How would you manage a symptomatic marginal zone lymphoma of the base of tongue causing globus sensation also incidentally found to have squamous cell carcinoma in situ?

I would not irradiate a Stage 0 oropharyngeal cancer, much less irradiate the necks electively. But this is not just a CIS (TisN0M0 of the base of tongue) case; this is a very interesting/rare case presentation of what strikes me as a kind of Waldeyer's ring "MALToma" of the lingual tonsils. MALToma...

Carcinoma in situ of the tongue would be unusual and the extent would likely be hard to distinguish. I would irradiate as I would a T1 and electively treat the neck. I will leave the lymphoma treatment recommendation to the lymphoma mavens.

The 5-year overall survival of low IPI MALT approximates 99%. In the IELSG 19 study, the most common cause of death was a different malignancy even in the therapeutically inferior arm. So while clonal, the vast majority of MALTs are not particularly threatening. And marginal zone lymphoma (including...