REMEMBERING PROF. D. KUTTY - FIGHT CERVICAL CANCER BY VACCINATION AND EARLY DETECTION

Prof. Kutty, Prof. Meena Mukherjee, Prof. Prabha Mehra, Dr. Kalyani Das, Dr. Chandrawati, Dr. Asha Harish and Dr. Lakshmi Singh taught us Obstetrics and Gynaecology in King George's Medical College, Lucknow. They were all kept very busy because ladies from all over the state and even from Nepal and Bihar would come to Lucknow for treatment as our OBG service had a stellar reputation. Despite being so busy, being surrounded by patients in OPD and in the wards, these ladies were always smiling and their affection for students was matched only by their simplicity. Whether in lectures or in demonstrations or in ward rounds, they were always keen to teach, but I cannot vouch for the fact whether we were keen to study. 

Prof. Kutty was our Head of the Department and a wonderful teacher. She had a soft corner for the poorest of the poor and would go an extra mile to accommodate their surgery even when her O.T, list was over spilling. She would often go to a hospital run by her spiritual Guru Swami Sivananda ji Maharaj in Haridwar to offer her services to the poor and after her retirement she permanently shifted to Haridwar and worked in Shivananda Charitable Hospital with the same zeal and zest with which she worked in K.G.M.C.

Prof. Devaki Kutty was from Kerala and did her graduation from Madras Medical College. Her destiny and our good luck brought her to King George's Medical College in Lucknow where she rose to the position of Head of the Department. Her parents stayed with her and in one of her vacations with her parents to Badrinath and during this trip she came across saint and sage H.H. Sri Swami Sivanandaji Maharaj of Muni-Ki-Reti, Sivananda Ashram, a couple of km further from Rishikesh on the road to Badrinath Dham. She visited the Ashram and knew that this was the place she would be visiting again and again to serve the suffering humanity. Her Gurudev imparted a spiritual impulse to her life and set into activity her latent spirituality. The devotee in her also became a Sadhika. 

Then onwards every year, year after year, she would depart from Lucknow the evening of the very day her annual leave commenced and arrive in Rishikesh the next morning and immediately start her Bhakti and Karma Yoga Seva at the Ashram for 30 days. Her house at Jagat Narayan Road itself became the venue for the spiritual gatherings and Satsang and Bhajans for the devotees. 

 

Four decades ago cervical cancer was a major death risk for women all over the world, mainly because by the time this form of cancer enters its later stages, it has very few obvious outward symptoms. I remember Prof. D. Kutty, teaching us about Cancer Cervix, but the situation is not that gloomy any more. Nowadays it can be detected early with Pap smear tests and education about warning signs, is dropping the death rate of this disease significantly. That is the reason why I am liberally borrowing from the recent literature and augmenting my 45 years old class notes, as almost every aspect of the disease has changed in all these years, and yet it remains the second commonest cancer in women in India at 22.8%, second only to Breast cancer (27%). Every year 60,000 ladies fall victim to Cervical cancer in our country.

Both medical professionals and the female population must learn the warning signs and risk factors associated with cervical cancer, to help prevent this deadly disease from winning.

 

Factors that increase the risk for cervical cancer

1.      HPV - The Human Papilloma Virus is spread through skin contact and considered a virus that can lead to cervical cancer. It can be detected through pap smears or if warts develop. There is a vaccine against it.

2.      Oral contraception - Some of the hormones released through this form of birth control can create an ideal breeding ground for this cancer. The risk increases the longer one takes the pills and doubles after 5 years of consumption.

3.      Diet – There is a higher risk of cervical cancer for overweight women and women whose diets lack essential nutrients.

4.      Chlamydia – Women have been infected with chlamydia in the past or currently infected from it reveal a higher risk for cervical cancer infection.

5.      Pregnancies - Little is known why women who have had 3 or more full-term pregnancies have a higher risk of developing cervical cancer, however, it’s something to be aware of.

6.      Early sexual activity - Having sex at an early age increases your risk of HPV

7.      Early first pregnancy – Women who have a full-term pregnancy before the age of 17 are twice as likely to develop cervical cancer later in life as women who had their first pregnancy after the age of 25.

8.      Increasing number of sexual partners - The greater your number of sexual partners, and the greater your partner's number of sexual partners, the greater your chance of getting HPV

9.      HIV – The human immunodeficiency virus damages the immune system, increasing the risk of HPV infection.

10. Genetics– This is more controversial, however some research presents evidence that the risk is more probable if you have family members who have developed the disease.

