Maggie McKay (Host): This is Community Connect presented by Tampa General Hospital. I'm your host, Maggie McKay. Joining me today is Dr. Matthew Mifsud, Vice Chairman of the Department of Otolaryngology and a Head and Neck Oncologist at the University of South Florida.

Have you ever felt a lump on your neck and thought, what is that all about? Well, we're going to get an overview on neck masses and what you need to be aware of. Thank you so much for joining us today.

Matthew Mifsud, MD: Thank you for having me.

Host: Absolutely. So what are some of the most common lumps or bumps you see in the neck on a daily basis?

Matthew Mifsud, MD: Yeah, so unfortunately most of the things we see in adults are things you want to pay attention to. So, very common one are things like a thyroid lump or nodule, something in the middle of the neck. We also see in my practice, a lot things in the saliva or the spit glands kinda lumps in the side of the cheeks. But the other things we see are lymph nodes, potentially lymph nodes with cancer. So things that you really want to pay attention to.

Host: When should I be concerned about a mass in my neck? When should I see my doctor? When should I consider a referral to a specialist?

Matthew Mifsud, MD: So there's a few things that you really want to think about. First, I'd say, when should you not be concerned? Things that are small, like, pea size, quarter of an inch, half an inch, something like that, that are soft, rubbery, roll around, particularly kind of around bone, like under the clavicle or the jaw.

Those are things you don't need to worry about. When you need to start worrying are things that are getting a bit bigger. What I would say, what we say is about two centimeters, or an inch or so that kind of have substance to them, that are firm, particularly things that run along the middle of the neck or the side of the neck. I think that's number one thing you need to think about. Anything that's been around for more than a few weeks or month, have to get that looked at. Obviously, when you start having any other symptom and you have a lump in the neck, you need to really think about it. So, changes in swallowing, loss of weight that you can't explain. Some type of change in your voice. Pain that is just, you can't quite get rid of. Those are things you really need to think, okay, what's going on here? Let's look into this.

Host: Can you tell us what steps you take to diagnose different neck masses?

Matthew Mifsud, MD: There's a few things. First, we start basic exam. We get our hands on people. We feel, we look in their mouth, we look in their throat, we look in their neck. Then one thing that we have in our department that's a little unusual is we actually do a lot of ultrasound in our own clinic.

So we'll actually use the ultrasound machine right then and there the first time we meet someone. We could take a look at the quality of the neck lump. We can look at the thyroid really well and really get a good sense. And I'll give you a good example. I saw a patient today who comes in with this big growing thing on the side of her neck. She thought it was a cyst. Had some CAT scans elsewhere that didn't really explain it. And then we immediately got her into the clinic, brought in an ultrasound, and I could see a thyroid nodule that wasn't previously seen and a mass in the neck. And we already know what's going on.

 Sometimes we do order those complicated scans like a CAT scan or MRI or things like that, and we kind of add that to it. And then another thing we do a lot of is needle biopsy. So if you have a lump in the thyroid or lump in the side of the neck, right there in the clinic, again with that ultrasound, we can put a little needle in it, take a sample, and really kind understand what's going on.

Host: So let's talk about children. Can they get neck masses as well? What are some of the different conditions we may see in them?

Matthew Mifsud, MD: The good thing about children is, which is different than adults. But the kind of things that they're getting are actually going to be more benign, well-behaved, things that you don't have to be as concerned about. And there's kind of three common lumps that kids can get. The first two are both congenital. One of them is called the brachial cleft cyst, and that's something that grows on the side of the neck. And what this basically is, is a remnant of development. So when you're in your mom, when you're growing, when you're developing, when you start off, we all kind of look like fish.

We all kind of have things that look a little bit like gills.

 In some of us, for some reason, those structures actually kind of get left behind and can create a little cyst that can grow and form a lump in the neck, side of the neck. There's something in the middle of the neck called the thyroglossal duct cyst, which is a very similar kind of origin, but instead of coming from that area, comes in the middle, comes from thyroid tissue.

But again, it kinda shows up as often a painless lump in the middle of the neck. Sometimes something that's actually infected will kind of swell up, you get antibiotics, it comes down, but the lump doesn't go away. Both of those are things we treat with surgery or observation, kinda watching to see if they shrink down on their own.

The third one that's really common in kids is more something infectious. So they get a really sudden swelling in the neck. It's inflamed, it's irritated, it's painful, usually the kind of thing that's going to go away within antibiotics. That's really what we see commonly in kids. Now, of course, kids can get all sorts of things in the neck.

There's always risk of very rare types of things, like a sort of rare type of cancer and stuff like that. But most are going to be the one of those three benign type conditions.

Host: That's gotta be concerning for parents, though. I mean, for you you see it every day, but if you see a lump in your child's neck, should you just pick up the phone right away and call the doctor?

