Follow-up after treatment for oral cancer

Follow-up after treatment is an important part of cancer care. Follow-up for oral cancer is often shared among the cancer specialists and your family doctor. Your healthcare team will work with you to decide on follow-up care to meet your needs.

Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:

• pain
• discharge from the wound
• difficulty opening the jaw (called trismus)
• weight loss
• changes in vision, hearing or taste
• difficulty chewing, speaking or swallowing
• any new lump or swelling in the mouth or neck

The chance that oral cancer will come back (recur) is greatest within 2 to 3 years, so you will need close follow-up during this time. It is important to quit smoking to help reduce the risk of cancer coming back. People with a history of heavy tobacco and alcohol use also have a risk of developing a second primary tumour of the digestive tract.

Follow-up visits for oral cancer are usually scheduled:

• every 1 to 3 months for the first year
• every 2 to 6 months for the second year
• every 4 to 8 months for the third to fifth year
• every 12 months from the sixth year onward

During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping.

Your doctor may do a physical exam, including:

• checking for speech and voice problems and assessing speech and hearing
• looking at the entire mouth
• feeling the lymph nodes in the neck (cervical lymph nodes)
• examining the teeth for signs of decay
• looking at the inside of the nose using an endoscope

Tests are often part of follow-up care. You may have:

• a chest x-ray to check the lungs
• imaging tests (CT scan, MRI, PET scan) to look for signs of disease or the cancer coming back (recurrence)
• blood tests to check the levels of thyroid-stimulating hormone (TSH) and monitor thyroid function after radiation therapy to the neck

You may also have one of the following tests to assess swallowing.

Fibre optic endoscopic evaluation of swallowing (FEES) uses a special endoscope with a fibre optic camera to look at the pharynx and larynx while the person swallows.

Modified barium swallow (MBS) uses x-rays and a contrast medium( barium) to record swallowing movements.

If the cancer has come back, you and your healthcare team will discuss a plan for your treatment and care.

If you had surgery or radiation therapy to the mouth it is important to have lifelong dental follow-up care and rehabilitation. If you need dental work such as having teeth pulled after you have had radiation therapy to the mouth, it should be done in the hospital by a dental oncologist or oral surgeon.

To make the decisions that are right for you, ask your healthcare team questions about follow-up.