When I was at the recent Hopkins Head and Neck Cancer Conference (which was primarily for doctors and nurses) two top ENT surgeons and a top medical oncologist all said -- repeatedly -- that "for a patient presenting with a neck mass, it should be considered cancer unless proven otherwise." However they also said that a two-week course of antibiotics to rule out infection would not have a significant impact on diagnosis and treatment.

My husband had a neck lump in November 2003 and his doctor thought it was an infection, it went away for almost a year -- then came back in October 2004. No one thought it was cancer -- even the ENT who did an immediate incison and drainage because of its size -- because in the MRI and CT scans it looked like a cystic node, per the radiologist. However, it was and was finally dx'd several months later. Luckily for him, there had been almost no growth (comparing the two sets of MRIs and CTs) but there could well have been!

In retrospect the 2003 lump was probably the first indication, on same side and in same place. That would have meant the cancer was even then in his lymph nodes, thus treatment would have been the same, but still an earlier diagnosis would have been very beneficial. Perhaps he cancer would not have invaded the base of tongue or the second node. (His doctors speculated that he may have had this cancer 5 years or so.)

Dr. Gillison (at the same conference) who is working on human papilloma virus-16 HNC (see the OCF web site for more info on this) also spoke. She emphasized that there is a changing demographic -- younger patients, fewer of them smokers, more cancers in tonsil and base of tongue. And many patients presenting at an advanced stage with an initial neck mass as the first symptom. Many of these are HPV-16 positive, as was my husband.

Doctors should be aware that any neck lump should be an immediate red flag for further investigation!

Gail