Oral Cavity Cancer Timeline: Surgery Followed by Radiation

When the pathology report after surgery shows intermediate-risk features, radiation to the mouth and neck usually follows, starting within about 6 weeks of the operation and lasting 6 to 6.5 weeks.

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

After surgery, radiation is usually added when the removed tissue shows features such as a larger or deeper tumor, several involved lymph nodes, cancer growing along nerves or in small vessels, or margins that are close but clear. When cancer is found at the margin or outside a lymph node, chemotherapy is usually added as well (see surgery followed by chemoradiation).

Before surgery and surgery (weeks 0 to 6)

The steps before surgery and the operation itself, including the neck dissection, reconstruction, tracheostomy and hospital stay, are the same as on the surgery alone timeline. The early dental check matters most on this track: teeth in poor condition are treated or removed at least 2 weeks before radiation starts, to lower the risk of osteoradionecrosis.

Healing before radiation (weeks 4 to 10)

The surgical sites heal for about 5 to 6 weeks. During this time the pathology report comes back, the radiation oncologist plans treatment, and a custom mask is made to hold the head still during treatment. Radiation ideally starts within about 6 weeks of surgery.

Radiation (about weeks 10 to 16)

• Radiation is given 5 days a week (Monday to Friday) for about 6 to 6.5 weeks. Each visit is short; most of the time is spent positioning.

• Side effects build gradually and are usually worst in the last week or two and for a couple of weeks afterward: mouth and throat soreness (mucositis), dry mouth, taste changes, swallowing trouble, tiredness, skin changes and weight loss.

• A feeding tube placed at surgery is often kept through radiation and is usually removed within about 6 months.

• The dietitian and speech-language pathologist stay closely involved.

Recovery (months 4 to 12)

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

• Speech improves over the months after surgery.

• 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 radiation 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 (around the time of radiation), 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.

Compared with surgery alone, scores dip lower and recover more slowly after radiation, though overall scores were above the starting level by 1 year. Where the numbers come from: overall and mood scores come from a study of mouth cancer treated with surgery followed by radiation; swallowing and speech come from a study of people with advanced cancer of the mouth (and some of the throat), most of whom had surgery and radiation. 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 radiation: 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. Exposed bone or a mouth sore that does not heal is reported to the care team.

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

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