By Dr Ang Peng Tiam

Patients walk a long narrow stretch of my clinic, which lets in the sunlight from the garden outside, to get to my room.

One patient, who is a close friend, said to me: 'As I sit on the bench along the long corridor outside your consultation room, I think of it as the corridor of hope.'

Each patient, who sits waiting patiently for his turn to be called, is looking for words of encouragement to give him hope to soldier on.

Hope and false hope. Where does one draw the line?

I pondered this question as I looked at a patient who was only in her 30s. She had a deformity, about the size of a big grapefruit, on her left chest wall. However, that was not all. There were other tumours over her breastplate, ribs, spine and in her lungs.

She had already been to one of the other cancer centres and a biopsy of the mass had shown a high-grade chondrosarcoma.

Sarcomas are cancers that arise from the body's connective tissue, for example, muscle (rhabdomyosarcoma), fat (liposarcoma) and bone (osteosarcoma). In this case, the malignancy arose from the cartilage tissue and is called chondrosarcoma.

The treatment of choice for chondrosarcoma is surgery but this can be offered only if the disease is localised. However, this patient's disease was already widespread, so surgery was ruled out.

Unfortunately, these tumours are very resistant to chemotherapy. Fewer than 20 per cent of patients who are treated have meaningful responses.

Not all sarcomas are the same. For example, those that arise from the muscle are the most responsive to chemotherapy. More common in the young, these patients tend to do quite well.

I have seen similar tumours that make a young boy's tummy swell to the size of a woman's with a full-term baby. I have also dealt with this disease when it filled a patient's entire chest cavity. These tumours disappear after a couple of courses of chemotherapy, often to the amazement of everyone.

So patients with cancers that arise from the muscle have a chance of a cure even when the disease is quite advanced. Even those who are not cured are likely to enjoy a period of reprieve.

However, this is often not so with chondrosarcomas, the disease the woman in her 30s has.

'They tell me this disease usually does not respond to chemotherapy. Is that true?' she asked.

What hope can I give her? Here, I was reminded of what Prime Minister Lee Hsien Loong said in his recent address to the Singapore Medical Association, when he talked about a doctor's role in society. 'To cure, rarely. To reduce suffering, sometimes. To comfort, always,' he said.

So I told myself, do not think too much about the thin line between hope and false hope. Instead, draw strength from the ray of light in the corridor which gives comfort to so many.

'Yes, it's true the chances are slim but I have seen patients who have responded well to chemotherapy,' I told her truthfully.

She looked at me intensely. Her face glowed and I felt her spirit lift as she decided to accept treatment despite the slim odds.

A pre-treatment PET-CT scan showed extensive disease at many sites. We agreed on a plan to carry out three cycles of chemotherapy and to repeat the scan. If the disease did not respond, it would be pointless to go on.

The treatment programme is a fairly intensive one, employing a cocktail of chemotherapy drugs.

After nine weeks of treatment, she walked into the room with a nervous smile on her face.

'How, doc?' she asked. With slightly trembling hands, I opened the sealed envelope that contained the new PET-CT results - something I do many times each day.

Each time, I would say a little prayer that the patient would not be disappointed. I prepared myself mentally to present the news - whether good or bad.

The PET-CT scans showed a marvellous response. Every site which had indicated active cancers had shown improvement. I allowed myself a little smile as I told her the good news.

The woman handed me her personal journal in which she had chronicled her long journey. She asked me to pen a few words for her.

Too busy to entertain her as there were so many patients waiting for their turn, I promised her that I would do it later.

Instead, I decided to write about her in this column - about her courage and conviction, about walking the line between hope and self-deception and, now, heartachingly, between celebration and premature rejoicing.

While we have been victorious in this battle, the war is not over.

The road ahead is going to be both long and arduous.

This article was first published in Mind Your Body, The Straits Times.