Winning the war against cancer
Dr. Sultan Pradhan
Dr. Sultan Pradhan’s contribution to the field of medicine and oncology in particular has resulted in radical improvements. He has worked with several NGO groups and has been instrumental in improving the lives of Mumbai’s citizens. For his lifelong dedication to medicine and the people of Mumbai, we are proud to present the “Citizen of Bombay” award to Dr. Pradhan.
— President Rotarian Nirav Shah
There are many doctors in the field of oncology — in our city and our country. But I would want to share why the Awards Committee has found Dr. Pradhan to be not only a towering giant among many greats but also a citizen of our city with a vision for Mumbai’s fight against cancer. Dr. Pradhan was born into a business family and saw both his parents suffer from cancer. So he worked hard to become a cancer specialist. His work found immense recognition at the Memorial Sloan-Kettering Hospital in New York, in the Tata Memorial Hospital and the Prince Aly Khan Hospital in Mumbai through a career spanning over 37 years. Once he reached the top of his practice through hard work and research, which is respected world over, he decided to fight cancer with two approaches: prevention and cure. Realising that cancers of the head, neck and throat are the largest killers in our country, he inspired many outreach programmes to help patients see the early symptoms, and prevent children from succumbing to the tobacco menace. He has also created a huge programme for young doctors to learn under him and branch out to create centres of cancer cure across India. He says that we should have many Tata Memorials in our country and not just one in Mumbai. He has convinced the BMC, which we know can be a tough task, and spearheaded the head and neck department in Nair Hospital and Sion Hospital, making cancer surgery affordable and accessible to many patients in our city.
Dr. Pradhan’s resume is as soft-spoken as he is. The words in his resume hide a giant in the field of oncology. Cancer could not have found a more formidable enemy. With him we know that our generations will be protected and no one will succumb to cancer just because they couldn’t afford it. And that is a huge task. Ladies, gentlemen and fellow Rotarians, I am very proud to present to you the Citizen of Bombay for the year 2013-14: Dr. Sultan Pradhan.
— Rtn. Aditya Somani
Good afternoon, ladies and gentlemen. I am proud to receive this honour and thank you all for the appreciation of my work. As I humbly accept this honour, I would like to pay tribute to the institutions, organisations and individuals who have helped me in my endeavours. I am grateful to all these institutions that have nurtured me and provided me with an enabling environment to grow. I dedicate this honour and this talk to them.
My life is about surgical oncology with a major focus on head and neck cancers, and all scientific, academic and healthcare developments around this speciality. Cancers of the head and neck, cancers of the oral cavity (pharynx and larynx) together constitute almost 25% of India’s cancers. Three to four decades ago, we read the Western textbooks to get guidelines on how to treat this cancer. The Tata Memorial Hospital was perhaps the only centre in this country that provided state-of-the-art treatment for this cancer. Surgery is a major treatment modality for this cancer, and back then there were no head and neck surgeons outside Tata Memorial Hospital in this country.
This was largely because in our medical curriculum there was no training for head and neck cancer surgery for medical students. The Tata Memorial Hospital was bursting at the seams. There were hundreds of patients on the waiting list for surgery — after the evaluation and decision to go in for surgery. There was an urgent need to develop more head and neck surgeons as well as treatment centres. There was a need to develop the guidelines for treating this cancer and carry this speciality into public hospitals and medical colleges so that on one hand, the poor could get treatment, and on the other, medical students could get the exposure. It was also important then to control the gutka epidemic.
We have come a long way since those days but it is still work in progress. A lot of people have put in efforts to improve the situation compared to what it was then. I have done my little bit too and will try to take you through this journey of mine. As I do that, I shall highlight the contributions of institutions and organisations that have helped in every step of this endeavour.
First is the Tata Memorial Hospital — a giant among the institutions of oncology. It is the premier cancer institute in our country with national as well as international repute. It is here that I developed my roots and was trained under the stalwarts in the field
of oncology.
I learnt everything about surgery — how to perform, when to perform and, more important when not to perform. I got a solid grounding in the surgical techniques here, at the Tata Memorial.
It was at the Memorial Sloan-Kettering Cancer Center, New York that I first learnt the concept of “Evidence Based Medical Practice”. As I was learning about surgery under the leadership of some of the world’s most renowned surgeons, it was the first time that I was introduced to the concept of a Tumour Board.
A Tumour Board comprises a surgeon, a radiotherapist, a chemotherapist, a pathologist and a radiologist. They all meet and discuss every patient to make joint treatment decisions based on published literature. It was not a one-man show. It was not like the Tata Memorial, where a surgeon made the decision on what treatment should be given. A board took the decision based on available evidence.
When I came back to Tata Memorial after my full residency at Memorial Sloan-Kettering, I was quite excited about this new concept. A lot of existing practices and trends were questioned. We developed our own data and presented it to our seniors in the weekly academic meetings. We got full support from Tata Memorial — the seniors supported, critiqued, altered and gave healthy suggestions.
