Lump at back of neck top of spine

While some spinal tumors have no symptoms, most eventually lead to back pain and could also cause neurological deficits, such as numbness or weakness. Spinal tumor symptoms can vary greatly based on where the tumor is located and whether or not it is cancerous.

Índice Show

Pain from a Spinal Tumor
In This Article:
Red Flag Symptoms with Back Pain
Neurological Deficits from a Spinal Tumor
Dr John Chaplin, Neck Lump Surgeon, Auckland NZ
Presentation
A neck lump that is hard, irregular, large, solid, fixed and non tender is likely to be malignant.
Back of the Neck and Post Auricular
Anterior or Midline Neck Masses
Lateral Neck Masses
Submandibular Swellings
Lumps at the angle of the Jaw
Normal structures that are sometimes interpreted as neck masses
Is it normal to have a bump on the back of your neck spine?
What is the lump at the top of my spine?
What could a hard lump on the back of my neck be?
What does a cancerous lump on the back of neck feel like?

See how a tumor in the spine can cause pain and other symptoms, and can also lead to vertebral fractures. Watch Metastatic Spinal Cancer Video

Pain from a Spinal Tumor

Tumors in the spinal column may cause back pain by damaging healthy tissues, such as the vertebrae (bones), and/or by compressing (pinching) the nerves.

Spinal tumor pain may feel like one or more of the following:

Upper or middle back pain. While most spinal pain is located in the lower back or neck, pain from a spinal tumor is more likely to be felt in the upper or middle back. About 70% of spinal tumors are located in the thoracic spine.1
Watch Causes of Upper Back Pain Video
Deep ache. Spinal tumor pain may feel like an achiness or discomfort deep within the back, rather than feeling painful on the surface or skin.2
Sharp or shock-like pain. Pain from a spinal tumor may be limited to a specific region in the back, or it could travel along a nerve root (radicular pain) or the spinal cord (myelopathic pain). Shock-like pain could radiate into the chest, abdomen, leg(s), or arm(s).
Feels worse at night than during the day. Spinal tumor pain typically does not diminish with rest or activity avoidance, and it may intensify at night, causing disturbed sleep.2,3
Feels worse in the morning when waking up. For some people, spinal tumor-related back pain may be at its worst when waking up in the morning.
Worsens with touch or compression. Pain may flare up or intensify when the spinal tumor or nearby region is touched or undergoes compression, such as during strenuous activity.3
Lower back or neck pain. About 20% of spinal tumors are in the lumbar spine (lower back) and about 10% are in the cervical spine (neck).1

Spinal tumor-related pain may also be located in multiple levels of the spine, such as in the thoracic spine and lumbar spine, when there are multiple tumors or a tumor has become bigger.

Red Flag Symptoms with Back Pain

When back pain is accompanied by one or more of the following symptoms, it requires immediate medical attention.

Loss of appetite
Unplanned weight loss
Nausea or vomiting
Fever, chills, or shakes

These symptoms could indicate cancer or another serious condition is present.

See When Back Pain May Be a Medical Emergency

Neurological Deficits from a Spinal Tumor

When a spinal tumor grows big enough to compress the spinal cord or a nerve root, neurological deficits can occur. Examples include:

Radiculopathy. When one or more nerve roots become compressed or inflamed, pins-and-needles tingling, numbness, and/or weakness can radiate into the chest, abdomen, leg(s), or arm(s). These signs can vary based on the location of the tumor within the spine. A thoracic spinal tumor is more likely to radiate symptoms into the chest or abdomen, whereas a lumbar spinal tumor is more likely to radiate symptoms into the legs.
See Lumbar Radiculopathy
Myelopathy. When the spinal cord becomes compressed or inflamed, neurological deficits may be experienced anywhere in the body at or below the level of spinal cord compression. For example, numbness or weakness could travel into both legs and reduce coordination for walking.
Cauda equina syndrome. When the cauda equina (bundle of nerve roots that descend from the spinal cord) becomes compressed in the lumbar spine, it can cause numerous neurological deficits beneath the level of compression, such as numbness or tingling in the saddle region (inner thighs, genitals, and buttocks), walking dysfunction, and/or loss of bowel and/or bladder control.
Watch Cauda Equina Syndrome Video

Spinal tumors may cause neurological deficits with or without back pain and/or leg pain.

References

1.Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Spinal tumors of the spine. World J Orthop. 2016; 7(2): 109-116. doi: 10.5312/wjo.v7.i2.109.
2.Laufer I, Sciubba, DM, Madera M. Surgical Management of Metastatic Spinal Tumors. Cancer Control. 2012; 19(2): 122-8. doi:10.1177/107327481201900206
3.Lee JS, Jung C-H. Metastatic Spinal Tumor. Asian Spine J. 2012; 6(1):71-87. doi: 10.4184/asj.2012.6.1.71.

Neck Lumps

Dr John Chaplin, Neck Lump Surgeon, Auckland NZ

Neck lumps are very common and they are mostly innocent. Lumps in the neck are usually reactive neck lymph nodes or thyroid nodules but they can also, rarely, be cancer. I have presented a systematic method of evaluating neck lumps to determine what they are most likely to be.

Presentation

The features that help one diagnose neck lumps include:
Site ,size, edge, consistency, colour, attachment, transillumination, pulsation, tenderness, nodes.

A neck lump that is hard, irregular, large, solid, fixed and non tender is likely to be malignant.

Other features that help differentiate a neck lump include:
Age and site

One must always be aware that a lump may be a metastatic malignancy and that the first sign of the mass may be the primary site or vice versa.

Age

In Children and young adults inflammatory and congenital lumps are most common,

In adults a persistent lump is likely to be neoplastic and malignancy must be excluded.

