Oral Cavity Cancer Timeline: Surgery Followed by Chemoradiation

When the pathology report after surgery shows cancer at the margin or growing outside a lymph node, radiation is usually combined with chemotherapy, most often cisplatin, starting within about 6 weeks of the operation.

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.

Who follows this track

Two findings on the pathology report most often lead to this track: cancer at the cut edge of the removed tissue (a positive margin), and cancer that has grown outside the capsule of a lymph node (extranodal extension). In large studies, adding chemotherapy to radiation for these features improved tumor control and survival. When several intermediate-risk features occur together, chemotherapy is sometimes added as well. When cisplatin is not a good fit, because of kidney function, hearing or other health conditions, other drugs are available.

Before surgery and surgery (weeks 0 to 6)

The steps before surgery and the operation itself are the same as on the surgery alone timeline. Because cisplatin can affect hearing, a baseline hearing test is done before treatment, and a hepatitis B blood test is often added.

Healing before treatment (weeks 4 to 10)

The surgical sites heal for about 5 to 6 weeks while the radiation and chemotherapy are planned. Treatment ideally starts within about 6 weeks of surgery.

Chemoradiation (about weeks 10 to 16)

• Radiation is given 5 days a week for about 6 to 6.5 weeks.

• Cisplatin chemotherapy is given during radiation, usually every 3 weeks or weekly, through an IV.

• Side effects are those of radiation (sore mouth and throat, dry mouth, taste changes, swallowing trouble, tiredness, weight loss) and are often stronger with chemotherapy. Cisplatin can also affect hearing, the kidneys and blood counts, which are checked closely.

• A feeding tube is often used through treatment and is usually removed within about 6 months.

Recovery (months 4 to 12)

• Swallowing often dips around the end of treatment and then improves; many people are close to their starting point by about a year.

• Jaw-stretching exercises help prevent jaw stiffness (trismus).

• Return to work often takes about 6 months or more.

• A PET-CT scan about 12 weeks after treatment sets a new baseline.

Quality of life on this track

Average scores before surgery and at times after surgery (0 to 100; higher is better):

• Overall: 62 before surgery, 54 at 3 months, 58 at 6 months and 66 at 1 year.

• Swallowing: 90 before, 64 at 6 months and 69 at 1 year.

• Speech: 92 before, 73 at 6 months and 78 at 1 year.

• Mood: 69 before and 77 at 6 months.

No published study has reported these scores separately for people who had chemotherapy added to radiation after mouth cancer surgery, so the timeline shows the same scores as surgery followed by radiation. Adding chemotherapy usually makes side effects stronger during treatment, so the early dip may be deeper. 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.

• Dental visits and possible fluoride treatments continue for life.

• A thyroid blood test (TSH) every 6 to 12 months for the first 3 years checks for an underactive thyroid.

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

• Swallowing exercises, jaw stretching and lymphedema care continue as needed.