This young woman arrived at our emergency department with a mass growing within her right knee for about six months. It was not painful, but the resulting weight and leg weakness made walking impossible. Her family brought along a very poor-quality x-ray, which nevertheless showed multiple egg-shell-like layers of calcification surrounding the joint – quite characteristic for osteosarcoma, a bone malignancy.
Cancers in this part of Africa her frequent: skin cancers, breast cancer, lymphoma, and cervical cancer are especially common. But mature diagnostic capabilities, such as PET scanning and histo-pathology, or unheard of in the nation whose national health expenditure is on the order of $180 per person per year. And therapeutics, which are often successful for osteosarcoma, are sparse.
That evening, we gently explain to the young woman and her family the gravity of her cancer, and that the only therapeutic option was amputation of her entire leg. Even then, we could not guarantee that her cancer might recur at a different location. They became very quiet. The following morning when I return, her bed was empty. In a land where there is no modern oncology, family had already taken her home.