Prevention & Screening

Diagnostic Work-up & Referral

Supporting Patients During Treatment

After Treatment Surveillance

Advanced Cancer, Palliative, End-of-Life

Supportive Care & Wellness Resources

Head & Neck Cancer

Cancer Care Alberta

The evidence-based recommendations described below outline the standard follow-up procedures for head and neck cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.

Topics

Surveillance Activities & Timelines|Red Flags|Referrals for Recurrence|Complications & Late Effects of Treatment|Specific Concerns for Patients|General Support for Healthy Living

Quick Reference

Surveillance Activities & Timelines

Yearly Chest X-Ray (Anterior-Posterior as well as Lateral Views) to screen for evidence of pulmonary metastatic disease or new pulmonary neoplasms.

Yearly Serum Thyroid Stimulating Hormone (TSH) levels. If your patient was treated with radiation therapy as part of their head and neck cancer treatment regimen, they are at elevated risk of developing hypothyroidism.

Periodic Clinical Examination: If your patient is less than 5 years post-cancer treatment and no longer has follow-up appointments with the oncology team, clinical examinations should be performed every 6 months up to 5 years from treatment then annually thereafter. This includes specific examination of the head and neck including:

  • Neck palpation
  • Oral cavity examination in addition to routine physical examination
  • Patients may perform self-examination of their head and neck region every month

Regular preventative age-appropriate health screening (i.e., Pap smear, clinical breast examination, blood sugars) is recommended.

Red Flags

 
Symptoms / Signs Actions / Investigations
New mass in head or neck Refer back to the oncology treatment team for neck ultrasound +/- fine needle aspirate (FNA) biopsy.
New suspicious lesion or mass in oral cavity or oropharynx Refer to surgeon for consideration of biopsy.
New palpable lymphadenopathy Refer to surgeon for biopsy.
New ear pain or throat/neck pain Perform detailed head and neck examination for signs of recurrence. Refer to surgeon or treating oncologist for further assessment.
New persistent cough or dyspnea Perform chest x-ray and refer to oncologist for any signs suggestive of cancer recurrence.
Unexplained weight loss Perform detailed nutrition history and detailed head and neck exam.
 

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Referrals for Recurrence

Patients should be referred back to their initial treating oncologic surgeon or the nearest cancer centre.

Edmonton Cross Cancer Institute
Calgary Tom Baker Cancer Centre

If the oncologist's or cancer centre's contact information is not available, search the specific type of cancer they have in the Alberta Referral Directory for the most up-to-date information and instructions for referral.

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Complications & Late Effects of Treatment

Following treatment for head/neck cancers, your patient may present with some of the complications outlined below. Continue to monitor and address concerns related to cancer therapy during the follow-up period.

 
Complication Treatment-Related Causes Actions
Fatigue
  • Radiation
  • Chemotherapy
Dysphagia or Odynophagia
  • Radiation
  • Surgery
  • Difficulty with eating and drinking is often due to altered anatomy related to surgical removal of cancers or changes caused by radiation
  • Issues with oral intake should improve within the first 3 months of treatment completion; some patients may experience symptoms longer and should be encouraged to follow-up with a speech language pathologist and registered dietician
  • Persistent issues warrant further work-up to rule out other causes
  • Referral to local speech language pathology services can be made Tom Baker Cancer Centre, Cross Cancer Institute
Lymphedema
  • Neck Dissection
  • Radiation
Xerostomia (dry mouth)
  • Radiation
  • Neck Dissection
  • Surgery
  • Symptoms of dry mouth and altered taste begin to improve within weeks after radiation, but may take more than 1 year post-radiation to maximally improve
  • Some degree of chronic dry mouth post-radiation is common. This can be improved by increasing water intake, using xylitol-based chewing gum or rinses, or potentially a trial of salagen therapy (prescription drug)
Jaw Stiffness / Fibrosis
  • Radiation
  • Neck Dissection
Pink to Red Patches of Skin Discoloration
  • Radiation
  • Patients may experience pink to red patches of skin discoloration on the radiated site; referral to a dermatologist may be made if this is of concern
Neck Fibrosis
  • Radiation
  • Neck Dissection
Shoulder Dysfunction
  • Neck Dissection
Osteoradionecrosis
  • Radiation
  • Radiation may result in decay or death of treated bone
  • Patients may present with oral pain, drainage or bone exposure on mandible or maxilla
  • Oral pain should be investigated appropriately and if suspected to have osteoradionecrosis, refer to head and neck surgeon and/or oral maxillofacial surgeon for further work-up and management
Hearing Loss & Tinnitus
  • Chemotherapy
  • Radiation
  • Chemotherapy and radiation therapy may result in long-term hearing deficits
  • Referral to audiology is indicated if treatment related hearing loss and/or tinnitus is suspected
Psychosocial Distress
  • Stress of cancer treatment
  • Fear of recurrence
  • Post-treatment adjustments
  • Increasing helplessness/hopelessness, distress, anxiety or depression may be present
  • Patients experiencing these symptoms should be encouraged to inform their oncology treatment team for appropriate psychosocial referral
Sleep Apnea
  • Radiation
  • Sleep apnea often presents as fatigue during the day
  • Referral to a specialist for a sleep study or counselling is indicated
Thyroid Problems
  • Radiation
  • Radiation induced hypothyroidism may occur following head & neck cancer treatment
  • Routine assessment of thyroid gland function is recommended annually after radiotherapy in the neck area
Weight Loss
  • Radiation
  • Surgery
  • Depression
  • Weight loss may result from difficulties swallowing and resultant decreased food intake; altered presentation of food may also affect nutritional intake
  • Monitor patients who are at risk and refer to a registered dietician as necessary
 

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Specific Concerns for Head & Neck Cancer Patients

Self-Image

For many patients, the head and neck region is an important part of their self-image. Psychological counselling may be helpful for improving body image satisfaction, addressing relationship concerns and reducing sexual dysfunction.

Reconstruction & Rehabilitation

The contact information below may be helpful for patients considering reconstructive/rehabilitative surgeries following head and neck cancer.

Sexual Health

The Oncology and Sexuality, Intimacy, and Survivorship (OASIS) program assists patients with managing physical and emotional concerns. To refer patients to the OASIS program, contact:

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Note: The information on this page was adapted from the AHS Guideline Resource Unit's Head & Neck Cancer Transfer of Care Physician Letter. Also available is the Head & Neck Cancer Transfer of Care Patient Letter.