Since you are doing well, your primary care provider will be in charge of your recommended follow-up, which includes:

• Arranging tests to check for cancer (surveillance)
• Continuing to see you for any health conditions you have, or any new problems
• Referring you to a specialist or back to your cancer doctor if they have any concerns.

We recommend a physical exam with your primary care provider (family doctor or nurse practitioner). This includes a check of your mouth. This may also include other tests or procedures such as blood tests, x-rays, screening for other cancers and vaccinations. Your cancer doctor or surgeon will recommend how often you should have these tests.

During the first five years after completing treatment, you should be seen every six months by your family doctor for a physical exam. If your family doctor has any concerns of possible recurrent head and neck cancer, he/she will refer you back to your head and neck cancer surgeon and/or oncologist.

If you need a family doctor, you can find one by calling Health Link (811) or visit Alberta Find a Provider. Once you have a doctor, let them know they can view the healthcare provider follow-up recommendations at ahs.ca/guru.

Possible Causes: Radiation; Surgery

What You Can Do:

• Symptoms of dry mouth and taste changes start to get better a few weeks after radiation ends but can take up to a year or more.
• If your dry mouth is not improving, or if your symptoms get worse, talk with your primary health care provider.
• It is important to brush and floss your teeth often and have regular visits with your dentist.
• You can buy artificial saliva and other products to help with dry mouth (such as Biotene®) at your local pharmacy.

Possible Causes: Radiation

What You Can Do:

• While it is rare, radiation can cause the jaw bone to decay or die.
• If you have pain or notice drainage or discharge in your mouth, tell your doctor right away.
• They will need to arrange tests and follow-up care.
• Sometimes, treatment for this problem may involve surgery.

Possible Causes: Radiation; Surgery

What You Can Do:

• Jaw stiffness, restricted range of motion and discomfort may develop months to years after radiation and surgery.
• Ask for a referral to physical therapy or other rehabilitation clinic.

For swelling that does not go away.

Possible Causes: Surgery; Radiation

What You Can Do:

• Neck discomfort can be an early symptom of lymphedema. It sometimes happens with swelling, but not always.
• Ask for a referral to physical therapy or a rehabilitation oncology clinic.

Possible Causes: Radiation; Surgery

What You Can Do:

• Neck stiffness, discomfort and changes to your range of motion may develop months to years after radiation and surgery.
• Ask for a referral to physical therapy or other rehabilitation clinic.

Possible Causes: Radiation

What You Can Do:

• In the places you had radiation treatment, your skin may have patches of pink or red.
• Ask for a referral to a dermatologist if you are concerned.

Possible Causes: Radiation; Surgery

What You Can Do:

• Treatment can cause problems with eating, drinking, and swallowing.
• This should improve in the first 3 months after treatment finishes. 
• If difficult and painful swallowing continues, tell your primary care provider. 
• Your doctor can refer you to a local speech language pathologist, or to the speech language pathologist associated with the regional cancer centre, so you can have an assessment and treatment

Possible Causes: Surgery

What You Can Do:

• Shoulder problems can happen after surgery. It takes the body a long time to heal (months to years). 
• Ask for a referral to physical therapy or other rehabilitation clinic.

Possible Causes: chemotherapy; radiation

What You Can Do:

• Long term hearing damage can happen because of treatment.
• Tell your primary care provider if you are having problems hearing. They may refer you to a specialist if you have treatment-related hearing loss.

Possible Causes: stress of cancer treatment; adjusting after treatment

What You Can Do:

• Cancer treatment brings up many feelings for people. If you are struggling with feelings of helplessness, hopelessness, distress, anxiety or depression, talk to your doctor.
• You can also find ideas for how to manage these feelings in the After Treatment Book.

Possible Causes: surgery; radiation

What You Can Do:

• Sleep apnea occurs when people have trouble breathing while they are sleeping. Many of the changes to your upper airway that have occurred during cancer treatment may increase the risk of sleep apnea. 
• Sleep apnea often presents as fatigue during the day despite trying to get adequate levels of sleep. 
• If you are struggling with this please talk to your doctor who may order a sleep study or provide counselling and other interventions.

Possible Causes: surgery; radiation; low thyroid hormone levels; sleep apnea

What You Can Do:

• Cancer treatment may cause long term fatigue or low energy. 
• If you are struggling with managing your energy levels talk to your doctor.

Possible Causes: radiation

What You Can Do:

• Your thyroid gland may not work as well as before and may not produce the right amount of hormones. If this happens, you may experience loss of appetite, weight change, intolerance to hot or cold, fatigue, constipation, or memory problems. 
• Your doctor will check your thyroid function during your follow-up visits. They will prescribe thyroid medication if you need it.

Possible Causes: surgery; radiation; depression following cancer

What You Can Do:

• Inform your doctor if you are experiencing unplanned weight loss for appropriate follow-up and referral to a registered dietitian.

• New lesion, ulcer or lump in the mouth, throat or neck
• New ear pain or throat/neck pain
• New or enlarging lymph node(s), especially in your neck, arm pit or groin area
• New persistent cough or shortness of breath
• Unplanned weight loss

The contact information below may be helpful if you are considering reconstructive or rehabilitative surgery:

• Dental Clinic - Arthur Child Cancer Centre (Calgary): 587-231-5676
• Dental Clinic - University of Alberta (Edmonton): 780-407-6854 
• Otolaryngology - Head & Neck Surgery (OHN) Coordinator (Calgary): 587-231-4365 
• Otolaryngology - Head & Neck Surgery (OHN) Coordinator (Edmonton): 780-407-7052
• Reconstruction & Rehabilitation: (iRSM) Institute for Reconstructive Medicine: 780-735-2660

Smoking increases the chance of many cancers; you should try to quit if you smoke. You can find more information about how to quit smoking in Reducing Your Risk & Screening.

Talk to your doctor if you have concerns relating to your body image following surgery. For many patients, the head and neck area 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.

Treatment for cancer can impact your sexual function, health, relationships, and sometimes causes distress over body image. Strategies and support are also available to help you and your partner with intimacy problems, distress, and adjusting to these changes. See Counselling & Support or Sexual Health & Cancer for resources to help you, and contact information to book an appointment with our Sexual Health Consultants.

Resources for low sexual desire, women’s sexual health (including vaginal dryness) and fertility are available at your cancer centre or see Cancer & Sexuality, MyHealth.Alberta.ca.