Early Oral Cavity Cancer Timeline: Surgery Alone

Most early (stage I or II) mouth cancers are treated with surgery alone: the tumor is removed through the mouth, the neck lymph nodes are checked or removed, and no added treatment follows when the pathology report shows no features that call for more.

This page is one of three treatment-track timelines for early oral cavity cancer. The steps before treatment, how a track is chosen and the follow-up schedule are covered on the early oral cavity cancer treatment timelines page.

Who follows this track

Surgery alone is the most common track for early mouth cancer. Whether a person stays on it is known only after surgery, once the pathologist has examined the tumor, its margins and the lymph nodes. If the report shows higher-risk features, treatment continues as surgery followed by radiation; if it shows a positive margin or cancer growing outside a lymph node, it continues as surgery followed by chemoradiation or a second operation.

Before surgery (weeks 0 to 4)

The biopsy, scans, meetings with the care team, dental check, speech and swallowing baseline, dietitian visit and the tumor board's recommendation are the same on every track and are described on the overview page. Studies show the best survival when surgery happens within about 20 to 30 days of diagnosis.

Surgery (about week 4)

• The tumor is removed through the mouth with a rim of healthy tissue around it (see mouth tumor treatments).

• The neck plan depends mainly on how deeply the tumor has grown: a neck dissection for tumors deeper than about 3 to 4 mm, a sentinel lymph node biopsy in some cases, or close watch with neck ultrasound for very thin tumors. If a sentinel node contains cancer, a neck dissection follows.

• The area is usually closed with stitches, a skin graft or a local flap.

• The hospital stay is often 1 to 3 days, and up to about a week when a skin graft or flap is used. A breathing tube in the neck (tracheostomy) is rarely needed.

On this track, surgery is the end of treatment, so the follow-up clock starts on the day of surgery.

Pathology results (about week 6)

About 1 to 2 weeks after surgery, the pathologist's report describes the tumor's size and depth, its margins and the lymph nodes (see understanding pathology results). In this timeline the report shows clear margins, no lymph nodes with cancer and no other risk features, so no added treatment is given. A single small lymph node with cancer and no other risk features may also stay on this track, with radiation considered rather than required.

Healing (weeks 4 to 16)

• The mouth is sore for the first week or two. A speech and swallowing therapist usually checks swallowing the day after surgery, and most people start liquids or soft foods within days.

• Most people return to a near-normal diet within about 4 to 6 weeks. A feeding tube is used only when needed.

• Some tongue stiffness, change in speech or limited mouth opening can occur and usually improves over 1 to 3 months with therapy (see swallowing problem treatments). Numbness of the tongue is described on the tongue numbness after surgery page.

• Neck healing after a neck dissection is described on the neck dissection recovery page.

• Return to work is often within a couple of months, and sometimes sooner after small procedures.

Quality of life on this track

Average scores before and in the first 6 months after surgery (0 to 100, higher is better):

• Overall: 60 before surgery, 70 at 1 month, 72 at 3 months and 79 at 6 months. Overall quality of life often rises after surgery, as the worry of the diagnosis eases and the treatment is over.

• Speech: 96 before, a dip to 77 at 1 month, 85 at 3 months, and back to 97 at 6 months.

• Mood: 81 before, 89 at 1 month and 3 months, and 94 at 6 months.

• Swallowing: 88 before, 92 at 6 months and 88 at 1 year, so swallowing stays close to where it started. No early mouth cancer study was found using the swallowing questionnaire used in the other timelines, so these numbers come from the swallowing part of a general head and neck questionnaire.

Where the numbers come from: a small study of people who had part of the tongue removed, nearly all for stage I or II cancer, with questionnaires before surgery and 1, 3 and 6 months afterward. The swallowing numbers come from a study of people with stage I or II mouth cancer, most treated with surgery alone, surveyed before treatment, at 6 months and at 1 year. A third study of people treated with surgery alone, mostly for stage I or II cancer, found a similar pattern for overall quality of life: 69 before, a dip to 62 at 3 months, 70 at 6 months and 75 at 1 year. The dashed points come from a separate study of people treated with surgery alone for early mouth cancer, surveyed once, about 1 to 5 years after treatment: overall 81, speech 86 and mood 83, showing that scores stay high over the longer term. Averages describe groups of people, not what any one person will feel. The questionnaires are described on the quality-of-life questionnaires page.

Check-ups and long-term care

• Check-ups follow the usual schedule counted from the end of treatment: every 1 to 3 months in the first year, every 2 to 6 months in the second, every 4 to 8 months in years 3 to 5, then yearly.

• Each visit includes an exam of the mouth and neck. Routine scans are not automatically needed without symptoms, so a new sore, lump, pain or trouble swallowing is reported to the care team promptly.

• Without radiation, the long-term dental, dry mouth and thyroid effects of radiation do not apply. Regular dental care continues, and speech and swallowing are checked over time.

• Staying tobacco-free and limiting alcohol lowers the chance of a new cancer in the mouth, throat, lungs or esophagus.