Thyroid cancer
Classification and external resources
Micrograph (high power view) of papillary thyroid carcinoma demonstrating diagnostic features (nuclear clearing and overlapping nuclei). H&E stain.
ICD-10	C73
ICD-9	193
eMedicine	ent/646
MeSH	D013964

Thyroid cancer is a thyroid neoplasm that is [(benign tumor)]. It can be treated with radioactive iodine or surgical resection of the thyroid gland. Chemotherapy or radiotherapy may also be used.^[1]

Symptoms[link]

Micrograph of a lymph node with papillary thyroid carcinoma.

Most often the first symptom of thyroid cancer is a nodule in the thyroid region of the neck.^[2] However, many adults have small nodules in their thyroids, but typically under 5% of these nodules are found to be malignant. Sometimes the first sign is an enlarged lymph node. Later symptoms that can be present are pain in the anterior region of the neck and changes in voice due to involvement of recurrent larygeal nerve.

Thyroid cancer is usually found in a euthyroid patient, but symptoms of hyperthyroidism or hypothyroidism may be associated with a large or metastatic well-differentiated tumor.

Thyroid nodules are of particular concern when they are found in those under the age of 20. The presentation of benign nodules at this age is less likely, and thus the potential for malignancy is far greater.

Diagnosis[link]

After a thyroid nodule is found during a physical examination, a referral to an endocrinologist, a thyroidologist or otolaryngologist may occur. Most commonly an ultrasound is performed to confirm the presence of a nodule, and assess the status of the whole gland. Measurement of thyroid stimulating hormone and anti-thyroid antibodies will help decide if there is a functional thyroid disease such as Hashimoto's thyroiditis present, a known cause of a benign nodular goiter.^[3] Finally, to achieve a definitive diagnosis before deciding on treatment, a fine needle aspiration cytology test is usually performed.

Classification[link]

Thyroid cancers can be classified according to their histopathological characteristics.^[4][5] The following variants can be distinguished (distribution over various subtypes may show regional variation):

• Papillary thyroid cancer (75% to 85% of cases ^[6]) – often in young females – excellent prognosis
• Follicular thyroid cancer (10% to 20% of cases ^[6])
• Medullary thyroid cancer (5%^[6] to 8% of cases)- cancer of the parafollicular cells, often part of MEN-2 syndrome.^[7]
• Anaplastic thyroid cancer (Less than 5%^[6]). It is not responsive to treatment and can cause pressure symptoms.
• Others
  • Lymphoma
  • Squamous cell carcinoma, sarcoma

The follicular and papillary types together can be classified as "differentiated thyroid cancer".^[8] These types have a more favorable prognosis than the medullary and undifferentiated types.^[9]

• Papillary microcarcinoma is a subset of papillary thyroid cancer defined as measuring less than or equal to 1 cm.^[10] The highest incidence of papillary thyroid microcarcinoma in autopsy series was reported by Harach et al. in 1985, who found 36 of 101 consecutive autopsies were found to have an incidental microcarcinoma.^[11] Michael Pakdaman et al. report the highest incidence in a retrospective surgical series at 49.9% of 860 cases.^[12] Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer. It was Woolner et al. who first arbitrarily coined the term "occult papillary carcinoma" in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter.^[13]

Etiology[link]

From the 1940s to 1960s, external, low-dose radiation to the head and neck during infancy and childhood was used to treat many benign diseases. This type of therapy has been shown to predispose persons to thyroid cancer. The younger the patient was at time of exposure, the higher the risk of developing cancer.^[2]

Another cause may be due to high-dose irradiation to the head and neck. Patients with Hodgkin lymphoma treated with mantlefield irradiation have an increased risk of developing thyroid cancer, although hypothyroidism is more likely.^[2]

Detection of metastases[link]

Detection of any metastases of thyroid cancer can be performed with a full body scintigraphy using iodine-131.^[14][15]

Treatment[link]

Thyroid cancer may require surgery. Common surgeries include thyroidectomy, lobectomy, and tracheostomy. ^[2]

