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My son was recently diagnosed with nasopharyngeal carcinoma stage 3. He had undergone 35 sessions of IMRT as well as six sessions of chemotherapy. Three more sessions of chemotherapy have been prescribed and the first one was completed last week. Two more to go in three weeks time. Recently his treating doctor found more lymph nodes in his jugular and submandibular regions. FNAC reported a highly suspicious deposit from a malignant carcinoma and excised biopsy was recommended. Is it safe to perform the biopsy? Will all the lymph nodes be removed during the operation? Patient is underweight and not eating well, will anaesthesia be performed in such cases? Will IMRT be required again and is that even possible to do it again? What are the options?
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.