Fatigue is one of the most common and debilitating cancer symptoms, and is associated with impaired quality of life. The exact pathophysiology of cancer-related fatigue (CRF) is poorly understood, but in any individual, it is likely multifactorial and involves inter-related cytokine, muscular, neurotransmitter, and neuroendocrine changes. Underlying CRF mechanisms proposed include central and peripheral hypotheses. Central mechanisms include hypotheses about cytokine dysregulation, hypothalamic-pituitary-adrenal-axis disruption, circadian rhythm disruption, serotonin, and vagal afferent nerve function while peripheral mechanisms include hypotheses about adenosine triphosphate and muscle contractile properties. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is characteristic. The purpose of this article is to provide a narrative review of the literature and present the current controversies in the pathophysiology of CRF, particularly in relation to central and peripheral hypotheses for CRF. An understanding of pathophysiology may facilitate direct and simple therapeutic interventions for those with cancer.

Introduction The COVID-19 pandemic has drastically altered healthcare provision in primary and secondary care settings in the UK due to significant resources being prioritised for coronavirus care. Services have been affected at all levels of the referral ladder due to reductions and in some cases complete cancellation of face-to-face care. Throughout the pandemic the OMFS unit observed increasing numbers of patients with later stage oral malignant disease, therefore significantly more invasive surgical intervention, and reconstruction, associated with increased morbidity and mortality. Method This retrospective review collated data of all OMFS patients with oral squamous cell carcinomas requiring surgical intervention between the 23rd March and the 31st December 2019 compared with the same time period in 2020. Data collected included age, sex, time from referral to both 1st appointment and treatment, TNM staging, types of neck dissection and reconstruction, length of stay in hospital and any adjunctive treatment required. Results On comparison of the data sets, the 2020 cohort of patients had an overall later TNM staging result, with an increasing requirement for radical neck dissections and postoperative adjunctive treatment such as chemo/radiotherapy. The study found that on average, patients experienced a shorter waiting time from referral to initial assessment and commencement of treatment during the pandemic when compared to the previous year. Conclusions Overall, less patients were referred into hospital during period of the pandemic, however patients seen were diagnosed with significantly more advanced disease, this is likely attributed to reduced primary care services and delayed presentation.

Introduction Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients. Method A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours. Results 240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases. Conclusions The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.