11. Smoking - This can double the risk. The by-products of tobacco can damage the DNA of cervix cells, contributing the development of cancer. Smoking can also damage the immune system, creating a weakened system for fighting infections like HPV.

 

The warning sign symptoms

Millions of women continue overlooking symptoms - either due to a significant lack of awareness about cervical cancer and its symptoms, or fear, stigma, and a culture of silence that contributes to delayed screening. These womenare not just from rural area, many of them are youngsters, educated and from urban areas. Unfortunately, the early stages of cervical cancer lack both visual and physical symptoms. In the onset stages these are the typical symptoms:  

1. Leg pain - Some women experience swelling and pain in their legs. This can even be in the early stages. What happens is that the cervix swells, leading to an obstructed blood flow, causing the leg to swell and a feel a painful sensation.  

2. Vaginal discharge – Normally women will have small amounts of clear, odorless discharge. If the amount increases accompanied by an unpleasant smell and an irregular occurrence, this could signify the onset of cervical cancer.  

3. Unexplained vaginal bleeding – This is the most common of all the symptoms. If a woman has vaginal bleeding outside of her period or if she is postmenopausal, this can indicate cervical cancer. If one experiences ongoing bleeding in between menstrual periods or after sexual intercourse, contact your physician.  

4. Discomfort during urination – This more obvious symptom is described as a tight and concentrating stinging sensation when urinating, although it can feature other discomforting sensations. It’s important to keep track of your urinal patterns. If there are urinary symptoms, it can mean the cancer has spread to nearby tissue and you should consult with a physician for immediate attention.  

5. Irregular urination – Changes in your urinary frequency and appearance can indicate cervical cancer. If you notice more frequent urination, your urine is discolored or with blood, or there are noticeable changes to your regular routine and the development of incontinence (loss of bladder control) you should seek medical input from a professional.  

6. Pelvic pain – Although a fairly routine burden of being a women, if pains and cramps last for long bouts frequently, with pain more intense than regular and outside your menstrual period, this should be looked at by your doctor.

7. Back pain – This is a common symptom that can happen for a number of reasons, however if this is experienced along with a number of the other symptoms on this list, you should go for a medical check-up.  

8. Irregular monthly cycles – Your monthly periods should reach a consistent level with characteristic symptoms after adolescence and if you notice a change in the regular routine, whether in frequency or symptoms, it’s best to contact a physician.  

9. Painful intercourse – Discomfort during sex is called dyspareunia, and this unpleasant side effect can be a sign of cervical cancer. If it’s not cervical cancer it is still commonly linked to a disease and should be tended to by medical professionals.  

10. Loss weight & fatigue – cervical cancer can deplete the number of healthy red blood cells because there will be a higher presence of white blood cells fighting the disease. This results in anemia, which leads to lower energy levels and weight loss. If you suddenly feel tired and lose weight for no reason, it doesn't automatically means you have cervical cancer, but if accompanied by other symptoms on this list it could serve as a warning sign. In either scenario if you have unexplained weight loss and fatigue, talk to your doctor.

 

Types of cervical cancer

Cervical cancer is divided into types based on the type of cell in which the cancer begins. The main types of cervical cancer are:

• Squamous cell carcinoma. This type of cervical cancer begins in thin, flat cells, called squamous cells. The squamous cells line the outer part of the cervix. Most cervical cancers are squamous cell carcinomas.
• Adenocarcinoma. This type of cervical cancer begins in the column-shaped gland cells that line the cervical canal.

Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.

 

Preventative measures

Unfortunately cervical cancer is hard to treat because too often it’s detected too late. The good news is that cervical cancer can be prevented with knowledge and save practices:

1.      Pap smears – These tests are the best way to screen for the disease. Women ages 20 to 30 should have a test every 3 years. From ages 30 to 65 every 3 to 5 years and women over 65 years don’t need screening if they’ve had 3 tests in a row with regular results. This check-up needs to be undertaken despite having no symptoms at all, starting from the age of 30 and continuing at regular intervals.

2.      HPV vaccine – Medical professionals recommend both men and women have this vaccine to prevent the disease that leads to cervical cancer. The vaccine became available in 2006.

3.      Don’t smoke – Even secondhand smoke can increase the risk of contracting cervical cancer.

4.      Protection against STDs – HPV can be deceptively asymptomatic. If you don’t have a firm grasp of your partner’s sexual history, and haven’t been tested together, always use protection.