Radioactive Iodine-131 is used in patients with papillary or follicular thyroid cancer for ablation of residual thyroid tissue after surgery and for the treatment of thyroid cancer. Patients with medullary, anaplastic, and most Hurthle cell cancers do not benefit from this therapy.^[2]

External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis.^[2]

Sorafenib and sunitinib, approved for other indications show promise for thyroid cancer and are being used for some patients who do not qualify for clinical trials.^[16] Numerous agents are in phase II clinical trials and XL184 has started a phase III trial.^[16]

Prognosis[link]

The prognosis of thyroid cancer is related to the type of cancer and the stage at the time of diagnosis. For the most common form of thyroid cancer, papillary, the overall prognosis is excellent. Indeed, the increased incidence of papillary thyroid carcinoma in recent years is likely related to increased and earlier diagnosis. One can look at the trend to earlier diagnosis in two ways. The first is that many of these cancers are small and not likely to develop into aggressive malignancies. A second perspective is that earlier diagnosis removes these cancers at a time when they are not likely to have spread beyond the thyroid gland, thereby improving the long-term outcome for the patient. There is no consensus at present on whether this trend toward earlier diagnosis is beneficial or unnecessary.

The argument against early diagnosis and treatment is based on the logic that many of small thyroid cancers (mostly papillary) will not grow or metastasize. This viewpoint holds the overwhelming majority of thyroid cancers are overdiagnosed (that is, will never cause any symptoms, illness, or death for the patient, even if nothing is ever done about the cancer). Including these overdiagnosed cases skews the statistics by lumping clinically significant cases in with apparently harmless cancers.^[17] Thyroid cancer is incredibly common, with autopsy studies of people dying from other causes showing that more than one third of older adults technically has thyroid cancer, which is causing them no harm.^[17] It is easy to detect nodules that might be cancerous, simply by feeling the throat, which contributes to the level of overdiagnosis. However, very few of the people with these accidentally discovered, symptom-free thyroid cancers will ever have any symptoms, and treatment in such patients has only the potential to harm them, not to help them.^[17]

Thyroid Cancer is three times more common in women than in men, but according to ^[18] European statistics, the overall relative 5-year survival rate for thyroid cancer is 85% for females and 74% for males.^[19]

The table below highlights some of the challenges with decision making and prognostication in thyroid cancer. While there is general agreement that stage I or II papillary, follicular or medullary cancer have a good prognosis, it is not possible when evaluating a small thyroid cancer to determine which ones will grow and metastasize and which will not. As a result once a diagnosis of thyroid cancer has been established (most commonly by a fine needle aspiration), it is likely that a total thyroidectomy will be performed. This drive to earlier diagnosis has also manifest itself on the European continent by the use of serum calcitonin measurements in patients with goiter to identify patients with early abnormalities of the parafollicular or calcitonin producing cells within the thyroid gland. As multiple studies have demonstrated, the finding of an elevated serum calcitonin is associated with the finding of a medullary thyroid carcinoma in as high as 20% of cases. Does the finding of a small medullary thyroid carcinoma (which may lie dormant) justify the performance of a total thyroidectomy (necessary to perform total thyroidectomy because the medullary thyroid carcinomas identified may be microscopic and not identified by imaging or evaluation of the thyroid gland at the time of surgery) with its attendant risk of permanent hypoparathyroidism (low calcium) and damage to the nerves innervating the vocal cords (causing permanent hoarseness in 2-4% of patients)? In Europe where the threshold for thyroid surgery is lower than in the United States, an elaborate strategy that incorporates serum calcitonin measurements and stimulatory tests for calcitonin has been incorporated into the decision to perform a thyroidectomy; thyroid experts in the USA, looking at the same data sets have, for the most part, not incorporated calcitonin testing as a routine part of their evaluation, thereby eliminating a large number of thyroidectomies and the consequent morbidity. The European thyroid community has focused on prevention of metastasis from small medullary thyroid carcinomas; the North American thyroid community has focused more on prevention of complications associated with thyroidectomy (see American Thyroid Association guidelines below). It is not clear at this time who is correct.

