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.