One of my newer patients, a young woman of 35, was diagnosed with lymphoma, a cancer of the lymph nodes.

She has a young son. Her husband showed me photos of him on his handphone. He is a very cute little boy. I saw pictures of him when he was a newborn and more recent ones of him when he was about a year old.

One of the main issues we discussed was fertility. The mother is keen to have another baby after she completes her treatment.

She has a type of lymphoma called Hodgkin's Disease and her chances of a cure are excellent - estimated at above 80 per cent. However, I felt that she definitively needed chemotherapy.

In the older chemotherapy programmes for this disease, there was a near certainty that she would never be able to conceive after the treatment.

However, there are newer programmes which have been specially designed to preserve fertility. And more than 50 per cent of patients on these programmes will be able to conceive and have children.

Despite this reassurance, my patient wanted to know if there was anything else that could be done to improve the odds.

Naturally, the issue of harvesting the eggs was raised. She opted to delay her treatment for two weeks so that she could receive hormonal therapy (to stimulate ovulation) and the eggs could be harvested.

After a few days, her gynaecologist convinced her that she should not go through with the harvest as there was no assurance that the stimulation of ovulation or the harvest would be successful under such stressful conditions.

She relented and started chemotherapy after two days of hormonal treatment.

I take a pragmatic approach towards this issue of fertility.

As an oncologist, I cannot compromise on the treatment of the cancer. But as a doctor, I need to remind myself to listen to the patients first and to try to understand them.

If we can meet both objectives - of preserving fertility and giving optimal treatment - then the solution is simple.

Sometimes, it is not possible. For example, if a woman in her late 30s has breast cancer and needs to have chemotherapy, the chances of preserving her fertility are very low.

Depending on the stage and prognosis of her cancer, we need to discuss the different chemotherapy treatments.

Sometimes, in order to ensure that they have some treatment (even though it may not be the 'best'), we have to come up with treatment programmes that do not affect their menstruation and fertility.

Although this is not a common problem, from time to time, we encounter women who are very keen that their fertility be preserved.

Some women will even refuse chemotherapy if we cannot assure them that their fertility will be preserved.

For men, the problem is easy to solve. They can simply opt for sperm banking. Their seminal fluid is collected over two to three days and we are all set to start chemotherapy.

For young women, we have to discuss the issue in greater detail because harvesting the eggs before treatment is a fairly complex affair, which can take from 10 to 20 days.

But there are times when the two needs conflict.

When a young woman is diagnosed with ovarian cancer, the cornerstone of management is the complete removal of both ovaries and the uterus.

After that, these patients have no chance of conceiving.

One patient, now more like a friend because I've looked after her for almost 10 years, was in her 20s when she was diagnosed with cancer of the ovary.

Although only one ovary was involved, the treatment requires for both ovaries plus the uterus to be removed.

It was a matter of life and death. She had very strong support from her husband and much as they wanted children of their own, they agreed that it was more important for her to do what was necessary to cure her of the cancer.

She had the surgery, followed by chemotherapy. Today, she is alive and well. The couple adopted two newborn babies and these children are now of school-going age.

I have also seen many patients who have conceived and had babies.

Most people don't realise that pregnant women can receive chemotherapy from their second trimester.

I know of no less than 10 babies who were born to mums who were on chemotherapy. All of them were born healthy!

I have pictures of these mothers, pregnant but bald, while they were on chemotherapy. And then pictures of them cuddling their babies after they were born.

I show these to pregnant patients and this helps convince them that it can be done - and safely - with no harm to either the mother or the baby.

I also have many patients who have completed their chemotherapy and gone on to have children.

Life is stronger than disease and surprises us every day.

Dr Ang Peng Tiam for Mind Your Body

The medical director of Parkway Cancer Centre has been treating cancer patients for nearly 20 years.

In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

He also recently published a book of patient stories, Doctor, I Have Cancer. Can You Help Me?, which has been translated into four languages.

Dr Ang begins a fortnightly column in Mind Your Body today.