As clearly demonstrated in the Table below, individuals with stage III and IV disease have a significant risk of dying from thyroid cancer. While many present with widely metastatic disease, an equal number evolve over years and decades from stage I or II disease. As such, physicians who manage thyroid cancer of any stage treat it with respect and recognize that a small percentage of patients with low risk thyroid cancer will progress to develop metastatic disease and die. Fortunately, for those with metastatic thyroid cancer, the last 5 years has brought about a renaissance in thyroid cancer treatment. The identification of some of the molecular or DNA abnormalities for thyroid cancer has led to the development of therapies that target these molecular defects. The first of these agents to negotiate the approval process is vandetanib, a tyrosine kinase inhibitor that targets the RET proto-oncogene, 2 subtypes of the vascular endothelial growth factor receptor and the epidermal growth factor receptor.^[20] More of these compounds are under investigation and are likely to make it through the approval process. For differentiated thyroid carcinoma strategies are evolving to use selected types of targeted therapy to increase radioactive iodine uptake in papillary thyroid carcinomas that have lost the ability to concentrate iodide. This strategy would make it possible to use radioactive iodine therapy to treat "resistant" thyroid cancers. Other targeted therapies are being evaluated, making it possible that life will be extended over the next 5–10 years for those with stage III and IV thyroid cancer.

Prognosis is better in younger people than older ones.^[19]

Prognosis depends mainly on the type of cancer and cancer stage.

See also[link]

• Potassium iodide
• Thyroid neoplasm
• Thyroid nodule
• Medullary thyroid carcinoma
• Papillary thyroid carcinoma
• Follicular thyroid carcinoma
• Anaplastic thyroid carcinoma

References[link]

External links[link]

• Media related to Thyroid cancer at Wikimedia Commons
• International Thyroid Oncology Group
• Thyroid cancer at the Open Directory Project
• Thyroid Cancer Causes And Symptoms
• Thyroid Cancer Clinical Trials Page of the American Thyroid Association
• Thyroid Cancer Survivors' Association
• The THANC (Thyroid, Head and Neck Cancer) Foundation
• Cancer Management Handbook: Thyroid and Parathyroid Cancers
• The American Thyroid Association Guidelines Taskforce (2006). Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer
• Clinically reviewed thyroid cancer information for patients from Cancer Research UK
• UK thyroid cancer statistics from Cancer Research UK

This biographical article needs additional citations for verification. Please help by adding reliable sources. Contentious material about living persons that is unsourced or poorly sourced must be removed immediately, especially if potentially libelous or harmful. (May 2010)

The Basics
The Basics at the Oxford Art Factory, 2010
Background information
Origin	Melbourne, Australia
Genres	Rock
Years active	2002–present
Labels	Independent, Albert Records
Associated acts	Gotye, Down Hills Home, Dog With Wheels, Blood Red Bird
Website	The Basics Official Website
Members
Wally De Backer Kris Schroeder Tim Heath
Past members
Michael Hubbard
Notable instruments
Lead guitar, drums, bass guitar.

The Basics ( /ˈbæzɪtʃ/ BAZZ-ich) are a three-piece band from Melbourne, Australia, formed by Wally De Backer and Kris Schroeder in 2002. Their style has been described as anything from 'indie-pop' to 'rock'n'roll' to 'pop-rock', though their records show they span a wide range of genres, including reggae, ska, country, and electro-pop. They are "recognised as one of Australia's hardest-working bands".^[1]

With close to 1000 shows in their ten-year career, their live performances are well-known for their sense of humour and energy.^[2]

Formation[link]

The Basics were formed after Kris met Wally at a party in Melbourne.^[3] The event was to see off the young aspiring producer, who was about to depart for Los Angeles, and together with a number of musician friends, the two jammed on some blues-rock standards. Later that night, they bonded over a mutual love of The Beatles, 70s and 80s cartoon theme songs and old Sierra adventure games.