 

 The history, largely untold, of the development of cervical cytology, of effective screening and its ultimate success in reducing cervical cancer incidence and mortality, and the viral cause of cervical cancer, took place within a complex social background of changing attitudes to women’s health and sexual behaviour. Dr Georges Papanicolaou’s screening method (the Pap smear) started in the US in the 1940s. It was widely used in the UK a decade later and a national programme of cervical screening was established in 1988. The association of sexually transmitted human papillomavirus (HPV) with cervical cancer was less readily accepted. The detection of HPV16 in cervical cancers at the end of the 1970s was aided by the explosion of laboratory, clinical, and public health research on new screening tests and procedures. These made possible the successful development, licensing and use of preventive vaccines against the major oncogenic HPV types, HPV16 and -18.

WHAT DO YOU TELL THE PASSING OUT GRADUATES?

 

Teaching goes beyond sharing knowledge; it’s about creating connections and molding lives and laying the foundation of a better world. As educators, we dedicate our time, energy, and hearts to nurturing young minds. Finding the right words can be tough when the time comes to say goodbye. My generation is in that juncture of life when my colleagues are asked by the college administration to deliver the farewell speech to the passing out students. They often turn to me to advice them regarding what should they be telling their students in such a farewell speech.

A well-crafted speech can create a lasting impression, whether you’re retiring, or saying farewell to a graduating class. This will be my format and content. Your’s might differ but such is the occasion that it cannot be much different.

I will usually start with a very brief introduction like today marks the end of our journey together, but it’s just the beginning of yours. As I stand here, looking at your eager faces, I’m filled with a mix of pride and nostalgia. We’ve shared so much over the years – laughter, challenges, and countless “aha” moments. I cannot say you were exceptionally well behaved all the time, but then neither was I an exceptional role model every day. Teaching isn’t a one-way street – you’ve taught me patience, adaptability, and how to explain the same thing in ten different ways until it clicks! So, thank you for that. We the teachers however, have tried to teach you much more than what is written in books. So, as you go out to make your mark on the world stage, I will leave you with a bunch of dos and don’ts, otherwise I will be failing in my teaching responsibilities:

 1. Don’t associate with the wrong people

People who make you feel like you’re not worth their time, who treat you like you’re beneath them, or who never back you up when you need them to are not people deserving of your time and energy. Your dignity is not negotiable. True friends will make time for you and stick with you through thick and thin.

2. Stop avoiding your problems

It may be the easy thing to do in the short term, but in the long run, you’ll just face them again and again. It’s better to tackle hardship head-on. You probably won’t solve your problems instantly, but the process is what counts – learn from your mistakes, adapt, and grow. Eventually, it’ll make you a better, stronger person.

3. Don’t lie to yourself

Honesty is the best policy and the only policy, and being honest with yourself is the most important part of this policy. When you lie to yourself, you know that you’re lying, so it’s pointless and will make you feel like a disingenuous person. Don’t do it.  

4. Don’t ignore your own needs

You may want to be there for all of your friends, all the time, or you may think that your children’s / student’s needs come before your happiness. They don’t. If you suppress your needs, you’ll become tired, because fighting a need is tiresome, and you’ll end up unhappy at best and severely depressed at worst. Take some “me time” - indulge in a hobby or passion. It’s worth it.

5. Be yourself

Trying to be someone you’re not is hard work, and ultimately, you’ll always be afraid others will find out. The most gratifying relationships are with people who appreciate you for who you are, not who you want others to think you are. Be genuine, and try to be the best version of yourself, improving every time.

6. Let go of the past

It cannot be changed, so learn from it and get on with it. Those who dwell in the past are jeopardizing their future.

 7. You can make mistakes

“To err is human, to forgive is divine” – we all make mistakes, and no one is perfect. The only way to make no mistakes is to do nothing, and people who are afraid of mistakes are often paralyzed by that fear. The more things you avoid out of fear, the more regrets you’ll end up having.

8. Let bygones be bygones

Staying up late at night, thinking of all of the things you did wrong, all of the conversations that could have gone differently if you’d have said (or hadn't said) that one thing? You’re wasting your time and energy. Past mistakes are made and then are in your past - you can learn from them, make amends, and move on. The knowledge learned from the mistakes you made in the past are helping to shape your future. They will end up making you a better person.

9. Money can’t buy you happiness

That new TV, shiny car, those diamond earrings – they may make you happy for a few minutes, a few days or even a couple of years, but true happiness comes from within. Follow your passions and enjoy life – that will make you truly happy.

10. Happiness is in you, not in other people

Other people are looking for happiness just like you, they may like to join you for the ride, but the only person responsible for your happiness - is you.

