Oropharyngeal Cancer Timeline: Surgery Followed by Chemoradiation

When the tissue removed at surgery shows higher-risk features, such as cancer at the cut edge or cancer growing outside a lymph node, radiation with cisplatin chemotherapy follows surgery.

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

This track begins like surgery alone and is decided after surgery, when the pathologist examines the removed tissue (see understanding pathology results). Chemotherapy is added to radiation when the report shows higher-risk features, mainly cancer at the cut edge of the removed tissue or cancer that has grown through the outer wall of a lymph node. Adding cisplatin makes the radiation more effective at lowering the chance of the cancer returning. When the features are less worrisome, radiation alone follows surgery, which is the surgery followed by radiation track.

Before surgery (weeks 0 to 4)

The biopsy, scans, p16 (HPV) result, meetings with the care team, dental check, baseline swallow test, dietitian visit and the tumor board's recommendation are described on the overview page. Because cisplatin is possible on this track, a baseline hearing test is also done.

Surgery and healing (weeks 5 to 10)

• Transoral robotic surgery removes the tumor through the mouth (see throat cancer treatments), usually with a neck dissection. The hospital stay is often 1 to 6 days.

• About 5 weeks of healing follow before chemoradiation begins. The pathology report usually arrives 1 to 2 weeks after surgery.

Chemoradiation (about weeks 10 to 16)

• Radiation is given 5 days a week for about 6 weeks, ideally starting within about 6 weeks of surgery.

• Cisplatin chemotherapy is given by IV during the weeks of radiation. Cisplatin remains the standard drug for those who can take it, because gentler substitutes have worked less well in large studies.

Side effects and healing

Side effects build gradually during treatment, are usually at their worst in the last week or two and the 1 to 2 weeks after it ends, and then slowly improve. Adding cisplatin makes them somewhat stronger than with radiation alone.

• Sore mouth and throat (mucositis): starts around the second week of radiation, peaks near the end, and usually heals within 3 to 4 weeks after treatment ends.

• Swallowing and taste: swallowing trouble peaks late in treatment and improves mostly over the following 6 to 12 months. Most taste returns over 3 to 12 months, though some changes can linger.

• Dry mouth: begins early and often partly recovers over 1 to 2 years, though some dryness can last.

• Weight loss and tiredness are common, and a temporary feeding tube is needed by some people.

• Cisplatin effects: nausea, hearing changes or ringing in the ears, and low blood counts, which are checked with blood tests during treatment.

Check-ups and scans

• The follow-up clock starts at the end of chemoradiation, about week 16.

• A PET-CT scan about 12 weeks after treatment checks whether it worked.

• Check-ups then follow the usual schedule: 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.

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: 94 before, 83 at 3 to 6 months and 85 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.

These studies did not measure scores in the weeks right after treatment, when side effects peak. The chemoradiation timeline shows how much scores typically dip at the end of chemoradiation and how they recover.

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, which included people who had surgery alone, surgery with radiation, and surgery with chemoradiation. The swallowing scores come from a large study that reported surgery followed by chemoradiation separately. The questionnaires are described on the quality-of-life questionnaires page.

Long-term care

• Dental visits and possible fluoride treatments continue for life, because of the jaw-healing risk after radiation (osteoradionecrosis).

• A thyroid blood test (TSH) every 6 to 12 months for 3 years checks for hypothyroidism.

• Swallowing exercises and periodic checks continue, and staying tobacco-free lowers the risk of the cancer returning or a new cancer.

• Hearing changes after cisplatin can persist, and hearing aids help when needed (see hearing loss treatments).