Matthew Mifsud, MD: Yeah, I mean, I think the reality is that most parents are not going to watch one of these things with their kids. And I think it's also important, with kids, you are always going to be more concerned about infection, right? So, something that might need in treatment, that might need antibiotics that might cause a bigger problem if it's set on.

So I think if you see any of these things as a, a parent, the best thing to do is find out right away, what is this? Do I need treatment? Do I need to see a specialist? There's no point in waiting because it's only going to drive you crazy. At least it would be for me if it were my kids.

Host: Let's talk a little more about head and neck cancers and how you treat these at USF Tampa General.

Matthew Mifsud, MD: Yeah, so I mean cancer is sort of what I do day in, day out and again, one of the common reasons these patients show up is a lump in the neck. But when we talk about head and neck cancers, what makes it a little bit tricky is it's not a one size fits all type of approach. I think people have a pretty good understanding of what a breast cancer is, for example, what a lung cancer might be.

Not that those aren't really complicated. They absolutely are, but it kind of is a very single, compartmentalized type of thing. The problem with head and neck cancers is any cancer that grows anywhere pretty much from the neck up in many different locations can be a head and neck cancer, and we have to treat each of those differently.

But what we do at USF and Tampa General is we do this as a team approach. We have a group, we all take things from different angles. We have surgeons, we have medical oncologists, we have radiation oncologists. We have all sorts of support staff, like speech therapists and physical therapists and social workers, et cetera.

And we look at each patient and think what is going to be best for their individual situation? And some patients, that's where I get involved and they need surgery. And there's a whole spectrum of surgeries from very simple to very complicated. Sometimes they need radiation first, and then I have them see my partner as radiation.

 More than ever even changing over the last year, a lot of our patients actually need some sort of new treatment. Something like immunotherapy, which is a immune system response against cancer. I have them see my medical oncology partner and they would start with the treatment. Most patients actually need a combination of these things.

So a lot of what we're doing day to day is kind of figuring out what combination works for you and where do we start? Do we start with the surgery? Do we start with the radiation? Do we start with the drugs or the new targeted treatments? And, that's really what we're working on every patient kind of developing a plan that's right for them.

Host: I know you're an expert on salivary gland masses. Can you tell us a little bit more about how these present and how you treat these?

Matthew Mifsud, MD: Yeah. So, that's where the other thing that I do day to day, it's a big part of my practice and, the way salivary gland lumps start out is exactly the same as we start prep from the beginning. A lump in the neck. Usually these are more lumps that are a little bit higher up. They kind of are sitting in front of the ear or, just along the lower edge of the jawbone. I'd say 95% of patients who show up, it's a painless lump that just keeps growing and won't go away. Most patients start to kind of get worried when they can really feel it, they can start to see it. And that's usually when they come in. The way we work these up is very similar to how we did before.

Same group of different scans, exam, biopsy, all of that. But the way we treat these is usually with surgery, and that's because most lumps that grow in the salivary glands will slowly grow over the course of patient's life. A lot of the patients who we see with these are on the younger side, in the twenties, thirties, forties, and fifties.

So they're going to be around with these a while, and some of these do have a chance of turning into cancer. So a lot of these we will do surgery on. The surgery for these is a little complicated because there's a lot of nerves that are around most of these salivary glands, particularly the nerves that move the face, make you smile, close your eyes and do all of that.

So you really need to be with an expert that works around those nerves every day. What we do in my practice is a little different than maybe the average is. We do really customize the surgery for the patient, the tumor. So I don't treat someone who has a two centimeter tumor who is 25, the same as someone who's got a five centimeter tumor who's 50.

Different patients can get different incisions based on the location, and some patients we'll even do reconstructive surgery, like we'll take some fat from their belly to put it up there to make sure they look the best. So we really customize our treatment based on who you are and what your individual situation is.

Host: Is there anything else in closing that you'd like to add that maybe we did not cover?

Matthew Mifsud, MD: I think the biggest thing for me that I think is important for anybody who's got one of these lumps or bump in the neck is you really want to, particularly as an adult, make sure you get seen early. If you have anything more than a month, just come in, get seen, get a scan, get an ultrasound, have someone that knows what they're talking about really do an evaluation. One of the biggest problems a lot of our cancer patients have is they're often thought that they're coming in with an infection. They're treated with many rounds of antibiotics before they get the right diagnosis.

And so I think as an adult, you really want to make sure that you really get the right assessment early so that you can come up with the right plan. And then I think the other thing to really highlight for us is that a lot of these things require multiple different people. And then the best care you can really get is with somebody who can really give you multiple different opinions that works with different people that works as a team. I think you're going to get the best care.

Host: Well, this has been so educational and informative. Thank you so much for sharing your expertise.

Matthew Mifsud, MD: Thank you for having me. It was great.

Host: That's been Dr. Matthew Mifsud. And for more information you can visit tgh.org/ent. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect presented by TGH on your favorite podcast platform. I'm Maggie McKay, and this is Community Connect presented by TGH. Thanks for listening.