from lymphoma or leukemia or can be because of metastasis from an adjacent solid tumor such as rhabdomyosarcoma, neuroblastoma, or nasopharyngeal carcinoma It can be difficult to distinguish the primary tumor mass from a lymph node in these circumstances Clinical Assessment Children with neck tumors, regardless of etiology, must be evaluated for impact on the airway, breathing, and circulation Clinicians should explicitly consider the following: Does the mass compress the airway? Does the patient experience respiratory distress or is there a compromise to breathing? Does the mass interfere with circulation of the head and neck leading to SVC syndrome (see “Tumors of the Thorax” section)? Does the tumor threaten to compress the cervical spine (see “Tumors in and Around the Spinal Cord” section)? Following this assessment, a careful history should address the duration the mass has been present and its rate of growth, any recent infectious illnesses, the patient’s immunization status, cat exposure, medications, and the presence of systemic systems Physical examination should assess for other masses or lymphadenopathy in the body In evaluating nodes of the neck, reactive nodes are often small, mobile, and soft, or while infected nodes may be enlarged, red, and tender Characteristics that make malignancy more likely include nontender masses, very firm/hard texture, diameter more than cm, adherence to other structures, irregular margins, and absence of signs or symptoms of infection Management Often radiographic imaging and laboratory evaluation is not needed However, in the case of suspected leukemia or lymphoma, laboratory studies should be obtained to assess for hyperleukocytosis, cytopenias, and TLS (see preceding discussion on leukemia) Radiographic imaging should be pursued if more information is needed about the tumor’s position in relationship to the patient’s airway and other vital structures of the head and neck When indicated, this is best accomplished with a CT scan In addition, a chest x-ray should be obtained to explore whether the disease could include a mass in the anterior mediastinum Laboratory evaluation should include a CBC with differential, ESR and LDH (which may be elevated in certain lymphomas), testing for any relevant infectious etiologies, and consideration of thyroid function testing