Site

There are Six general regions in the neck where lumps characteristically appear

Anterior or midline divided into supra and infra-hyoid
Lateral either, carotid/ jugular or posterior triangle including the supra-clavicular region
Submandibular
Angle of jaw
Post Auricular
Back of Neck

Back of the Neck and Post Auricular

The only masses that characteristically develop in the Back of the Neck are superficial masses like lipomas and sebaceous cysts and vascular or lymphatic malformations. These types of masses can occur anywhere in the neck and for that matter on the body. In the post auricular area lymph nodes can be enlarged by inflammation, lymphoma or metastatic skin tumours like melanoma or SCC from the posterior scalp. An abscess can develop from a necrotic node or from mastoiditis with erosion of the mastoid bone. The middle ear will always be abnormal if the cause of the abscess is mastoiditis.

Anterior or Midline Neck Masses

Infrahyoid masses will be mostly thyroid in origin see Thyroid Surgery. Nearly all thyroglossal duct cysts are below the hyoid, slightly left of midline, and seen in young people. Pretracheal nodes that are caused by metastatic laryngeal or thyroid tumours can also present in this region . Suprahyoid masses may be thyroglossal but are more likely to be submental lymph nodes involved by inflammation or malignancy from the skin of the lips, anterior facial skin or oral cavity, particularly the floor of mouth. Dermoids are rare developmental inclusion cysts that form in the midline during embryonic development but often do not manifest until later in life. Thyroid tissue can arrest anywhere along the thyroglossal tract and can present in the submental region.

Lateral Neck Masses

Woman with a right level 2 nodal mass suggestive of a metastatic HPV related oropharyngeal cancer

Lateral neck masses are more complex. They most commonly present in the carotid sheath in association with the carotid artery or jugular vein but they can also appear in the posterior triangle.
Solid lesions in the lateral neck are either nodal (inflammatory or metastatic malignancy) or they are rare tumours like carotid body tumours, neurogenic tumours associated with many of the nerves in the neck or rarely they can be malignant sarcomas of the deep neck tissues.

Cystic lesions may be congenital branchial cleft cysts or lymphatic/vascular malformations. However they may also be cystic malignant nodes. These are notoriously difficult to diagnose and needle biopsies are usually non- diagnostic.
Cystic nodal metastases are frequently confused with benign branchial cleft cysts and a careful history of upper aerodigestive tract symptoms is important to elicit.
Lesions in the skin and subcutaneous tissues are usually benign but skin cancers and melanoma can occur as cutaneous nodules.
Nodal lesions in the posterior triangle and supra-clavicular area are uncommon. Metastases to this area either come from skin lesions in the posterior scalp or nasopharyngeal carcinoma. Typically TB can affect lymph nodes in this area. Atypical TB in children tends to affect level I nodes in the submandibular area.

Submandibular Swellings

Young woman with a large right primary submandibular gland tumour

Lumps in the submandibular area are usually related to the submandibular gland. Obstruction of the duct by stones or sludge typically presents as painful swelling associated with eating or even with the thought of food. The swelling will generally resolve over a period unless an ascending infection develops. Sometimes the stone can be felt in the duct in the floor of the mouth. Massaging the gland rather than producing a good flow of clear saliva often produces a small amount of turgid saliva or none at all.

Submandibular salivary tumours present as painless progressive swellings. About 50% are malignant. See Salivary Gland Surgery

Lymph node metastases to this area are either from lip or anterior facial skin cancers or from tumours on the oral tongue, floor of mouth or buccal mucosa.

Ranula, from the Latin “Rana” meaning frog, are mucous extravasation pseudocysts from the sublingual gland. They usually present as a cystic swelling in the floor of the mouth but they also may present as a soft fluctuant swelling in the submandibular region when they “plunge” through the mylohyoid muscle. Aspiration of mucoid saliva form this lesion confirms the diagnosis. They have characteristic CT findings and are treated by trans-oral removal of the sublingual gland.

Lumps at the angle of the Jaw

Young patient with a right parotid gland tumour

Lumps at the angle of the jaw are often related to the parotid gland and are either lymph nodes or salivary gland tumours. Most parotid gland tumours are benign but around 20% are malignant. NZ has a high incidence of skin cancer to that spreads to lymph nodes and in the parotid and our most common parotid malignancy is metastatic skin squamous cell cancer (SCC) followed by melanoma. See Salivary Gland Surgery
Congenital cysts can also occur in this region and they generally originate from the first branchial arch.

Normal structures that are sometimes interpreted as neck masses

Hyoid bone, lateral process of C2, ptotic submandibular glands, masseter muscle, mastoid tip, omohyoid muscle.

Is it normal to have a bump on the back of your neck spine?

Muscle knots, a pinched nerve, or contracting tissue may sometimes give the appearance of neck lumps, especially after strenuous exercise and physical exertion. These lumps are fairly common, appearing with both children and adults.

What is the lump at the top of my spine?

Kyphosis is a condition where the spine curves at an increased angle, causing a rounding or hump to form around the upper back or shoulders. There are many possible causes of kyphosis, including aging, poor posture, and spinal conditions. In the past, kyphosis was referred to as “dowager's hump”.

What could a hard lump on the back of my neck be?

The most common lumps or swellings are enlarged lymph nodes. These can be caused by bacterial or viral infections, cancer (malignancy), or other rare causes. Swollen salivary glands under the jaw may be caused by infection or cancer. Lumps in the muscles of the neck are caused by injury or torticollis.

What does a cancerous lump on the back of neck feel like?

Cancerous lumps are typically hard and often pain-free in the early stages, starting up deeper in the body. Lumps that are associated with growths or sores in your mouth are also worrisome, as is any lump accompanying throat problems, such as hoarseness or trouble swallowing.