Initially, they played around Melbourne as an acoustic guitar/drums combo, starting at The Opposition in Frankston and the House of Fools in Footscray, where in late 2002 they met Michael Hubbard and later invited him to join them on electric guitar.^[4] Though lacking any real experience with the instrument, Kris willingly purchased his first bass guitar, and the trio was born. During this time, the group start performing songs with more complicated three-part harmony.

During late 2002 and early 2003, The Basics recorded and released an album called Get Back through MGM Distribution. They began what was to become regular tours of the East and West coasts of Australia.

2004-2005: Current lineup[link]

Tim Heath joined the group in June 2004, after Michael decided to pursue his solo career, which has included being one half of Down Hills Home.^[4] Tim was reportedly the only person to reply to an advertisement in Melbourne's Beat Magazine looking for a new guitarist. Tim apparently answered the advertisement - which said the applicant "must have a love of 50s and 60s rock'n'roll" - thinking that he would be meeting "a couple of old guys to play with on the weekends over some beers". They soon recorded For Girls Like You.

The Basics in 2005 continued to tour and play small festivals, and after releasing For Girls Like You through MGM Distribution, they departed for a national tour of Australia, which lasted for two months and took them to every Australian state and territory. Stuart Padbury, a young Melbourne sound engineer, joined them on much of this tour. On returning, the band began demonstrating songs for a new album.

2006-2009: Touring and soundtracks[link]

In 2006, The Basics began recording what was to become known as Stand Out/Fit In. Taking several months, it was not completed until the end of the year, despite intentions to have it released in June. Instead, they held a successful 'album preview', where each of the tracks was demonstrated in 'rough form' accompanied by a music video for each (produced by Melbourne photographic artist James Bryans). The band also talked about the origins of the songs. This event brought a lot of attention to the band for the idea's originality. They pre-released a radio single 'Just Hold On' from the album. The band were invited to play the hugely popular Homebake Festival in Sydney, where they received a great response, after being introduced onto the stage by a short stocky Asian guy with big calves ("one of the highlights" wrote The Daily Telegraph).

In 2007, the band departed on a tri-state residency which saw them play Melbourne, Sydney and Brisbane every week for the month of April - a bold move which brought further attention to the band for its original idea.^[5] Riding on the wave of this tour, Schroeder, De Backer and Heath departed on their first overseas tour which saw them performing 26 shows around Japan, Norway and the United Kingdom.^[6] They also toured twice more up the East Coast, one of which was with popular Japanese band The Bawdies. Their song 'Rattle My Chain' was used in a series of commercials for Volvo Australia. The song 'Hey There!' featured in the British film The Bank Job - starring Jason Statham - and was used as the backing for a February 2007 short film directed by Tim Longhurst called The Rip. Their song 'Better' was featured in a surfing documentary about the invention of the shortboard in 1967.

In 2008, the band appeared on Australia's Channel 9 for Australia Day celebrations, performing two of their songs - 'Just Hold On' and 'Hey There!' - to an estimated audience of 2 million. Securing an Australian Government grant, they embarked on a two-month tour of Australia, specifically targeting "culturally underprivileged groups" in rural and regional schoolchildren and Indigenous communities. The programme had them holding masterclasses and performing alongside Indigenous groups in the remote Northern Territory and Queensland.^[7][8] Their initiative also had them raising money for the charity Lifeline^{[disambiguation needed ]}, their contribution to which was recognised with a plaque at the end of the tour. Season two of Californication starring David Duchovny featured their cover of the classic 'Have Love, Will Travel', most famously covered by 'The Sonics'.

In 2009, The Basics for the first time enjoyed the support of Australian radio network Triple J, which had reportedly snubbed the band's previous material.^[9] The singles 'With This Ship' and 'Like A Brother' were added to the station's playlist, and momentum carried The Basics overseas for a second tour of the United Kingdom and Norway, and also a series of shows in Dublin, Ireland. They were joined by the longtime front-of-house engineer Stuart Padbury, who had been mixing them since 2005. The band was often seen in the Grafton Street Mall in Dublin, busking to promote their concerts there. Their second show in Oslo, Norway, saw the band perform with Hot Tub, one of the members of the Norwegian boy band "Boyzvoice", in his first performance for several years. Season Eight of Scrubs featured the song 'Lookin' Over My Shoulder'.