11. A rolling stone gathers no moss

Problems and fears can paralyze you and get you stuck. You may need to stop over-thinking and try a different approach, but always take decisive action once you do. Sure, you’ll make mistakes, but at least you won’t be stuck anymore.

12. Don’t get into a relationship just because you’re lonely

A relationship requires two people who are both ready and willing to be in a relationship. Loneliness may be a terrible feeling, but being with the wrong person ends up feeling even worse. You’ll find the right person as long as you’re true to yourself.

13. Don’t wait until you’re “ready”

Life will always find ways to surprise you. Opportunities arise when you least expect them. You may never be ready, but don’t let it stop you. When an opportunity comes knocking – take it. When you need to do something – do it. Don’t get stuck in your comfort zone.

14. Life is not a competition

Stop comparing yourself to other people. There will always be someone who seems better looking, smarter, richer, or more talented. Nobody is perfect, including you. Your success is your own - between you and yourself.

15. Self-pity and complaints will get you nowhere

Wallowing in your own misery and constantly complaining doesn’t solve your problems and also tends to push people away. Consider every time something bad happened, and find the good that came out of it. You’ll realize that hardship is just a matter of perspective.

16. Grudges are bad for your health

Holding on to anger and hate will push people away and end up hurting you and your loved ones. To forgive doesn’t mean ignoring what was done to you, but rather to acknowledge it and refuse to let it dampen your happiness. Also, remember to forgive yourself as well.

17. Don’t let others make you stoop to their level

Refuse to lower your standards to accommodate those who refuse to raise theirs.

18. Stop wasting time on justifying yourself

Your friends don’t require explanations, and enemies won’t care. As long as you know in your heart that you are right, stop apologizing.

19. If something doesn’t work, try a different approach

Always have a Plan B. Albert Einstein once said that the definition of insanity is “doing the same thing over and over again and expecting different results.”

20. Perfect is the enemy of good

Perfection is impossible No one and nothing is perfect, and perfectionists are often the most frustrated people in the world. Give it your best and it really doesn’t matter if it is not perfect; it is your genuine effort that counts.

21. Don’t separate optimism from realism

Sometimes things fall apart, and that’s okay. Sometimes you feel weak, and that’s also okay. You can’t pretend that everything is fine when it clearly isn’t, so don’t avoid the truth – embrace it.

22. The easiest choice is not always the best one

Nothing worthwhile is ever easy, and the easy way out often leaves you feeling empty. Dare. Take risks. A truly extraordinary life is never an easy one. Challenge yourself, come out of your comfort zone. This is the only way to success.

23. Take responsibility for your actions  

The only person you can control in this world is you. Other people can’t make your dreams come true for you, nor can they take the blame for your mistakes. Don’t give other people power over you.

24. Worrying has never solved problems

Worrying doesn’t solve problems, but it definitely can create new ones. If you find yourself worrying about something, ask yourself if it will really impact you in the future – if it doesn’t, it’s not worth the worry.

25. Focus on what you want, not what you don’t want

A positive approach helps in two ways – it aids with your happiness and helps you solve problems faster than a negative one.

26. Remember to be grateful

When you wake up each morning, be thankful that you’re alive, appreciate each day, and be grateful for what you’ve got. In other parts of the world, people may not be so lucky.

27. Never stop learning

The world outside these walls is big and sometimes scary, but you’re ready for it. You have the tools, the knowledge, and most importantly, the character to face whatever comes your way. Be kind, be curious, and always keep learning.

28. Never fear failure

Failure is nothing but one of the stepping stones towards success. Don’t ever try to make a more serious issue of failure. It has helped you to rule out a wrong route towards success, it has done its job. Now leave it and trace an alternate part. Remember a failure but don’t let it intimidate you.

Your potential has no limits. Dream big, work hard, and don’t fear failure. Some of life’s greatest lessons come from our mistakes. And when things get tough – because they will – know that you have a whole community cheering you on. You’ve all grown so much, not just in height and girth, but in confidence, skills, and character. I’ve seen shy students find their voice, struggling learners discover their strengths, and natural leaders learn to lift others up. Each of you has something unique and valuable to offer the world. Thank you for your energy, your questions, your challenges, and your growth. You’ve made me a better teacher and a better person.

Education is the most powerful tool we have to change the world. Use it wisely, use it often, and never take it for granted. The future is in your hands, and I have no doubt that it’s going to be brilliant. As you leave these halls, know that you take a piece of all of us with you, just as you leave a piece of yourselves here. Go forth and make your mark on the world. I can’t wait to see what you’ll achieve.