Oral Cavity Cancer Timeline: Surgery Alone
When the pathology report after surgery shows clear margins, clear lymph nodes and no high-risk features, advanced oral cavity cancer may need no treatment beyond the operation, followed by regular check-ups.
This page is one of the treatment-track timelines for advanced oral cavity cancer. The steps before treatment, how a track is chosen and the long-term follow-up schedule are covered on the oral cavity cancer treatment timelines page.
Teal words in the timeline are links. On a phone, swipe sideways to see the whole graphic.
Who follows this track
Nearly everyone with advanced oral cavity cancer starts with surgery. Whether a person stays on this track is known only after surgery, when the pathologist examines the removed tumor and lymph nodes. If the report shows features that raise the chance of the cancer returning, treatment continues as surgery followed by radiation or surgery followed by chemoradiation.
Before surgery (weeks 0 to 4)
The biopsy, scans, dental check, swallowing and nutrition visits, and the tumor board's recommendation are the same as on every track and are described on the overview page. The dental check still matters on this track, because whether radiation will be needed is not known until after surgery.
Surgery (about week 4)
The tumor is removed with a margin of healthy tissue, together with a neck dissection to remove lymph nodes from the neck (see mouth tumor treatments).
When a large area is removed, a reconstructive surgeon rebuilds it, usually with a free flap of tissue, and sometimes bone, from the forearm, thigh or lower leg.
A temporary tracheostomy is often placed and is usually removed within about 4 to 7 days (see tracheostomy recovery).
A feeding tube provides nutrition while the mouth heals. It is usually temporary.
The hospital stay is commonly about 6 to 10 days, and longer after jaw or bone reconstruction.
On this track, surgery is the end of treatment, so the follow-up clock starts at 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, the lymph nodes, and whether cancer was growing along nerves or in small vessels (see understanding pathology results). In this timeline, the report shows no features that call for more treatment, so no added treatment is given.
Healing and rehabilitation (weeks 4 to 30)
Mouth soreness and swelling are worst in the first 1 to 2 weeks.
Speech and swallowing therapy start in the hospital and continue for weeks to months. Speech is usually hardest in the first few weeks and then improves.
Healing of the neck is described on the neck dissection recovery page. Numbness of the tongue or weakness of the lower lip can follow some operations (see the lingual nerve and lower lip nerve pages).
Many people return to work within a few months.
Quality of life on this track
Average scores before surgery and at times after surgery (0 to 100; higher is better):
Overall: 69 before surgery, 62 at 3 months, 70 at 6 months and 75 at 1 year. The dip in the first months is followed by a return to, or above, the starting level.
Swallowing: 88 before and 87 at 6 months.
Speech: 92 before and 98 at 6 months.
Mood: 71 before and 90 at 6 months. Mood often improves once treatment is over.
Where the numbers come from: a study of mouth cancer that followed people treated with surgery alone and with surgery followed by radiation. Most of the people treated with surgery alone had smaller cancers, so the scores after a larger operation with reconstruction may dip more at first. The questionnaires are described on the quality-of-life questionnaires page. Swallowing on these timelines uses the swallowing scale of the same head and neck questionnaire as speech, shown as 100 minus the score so that higher means better, because published mouth cancer studies did not report the MDADI by treatment.
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 a full exam of the mouth and neck. 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. Speech, swallowing and any lymphedema are checked over time.
Staying off tobacco and limiting alcohol lowers the chance of a new cancer of the mouth, throat, lung or esophagus.
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