BEASTIE BOYS ADAM YAUCH GETS REAL ABOUT HIS CANCER
Beastie Boy Adam Yauch Has Cancer
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Beastie Boy Adam Yauch, who also goes by the name “MCA,” has announced that he’s about to undergo treatment for a cancerous tumor in his left parotid gland, which has caused the Beastie Boys to cancel their upcoming concert tour and postpone their new album release. The news has left many people with questions about this type of cancer, its actual location, and, of course, its prognosis. The good news is that it seems the cancer was caught early and should respond well to treatment with a favorable outcome and little or no impact on Yauch’s ability to sing.
First, the parotid gland is the largest of the salivary glands, which are paired organs located around the jaw. The parotid is at the back and bottom of the cheek and is accompanied by the submandibular (under the jaw) and sublingual (under the tongue) salivary glands.
The salivary glands are quite far from, and well above, the voice box, or larynx, with its vocal cords. This is why surgery on these glands would not typically be expected to impact speech, voice, or singing. And because the glands are paired, one of each type on either side of the face, the removal of one should have little to no impact on the amount of saliva produced either. For a Beastie Boy -- or any singer -- this is an important consideration.
The parotid gland is the most common location for salivary gland tumors, accounting for about 50-85 percent of cases. Interestingly, however, most salivary gland tumors (50-80 percent) are benign and not cancerous, and in particular, most parotid tumors are benign (70-80 percent). It seems, however, that Yauch was one of the minority of people to have a malignant tumor in his parotid gland (although we don’t actually know this for a fact). The difference between benign and malignant is determined by a pathologist through examination of the tissue under a microscope. Hopefully, the tumor might actually be benign, which would be great news.
Another way to distinguish between benign and malignant is whether the tumor has spread, because benign tumors, by definition, don’t spread, either to lymph nodes or to distant organs. According to the announcement, Yauch’s tumor had spread to a local lymph node, which would immediately categorize it as being malignant. Again, however, the only way to determine if the lymph node were truly affected by the cancer would be to examine it under a microscope. Lymph nodes are prone to become enlarged for other reasons besides cancer, most notably from a local infection or inflammation. Most people have had the experience of what’s commonly referred to as swollen glands, which are enlarged lymph nodes (sometimes called lymph glands but which are not true glands) draining the site of an infection (you might have swollen nodes in the neck in response to a throat or ear infection, for example).
The treatment of parotid gland cancer depends on the size and location of the tumor, the degree of its spread and the degree of its malignancy. The latter refers to the tumor’s appearance under the microscope. Some cancers still closely resemble the tissue of their origin and these are called low-grade or well-differentiated cancers and they typically have a better prognosis. Other cancers have undergone dramatic changes in their appearance such that they no longer resemble the tissue of origin and have a distinctly primitive and literally “ugly” appearance under the microscope. These are variously called high-grade, undifferentiated, or anaplastic, and these cancers typically have a worse prognosis.
With parotid cancers, another prognostic factor, besides lymph node involvement and degree of differentiation/appearance under the microscope is whether the tumor has affected the facial nerve. The facial nerve is the 7th cranial nerve, meaning that it’s one of the 12 cranial nerves that extend directly from the brain. The facial nerve passes right through the parotid gland and can easily be affected by tumors, depending on where in the gland they are located and their size.
Parotid gland tumors that affect the facial nerve typically have a worse prognosis than those that do not. Symptoms would likely be those of paralysis of the muscles served by the nerve, particularly those of the cheek. Those of you who have had or know of people who’ve had Bell’s palsy will recognize the symptoms of facial droop as well as paralysis of the eyelid. Involvement of the facial nerve can make surgery more difficult and in any event, removal of the parotid gland often results in some degree of facial paralysis, which, fortunately, is typically only temporary (but which can be permanent in very few cases). Overall, the risk and nature of complications of parotid gland surgery will depend on a variety of factors including the size and location of the tumor, the extent of the required surgery, the pathology of the tumor (its appearance under the microscope as discussed above) and, of course, the experience of the surgeon.
Similarly, the risk of recurrence of the cancer depends too on its location, size and microscopic appearance. Low-grade tumors that are completely removed at surgery usually do not recur. If the tumor is larger or of a higher grade (more malignant), or if it has already spread or involved the nerves or skin, it has a higher risk of recurrence. Those more malignant tumors require more than just surgery. They typically are treated with post-operative, also called adjuvant, radiation therapy. There is little use of adjuvant chemotherapy in parotid gland cancers.
While there are many questions remaining about Adam Yauch’s cancer, we know that parotid gland tumors typically have a better prognosis than do cancers in the other salivary glands. We know that the announcement said the cancer was caught early, which is another good prognostic sign. Also, it appears that there is no involvement of the facial nerve, another good thing. Most important, as you can see from the location of the parotid gland, it is well removed from the voice box and the vocal cords, which means that the surgery should not affect his singing ability. This will depend, of course, on whether there is hidden involvement of the facial nerve and whether the surgery causes any injury to this important structure. It seems unlikely, however, that there would be permanent damage to this nerve.
We wish him a good surgical outcome, a speedy recovery, and an excellent prognosis, and we hope the Beastie Boys are back on tour again soon.
Video: Yauch Announcement
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