###Human: Can excision biopsy remove the nodal metastasis in nasopharyngeal carcinoma? ###Assistant: Hi. First of all, based on the reports, the patient is hypovolemic (low BP). He needs a good oral diet and maybe if required admission and supportive care in the form of IV fluids. It looks like a recurrent disease in sub-mandibular nodes. It needs to be evaluated whether the nodal levels were included in the radiation therapy field or not (in-field recurrence vs out-field recurrence). In-field recurrences are difficult to treat and second-line chemotherapy or surgery can be planned (depending upon the response at the primary site: nasopharynx). Out of filed recurrence can be treated by radiation dose only if the meaningful dose of radiation has not been delivered in those regions. The biopsy can be performed if FNAC results are doubtful. You have not mentioned the date of completion of radiation therapy. Further course of action will also depend on that.