makati Medical Center (MakatiMed).
“That’s when you notice that, ‘Hey, my neck does not look even,’” says the doctor. “Or you could be part of a family group picture. Then when you check the photo, someone will point out that there is a lump in your neck.”
Described as the bridge between the head and the rest of the body, the neck houses many important parts. There is the throat (the passageway of air, food, and liquid, it is also responsible for our speech), the thyroid (the butterfly-shaped gland in front of your neck produces hormones that regulate heart rate, blood pressure, metabolism, body temperature, growth, and more), and lymph nodes (found at the front, sides, and back of the neck, as well as all over the body, these bean-shaped organs are your defense against infection).
Spotting neck issues
A lump or lumps in your neck indicate that something is going on with your health. “The most common is an upper respiratory tract infection,” shares Dr. Cabungcal. “In addition to a fever, cough, and cold, the lymph nodes in your neck become swollen and tender. That means they are busy trapping and filtering out the bacteria or virus responsible for your infection.” With medication and rest, your swollen lymph nodes and the rest of your symptoms should go away in a few days.
Dr. Cabungcal, however, is more concerned about painless lumps in the neck that gradually grow. Take goiter, for example, or the enlargement of the thyroid gland due to a hormonal imbalance or iodine deficiency. This manifests on the outside as a benign lump at the center of your neck that grows ever-so-slowly, taking months or even years before you notice it.
But the MakatiMed ENT doctor can spot them a mile away. “When a patient’s walking to my clinic and I can see a lump at the center of their neck, I already have an idea that it is goiter,” the doctor says.
Goiters can be subtle or downright obvious, as with the case of a patient with a goiter as big as his head. “In some government centers where we work, we get patients from far-flung areas who do not have access to healthcare,” he explains. “When these patients get to see a doctor in a hospital—if they get to see a doctor in a hospital—the swelling in their neck is already big.” Depending on its size, a goiter can impede your ability to swallow and breathe. And while painless, it can be heavy and uncomfortable.
Treatment for goiter includes medication to correct either an overactive or underactive thyroid, radiofrequency ablation (which uses radio waves to destroy abnormal tumors), and a thyroidectomy, a type of surgery to remove part or the entire thyroid gland.
Could you possibly have neck cancer?
But what if the large, painless lump on your neck comes with other worrying symptoms like swollen lymph nodes, difficulty in swallowing and breathing, a persistent hoarseness in your voice, fatigue, and unexplained weight loss? A biopsy plus blood and imaging tests will confirm—or rule out—if it is cancer of the thyroid gland, lymphatic system, or a metastasis of cancer of the tongue, throat, or another organ close to the neck.
“There is the impression that if the cancer has spread to the lymph nodes, it is hopeless,” says Dr. Cabungcal. “But with the latest surgical techniques and adjuvant treatments like chemotherapy, radiation, immunotherapy, and targeted therapy, the outcomes are still better even for stage 4 cancer patients.”
“Stage 4 is not a life sentence,” he declares. “There are many options available to you.”
Thyroid cancer is addressed with a thyroidectomy and neck dissection (or the surgical removal of malignant lymph nodes). Reconstruction is part of surgery for thyroid cancer, especially when the cancer has eroded through the skin. In microvascular free flap reconstruction, skin is sourced from the patient’s thigh; pectoralis major myocutaneous flap involves getting muscle from the chest wall. This is then transferred to the neck area, and surgeons connect arteries and veins to ensure a healthy blood supply. The intricate procedure takes a day to complete.
Following thyroidectomy, one of the first things patients ask Dr. Cabungcal is if they will lose their voice. “In general, 90% of the time, the voice is usually preserved,” he says.
For patients whose cancer has spread to their tongue or larynx, forcing surgeons to remove them, treatments and technology can make them regain their ability to speak. Fillers can be injected into the vocal cords, improving quality of speech. Patients can also undergo speech therapy to overcome slurring and some form of speech impairment. And if the larynx or voice box is removed, there is the electrolarynx, a battery-operated device that allows you to speak, albeit in a robotic tone, when you press it to your neck.
Depending on your case, post-surgery care can range from a quick follow-up to see if the wound has healed (for benign tumors), to a lifetime of consultations to ensure the cancer has not come back.
“This necessitates regular monthly follow-ups for the first six months. And then, later, once every two months, then three months. And then, as time goes by, it becomes yearly,” notes Dr. Cabungcal. “It never stops. I just tell my patients, “It is like our anniversary!”
The takeaway? See your doctor as soon as you know you have a lump on your neck, whether because it hurts, you felt it with your hands, or spotted it accidentally from a selfie.
“Not all lumps mean cancer,” stresses the doctor. “But the earlier we detect it, the earlier we assess it, the earlier it gets diagnosed, and the earlier you get your treatments, the better the outcomes.”
Article based on the Doctors on TV guesting of Arsenio Claro A. Cabungcal, MD last December 2, 2023.
For the complete list of Makati Medical Center’s Ear, Nose, and Throat (ENT)/Otorhinolaryngology Specialist, click here. You may also reach us via MakatiMed On-Call at (+632) 8888 8999 or at [email protected].
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