Current NCCN Follow Up Guidelines:

Printed by Ed Brown on 6/7/2013 10:25:43 AM. For personal use only. Not approved for distribution. Copyright � 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved.
2 � H&P exam:
b Year 1, every 1-3 mo
b Year 2, every 2-6 mo
b Years 3-5, every 4-8 mo b >5 years, every 12 mo
NCCN Guidelines Version 2.2013 Head and Neck Cancers
NCCN Guidelines Index Head and Neck Table of Contents Discussion
FOLLOW-UP RECOMMENDATIONS1
(based on risk of relapse, second primaries, treatment sequelae, and toxicities)
� Post-treatment baseline imaging of primary (and neck, if treated) recommended within 6 mo of treatment3 (category 2B) b Further reimaging as indicated based on signs/symptoms; not routinely recommended for asymptomatic patients
� Chest imaging as clinically indicated for patients with smoking history (See NCCN Guidelines for Lung Cancer Screening)
� Thyroid-stimulating hormone (TSH) every 6-12 mo if neck irradiated
� Speech/hearing and swallowing evaluation4 and rehabilitation as clinically indicated
� Smoking cessation and alcohol counseling as clinically indicated
� Dental evaluation
b Recommended for oral cavity and sites exposed to significant intraoral radiation treatment
� Consider EBV monitoring for nasopharynx
1Most recurrences are reported by the patient.
2For mucosal melanoma, a physical exam should include endoscopic inspection for paranasal sinus disease.
3For cancer of the oropharynx, hypopharynx, glottic larynx, supraglottic larynx, and nasopharynx: imaging is recommended for T3-4 or N2-3 disease only. 4See Principles of Nutrition (NUTR-A).
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Version 2.2013, 05/29/13 � National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN�.
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FOLL-A

SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023