Oropharyngeal cancer

Complete blood count, chemistry panel, albumin, and prealbumin should be measured to assess the patient's nutritional status before treatment because of the expected mucositis with radiation or dysphagia after surgery.

Physical exam and indirect or direct endoscopy of the upper airway should be performed monthly following treatment. A modified barium swallow or endoscopic exam should be performed 1 month after treatment to assess for dysphagia and aspiration risk, and for swallowing therapy. Patients with known aspiration should continue with tube feedings. Positron emission tomography-computed tomography should be performed 3 months after treatment to assess locoregional and distant metastases, and afterward at the discretion of the clinician (usually about 12 months).[41]Amin MB, Edge SB, Greene FL, et al, eds. AJCC cancer staging manual. 8th ed. New York, NY: Springer International Publishing, 2017.[66]Abgral R, Querellou S, Potard G, et al. Does 18-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med. 2009 Jan;50(1):24-9. http://www.ncbi.nlm.nih.gov/pubmed/19091901?tool=bestpractice.com ​ Audiometry should be performed for patients undergoing radiation or chemoradiation. Periodic thyroid function tests and carotid ultrasounds should be performed after neck radiation for thyroid hormone replacement.

Patients should be monitored closely for the first 5 years after treatment for early detection of recurrence and treatment complications at 3- to 4-month intervals. Adverse reaction monitoring is recommended for patients receiving or who have received checkpoint inhibitors.[112]National Comprehensive Cancer Network. NCCN clinical practice guideline​s in oncology: management of immunotherapy-related toxicities [internet publication]. https://www.nccn.org/guidelines/category_3