Oropharyngeal Cancer Timeline: Surgery Alone

Some small, early oropharyngeal cancers are treated with surgery alone: transoral robotic surgery (TORS) with a neck dissection, and no added treatment when the removed tissue shows no features that call for more.

This page is one of six treatment-track timelines for oropharyngeal cancer. The steps before treatment, how a track is chosen and the long-term follow-up schedule are covered on the oropharyngeal cancer treatment timelines page.

Who follows this track

Surgery alone is most often an option for small, early cancers, HPV-positive or HPV-negative, that can be reached and fully removed through the mouth. Radiation alone is the main alternative for many of these cancers, with similar survival in studies and a different set of side effects.

Whether a person stays on this track is only known after surgery. If the pathologist finds features such as cancer at the cut edge, several involved lymph nodes, or cancer growing outside a lymph node, treatment continues as surgery followed by radiation or surgery followed by chemoradiation.

Before surgery (weeks 0 to 4)

The biopsy, scans, p16 (HPV) result, meetings with the care team, baseline swallow test, dietitian visit and the tumor board's recommendation are the same as on every track and are described on the overview page.

Surgery (about week 5)

• Transoral robotic surgery removes the tumor through the mouth (see throat cancer treatments), usually with a neck dissection to remove lymph nodes from the neck.

• The hospital stay is often 1 to 6 days.

• A temporary breathing tube (tracheostomy) is sometimes used, but it is increasingly avoided for smaller tumors.

• Most people start swallowing by the day after surgery. A temporary feeding tube is needed in only a small share, around 5 to 7 percent at experienced centers when a swallowing therapist is involved.

• Healing of the neck is described on the neck dissection recovery page.

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

Pathology results (about week 7)

About 1 to 2 weeks after surgery, the pathologist's report describes the removed tumor, its edges and the lymph nodes (see understanding pathology results). In this timeline, the report shows no features that call for more treatment, so no added treatment is given.

Healing (weeks 5 to 13)

• The sore throat is worst for the first 1 to 2 weeks and then improves.

• Many people are back to their usual diet within about 6 weeks.

• Return to work is often around 2 months, sooner on average than after chemoradiation.

Quality of life on this track

Average scores before and after treatment (0 to 100; swallowing 20 to 100; higher is better):

• Overall: 81 before treatment, 78 at 1 year and 84 at 3 years.

• Swallowing: 89 before, 83 at 3 to 6 months and 86 at about 2 years.

• Speech: 93 before and 92 at both 1 and 3 years.

• Mood: 76 before, 85 at 1 year and 89 at 3 years. Mood often improves once treatment is over.

The dashed points on the timeline come from a small study of surgery alone that used a different questionnaire and reported middle (median) scores. One month after surgery, the middle scores were 50 for overall quality of life, 70 for swallowing, 100 for speech and 75 for mood, and most had returned to high levels by 6 months. They show the early dip after surgery that the other studies, which did not measure scores so soon, cannot show.

Where the numbers come from: the overall, speech and mood scores come from the surgery group of a randomized study that compared surgery with radiation for early oropharyngeal cancer. Most people in that group also received radiation or chemoradiation after surgery, so the same scores appear on all three surgery timelines. The swallowing scores come from a large study that reported surgery alone separately. 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, throat and neck, often with a small camera (fiberoptic laryngoscopy). Whether a baseline scan is done after surgery alone varies; otherwise imaging is usually done for a symptom or a concern found on exam.

• Without radiation, the long-term dental, dry mouth and thyroid effects of radiation do not apply. Swallowing is checked over time, and staying tobacco-free lowers the risk of a new cancer.