Despite all this promise, the band's album Keep Your Friends Close - produced and part-recorded by Peter Cobbin at London's Abbey Road Studios - though enjoying many favourable reviews,^{[10][11][12][13]} failed to impress Richard Kingsmill, music director of Triple J. This effectively ended the band's apparent upward spiral and the resulting album launch tour was reportedly "trying".

2010: Hiatus and live album[link]

In 2010, following the band's fourth stint at the Tamworth Country Music Festival, and the recording of a yet-unreleased live album, an indefinite hiatus was announced on the band's websites. This was in part due to the impending release of a new album produced by Wally for his Gotye project, and also to reported tensions within the band following the previous year's disappointments.

However, this hiatus was soon broken with a two-month residency at the Northcote Social Club in Melbourne, which saw an apparent return to form.^[14] The band's EP "Wait For You" enjoys airplay on Triple J.^[15] The Basics also played a one-off show at Sydney's Oxford Art Factory.^[16]

On 20 August 2010, The Basics released their fourth LP /ðəˈbæzɪtʃ/, available free and exclusively from their website for digital download^[17]. The band had reportedly moved to expand their listenership through this free giveaway, though 300 "Deluxe" CD/vinyl versions have been printed. /ðəˈbæzɪtʃ/ was recorded at the Northcote Social Club on 6 February, "in front of a live studio audience", and like the previous record, was mixed by Peter Cobbin at Abbey Road Studios. Technically a self-titled album, the phonetics spell out the accurate pronunciation of the band’s name. Kris Schroeder: "For years we’ve worked at bringing our live energy into the studio and thus far it’s been a bit hit-and-miss. Our trick this time was to pull a switcheroo and bring the studio to us instead; the result is the best and closest to us we’ve sounded yet."

Melbourne thespian and Dog With Wheels bassist David Bramble - friends with Heath from university days - has occasionally joined the band on tour, playing keys, often while sporting a large moustache. Other guests have included Jake Mason (saxophone), also of Cookin' on 3 Burners and The Bamboos^{[disambiguation needed ]}, Gideon Brazil (saxophone, flute), Simon Imrei (guitar and vocals) and Monty MacKenzie (saxophone).

Covers have often made an appearance from various sources: to date, some of the bands covered have been Cream, The Kinks, The Rolling Stones, The Police, Neil Young, Bob Dylan, New Kids on the Block, Richard Berry, Sonny Curtis and The Crickets, JJ Cale, Harry Nilsson, Bill Scott, Ryan Adams and The Coasters (via The Beatles for their cover of Three Cool Cats).

Members[link]

Current

• Wally De Backer - drums, vocals (2002-present)
• Kris Schroeder - bass, vocals (2002-present)
• Tim Heath - guitar, vocals (2004-present)

Former

• Michael Hubbard - guitar, vocals (2002-2004)

Discography[link]

Albums[link]

• Get Back (15 January 2004)
• Stand Out/Fit In (5 May 2007)
• Keep Your Friends Close (25 September 2009)
• /ðəˈbæzɪtʃ/ (20 August 2010)

EP[link]

• For Girls Like You (11 July 2005)
• Lookin' Over My Shoulder (10 February 2007)
• Like A Brother (5 June 2009)
• Wait For You (21 May 2010)

Singles[link]

• Call It Rhythm & Blues (20 August 2004)
• Just Hold On
• With This Ship (22 February 2009)

Upcoming projects[link]

The band is taking a three year hiatus, with an announced return to the stage together in early 2014. Wally De Backer launched Making Mirrors under his Gotye act in August 2011, Tim Heath will be touring and recording with Blood Red Bird, and Kris Schroeder recorded a solo EP titled, Patience in the Face of Control, before leaving Australia to work with the Red Cross in Kenya for a two year sabbatical.

References[link]

External links[link]

• Official Website
• Myspace Website