Ovarian cancer is the fifth leading cause of cancer related deaths in women with a five year survival rate of only 30–40%. Amongst the three broad subgroups of ovarian cancer, epithelial ovarian cancer is the most common and is divided in mainly five subtypes based histology and clinical behaviour. In patients when the disease is still confined to ovaries, surgery alone is curative for more than 90% patients. Unfortunately, most women are diagnosed with advanced stage disease and recurs in majority despite of debulking surgery and initial response to chemotherapy. Thus ovarian cancer is still a challenge to clinicians which gets more complicated due to asymptomatic nature of the early stage disease and frequent development of resistance to standard therapies. Therefore, researchers worldwide are engaged in identifying markers for early detection of ovarian cancer, investigating molecular mechanisms of chemoresistance, improving detection methods and developing novel therapeutic measures. In this review, we attempt to discuss the contemporary research and challenges associated with epithelial ovarian cancer along with the future improvements in various areas such as early detection of ovarian cancer through Multiplex-Methylation specific PCR (MSP) assay and Serial Analysis of Gene expression (SAGE) assay and identifying new biomarkers, facilitating personalised chemotherapy regime by various chemo-response assays, novel drugs and targeted therapies which will aid in enhancing the overall survival rate in future and overcome this deadly gynaecologic disease.

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Visual inspection with acetic acid (VIA) has been extensively investigated and accepted as potential alternative to cytology or Human Papilloma Virus (HPV) screening in limited resource settings. In developing countries, VIA may have several advantages over cytology or HPV screening. The consumables of the test are low-cost and readily available. VIA has potential of achieving large population coverage, as the test can be performed by a wide range of trained health care personnel and requires basic health infrastructure. It is a real-time test and offers logistic advantage of providing treatment for screen positive women during the same visit leading to high treatment coverage. The sensitivity and specificity estimates of VIA generally fall within the range of those reported for cytology and HPV testing. Randomized controlled trials evaluating test performance of VIA have demonstrated reduction in cervical cancer incidence and mortality in study population. The major limitation of VIA is that it is a subjective test and accuracy is dependent on the skill of trained providers. Low specificity and sub-optimal positive predictive value results in unnecessary referrals and/or treatment which can offset the perceived low cost of the test. VIA based screening programs are required to have clearly defined measurable indicators and a framework to identify the program strengths and weaknesses. Quality assurance of VIA is challenging specially because there is limited information on the test performance in multi-provider real programmatic setting. High quality training, periodic refresher courses, expertise of trained providers and close monitoring of performance indicators are required to ensure good quality VIA.

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Gonadotropin-releasing hormone (GnRH) is secreted from hypothalamic neurons and bind to receptors on gonadotrope cells of the pituitary gland, which then synthesize and release luteinizing hormone and follicle-stimulating hormone that regulate gonadal development. The presence of GnRH receptors and the effects of synthetic analogs of GnRH at extrapituitary sites is less clear. Several reports suggest that GnRH/analogues through cognate receptors may regulate mitogenic responses in cancer cells in an autocrine or paracrine manner. However, the inherent intracellular signaling pathways triggered are unknown. Using a highly specific antibody to human GnRH receptor we show that T47D breast cancer cells express GnRH receptors on their surface and that a GnRH analogue Cetrorelix inhibits proliferation of these cells, possibly via inhibition of processes that trigger cAMP formation.

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In 2011, a new histologic classification of lung adenocarcinomas (IASLC/ATS/ERS) was proposed based on the recommendations of an international and multidisciplinary panel that included thoracic medical oncologists, pulmonologists, radiologists, molecular biologists, thoracic surgeons and pathologists. This classification proposed a comprehensive histologic subtyping (lepidic, acinar, papillary, micropapillary and solid pattern) and a semi-quantitative assessment of histologic patterns (in 5% increments) in an effort to choose a single, predominant pattern. The prognostic value of this classification has been validated in large, independent cohorts from multiple countries. Patients with adenocarcinomas in situ and minimally invasive adenocarcinomas experienced no recurrence. Patients with micropapillary or solid predominant tumors would be classified as high risk for recurrence or cancer-related death. Patients with acinar and papillary predominant tumors might be classified as an intermediate-risk group, but further investigation is needed for papillary subtype. This classification, coupled with additional prognostic factors (nuclear grade, cribriform pattern, high Ki-67 labeling index, TTF-1 negativity, immune markers and SUVmax on FDG-PET), which we have published on extensively, could further stratify patients into prognostic subgroups that may help with clinical management. This new classification for the most common type of lung cancer is important for oncologists practicing in India, as its implementation would require only hematoxylin and eosin (H&E) histology slides, the most common type of stain used at hospitals. It can be implemented with basic pathologist training and no additional costs. Furthermore, implementation and analyses would identify if this classification is valid for Indian patients or a specific modification is required.

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Single nucleotide polymorphisms, also referred to as Single nucleotide variants remain single most dominant feature of variations in the human genome. The large numbers, stability and presence at easily detectable frequencies make them the most suitable potential markers for association studies in human health and disease. The study of these common genetic variants has now evolved and given rise to the understanding of less frequently encountered ‘rare’ variants of varying minor allele frequencies. The acceptance of role of rare single nucleotide variants in human diseases appears to coincide with the phasing out of the term ‘mutation’ in the dbSNP. The contribution of rare variants helps resolve the enigma of heritability of complex traits to a great extent. Integration of analysis of rare and common variants with the support of technological innovations and improved strategies for data analyses is expected to yield better and reliable association data. By virtue of their relatively stronger impact on the phenotype compared to that of the common variants, rare variants are likely to be better candidates as markers of association as well as targets for intervention strategies while providing mechanistic insights into the underlying biological processes. Starting with discussion of the basics of single nucleotide variants, this review summarizes concepts and principles of approaches used to study their association with parameters in health and diseases including cancer. Implications for studies in Indian population are discussed.

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