Q: My father is a cancer patient. He is suffering from myxoid chondrosarcoma and epitheloid sarcoma in his left shoulder. There is a huge lump in his left shoulder and it pains a lot. He also has a coin shape lesion in his right lung, which the doctors say is undifferentiated unclassifiable sarcoma. He is 54 years old. The pain is so severe that the doctors say that they have to amputate his left arm. I have been to many doctors and tried everything, but everyone says the same thing. He has been given 1st cycle of chemotherapy, but it has not done any good for him. The doctors have given me 2 days to decide whether he wants the amputation or wants the 2nd cycle. What should we do? Is there a way to save his life and his arm?

A:As per the history given by you, your father is suffering from a metastatic chondrosarcoma (sarcoma - a form of connective tissue cancer, which has already spread to some other organ in his body & in his case - lung) of his left shoulder. Unfortunately these tumours are not very radiosensitive or chemosensitive and surgery remains the mainstay of treatment. I understand that your father has unbearable pain due to his disease. But in his case the surgery is going to be purely palliative just to get rid of the pain, if at all the tumour is surgically respectable. We will be leaving behind tumour deposits elsewhere (lung) and may be if the surgery is poorly performed then locally also. I personally think that going in for a major mutilating surgery at this stage is not worthwhile due to the following reasons. 1. The tumour is already metastatic. 2. The location of the tumour suggests that it is not going to be a simple amputation and it may be necessary to disarticulate the entire shoulder joint, if at all this is possible. 3. Other forms of therapy may be of help. 4. Give him better quality of life by adopting various other palliative measures. You have not mentioned in details about the other forms of palliative therapy that have been tried. The following modalities may help - a) Morphine tablets in adequate dose and frequency with addition of other drugs as necessary b) Nerve block c) Palliative radiotherapy I must answer your last query in a more subtle way. Your father has reached a stage of cancer, which is incurable. Any amount of chemotherapy is not going to help. You must try palliative treatment, as suggested, to give him a better quality of life for his remaining life span. Chemotherapy may continue as a purely palliative procedure in addition to more reliable methods of palliation.