India was slowly developing its own database and guidelines for treatments. This was a great achievement. I really owe it to Tata Memorial and Memorial Sloan-Kettering for giving us insights and the room to pursue this research. The learning was not unidirectional.
I will give you one example here. I saw that in patients with advanced cancer of the tongue, it required total removal of the tongue — glossectomy. At the Memorial Sloan-Kettering they also removed the voice box because they felt leaving behind the voice box after removing the tongue could be dangerous as the patient will keep aspirating and might develop pneumonia. His speech will be unclear too.
So the first thing I did after coming back to India was to take up the study of total glossectomy with laryngeal preservation. Our experience was that with good nursing care the procedure was safe. The patients did not develop pneumonia. Their speech was understandable as they could form some short words with their lips. It was a wonderful thing and we presented it at the Asia Pacific Cancer Conference. It was then published in an international journal. The paper was picked up by the Year Book of Surgery and ultimately Memorial Sloan-Kettering and many other centres in the West changed the way they treated advanced cancer of the tongue. As a young Indian, it made me proud. The Tata Memorial Hospital could lead its way to the world.
It was an exciting period then. One of my senior colleagues, Dr. Ashok Mehta, an eminent head and neck surgeon of that time, founded the Society of Head and Neck Oncology. We travelled to all corners of the country, went to medical colleges, held conferences and live workshops where we demonstrated surgery. That exercise aroused interest among ENT post-graduates. Nobody ever talked about head and neck cancer surgery then. I will give full credit to Dr. Ashok Mehta for it. Soon, requests started coming in, from ENT post-graduates and young ENT surgeons, to specialise in head and neck surgery. But there was no system for the intake of ENT surgeons at the Tata Memorial. There was no budget to take ENT surgeons and that was the time when the Narotam Sekhsaria Foundation funded us for a special head and neck fellowship called “the Sekhsaria Fellowship”. Soon many head and neck surgeons were being trained at the Tata Memorial Hospital and later at Prince Aly Khan Hospital. These youngsters then started practising head and neck surgery either within their nursing homes or within the hospitals where they practised.
We also needed to develop more centres. Sometimes Tata Memorial allowed us to take on an additional attachment. So I went to Prince Aly Khan Hospital, a small multi-specialty hospital within the large Aga Khan Development network. Currently, we have a full-fledged oncology service at the Prince Aly Khan Hospital with the workload only second to Tata Memorial Hospital. It was possible because of the support given by the Governing Board of Prince Aly Khan Hospital for development in this service.
We also undertook an outreach programme for tobacco control, where we went to several schools and educated children on the ill-effects of tobacco. It soon grew so big that the Salaam Bombay Foundation took over and till date, the Foundation is conducting a nice programme on the topic. It focuses not only on the “No Tobacco” message but also on developing the personality and self-esteem of those children in municipal schools.
Lastly, my dream since the past 20 years was to take the head and neck surgery programme into medical college hospitals. It was not easy until the Prince Aly Khan Hospital got into a partnership with the Municipal Corporation of Greater Bombay. We now have a six-year-old programme with Nair Hospital and Sion Hospital.
Today, many poor patients are getting treatment and many post-graduate students are getting exposure to the field of head and neck surgery. It is not possible to chronologically keep listing the various institutions, individuals and organisations who have helped me in doing the work that I do. I humbly accept this honour on their behalf. Thank you.
Excerpts from the Q&A session:
Q: I would like to ask you a question regarding cancers of the head and neck. What is the research availability and expense in oncology when it comes to the genetic testing of tumours?
Dr. Pradhan: Presently, all research grants for the country come through the Department of Biotechnology in Delhi, and some through the Council of Scientific and Industrial Research. One of the projects at the Prince Aly Khan Hospital that we are currently undertaking is through a grant from the Council of Scientific and Industrial Research. Its research topic is to find out and identify vernacular bio-markers that can predict the aggressive behaviour of some of the squamous cancers. This is funded entirely by the Council of Scientific and
Industrial Research.
Q: Can you throw a little light on HPV infection — cervical infection — and vocal cord cancer?
Dr. Pradhan: The human papillomavirus infection has been incriminated as the causative in almost all cervical cancers. In head and neck cancer, it is implicated mainly in oropharyngeal cancers. We have a research project going on and it is almost coming to an end – where we have examined all squamous cancers such as the oral cancer, oropharyngeal cancer, hypopharyngeal cancer and laryngeal cancer to see whether the HPV virus is implicated in any of those.
The available data still holds for oropharyngeal cancers and it is the most common.
The response to radiotherapy and chemotherapy is
better than the non-HPV initiated cancers.
Q: How do you collect the material when you suspect oropharyngeal cancer in a male?
Dr. Pradhan: It is done in the biopsy itself.