American Head & Neck Society

Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.

Surveillance Education

How often will my doctor see me after my cancer treatment is completed?

Your doctors will examine you according to the following schedule:

  • Year One: every 1-3 months
  • Year Two: every 2-6 months
  • Year three through 5: every 4-8 months
  • After 5 years: every 12 months

Which Doctor should I see?  Radiation Oncologist, Medical Oncologist or Surgeon?

Often in the first few years, all of your treating physicians will examine you. Depending on your status, your team may elect to alternate visits between physicians.

What imaging will I require during my surveillance period and when should I get it?

  • It recommended that patients undergo new baseline imaging within 3-6 months after treatment completion. The imaging can be in the form of PET scan, CT scan or MRI scan depending on the type of primary cancer treatment and your doctor’s judgment.
  • Routine imaging after this 6 month period for asymptomatic patients is somewhat controversial. Some benefits of routine surveillance imaging may be the possibility of increased survival if “silent” recurrences are caught early and the reassurance that is provided by normal test results. However, surveillance testing can lead to patient anxiety and unnecessary radiation exposure. Your doctor and team will discuss these issues with you.
  • Chest CT surveillance imaging is recommended for patient who are 50 years or older with more than a 20 pack-year history of smoking. The test is called a “low dose screening” chest CT scan which is done yearly.

What other tests should I have done during surveillance?

  • Head and neck cancer patients should have thyroid hormone testing every 6-12 months if they have received radiation. Sometimes EBV bloodwork is recommended if you have nasopharyngeal cancer.
  • It is typically beneficial to undergo speech/swallowing evaluation and rehabilitation in order to offset long-term side-effects of your cancer treatment. Your doctor will monitor you for signs and symptoms of aspiration or trouble swallowing.
  • You will be asked to have routine dental evaluations especially if you have dry mouth from radiation.
  • You will be referred for a nutrition evaluation by a registered dietician if there are ongoing weight loss problems.
  • If you are currently smoking or abusing alcohol, proper referral will be ordered to help you quit.
  • Your team will continue to screen you for distress and depression and provide a survivorship care plan for you.

When should I call my cancer doctor?

  • New symptoms of hoarseness, problems swallowing, neck, mouth or throat pain that have not resolved within 2-4 weeks
  • Unexplained weight loss
  • Oral bleeding or coughing up of blood

References

  1. Heineman TE, Kuan  EC, St. John MA. When should surveillance Imaging Be performed After Treatment for head and neck cancer? Laryngoscope2017; 127:533-534.
  2. Deutschman MW, Sykes KJ, Harbison J, Cabrera-Mufly C, Shnayder y. The impact of Compliance in Posttreatment Surveillance in head and Neck Squamous Cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2015; 141(6): 519-525.
  3. Roman BR, Goldenberg D, Givi B, The Education Committee of the American Head and Neck Society (AHNS). Head Neck. 2016; 38: 168-174.