Chemotherapy for primary bone cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells.
Chemotherapy is an important part of the treatment for most osteosarcomas, spindle cell sarcomas and Ewing’s sarcomas.
Chemotherapy is usually given before you have surgery or radiotherapy. When given before surgery, it can shrink the tumour and make it easier to remove. It can also reduce symptoms such as pain and reduce the chances of the cancer spreading.
If you have an osteosarcoma or Ewing’s sarcoma, you will also have chemotherapy after surgery or radiotherapy. This is to destroy any remaining cancer cells that may have spread to other parts of the body. It’s given because tiny amounts of cancer may be present, especially in the lungs, that are too small to be detected by a scan.
Before having chemotherapy you will have tests to check your hearing and how well your heart, liver and kidneys are working. The results are normally available after a few days. Your doctor will discuss them with you.
You may be offered chemotherapy treatment as part of a clinical research trial. Clinical trials are important because they can help to improve the way that bone cancer is treated. Your doctor or research nurse can discuss any relevant trials with you.
How chemotherapy is given
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Your doctors will discuss your chemotherapy treatment plan with you.
Chemotherapy drugs are usually given by injection into a vein (intravenously). Sometimes, to make this easier and to avoid you having frequent injections, a fine plastic tube called a central line can be put into a vein in your chest. The line is put in under a general or local anaesthetic.
Instead of a central line, a tube may be put into a vein in the crook of your arm. This is known as a PICC line (peripherally inserted central catheter line).
A tube with an injectable port just under the skin can also be used. This is known as an implantable port.
Chemotherapy is usually given as a series of sessions of treatment. Each session usually lasts a few days and is followed by a rest period. The session of chemotherapy and the rest period is known as a cycle of treatment. A series of cycles makes up a course of treatment. The number of cycles you have will depend on the type of bone cancer you have and how well it is responding to the drugs.
Chemotherapy will usually mean spending a few days in hospital. Sometimes it may be given to you as an outpatient. In this situation it’s given continuously into a vein through a central line or PICC line. The dose is controlled by a small portable pump.
We have more information about central lines, PICC lines and implantable ports.
Side effects of chemotherapy
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Chemotherapy can sometimes cause unpleasant side effects. Any side effects that occur are usually temporary and can often be well controlled with medicines. The main side effects are described here, with tips on ways to avoid or reduce them.
Lowered resistance to infections (neutropenia)
Chemotherapy can temporarily reduce the production of white blood cells in your bone marrow, making you more prone to infection.
This effect can begin about seven days after treatment has been given, and your resistance to infection usually reaches its lowest point about 10-14 days after chemotherapy. Your white blood cells will then increase steadily and will usually return to normal before your next cycle of chemotherapy is due.
You should contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to make sure that your white blood cells have recovered. Occasionally your treatment might need to be delayed if your blood count is still low. Sometimes an additional drug called G-CSF may be given to help your bone marrow make white blood cells more quickly and so reduce the risk of infection.
If the level of red blood cells in your blood is low, you may feel tired and breathless. This is called anaemia. Anaemia can be treated by having a blood transfusion.
Bruising and bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Having low numbers of platelets increases your chance of bleeding, and this can affect people in different ways. Tell your doctor or the hospital straight away if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood in your urine or stools, blood spots or rashes on the skin. You may need to have a platelet transfusion.
Some of the drugs used to treat primary bone cancer may make you feel sick (nauseated) and sometimes actually be sick (vomit). Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness continues, tell your doctor so they can prescribe other anti-sickness drugs that may be more effective.
Some chemotherapy drugs can make your mouth sore and cause mouth ulcers. Regular mouthwashes are important and your nurse will show you how to use these properly. If you don’t feel like eating during treatment, talk to your nurse or ask to see a dietitian for advice. We have a slideshow about the things you can do to help you to cope with a sore mouth.
Some chemotherapy drugs can cause temporary hair loss. This can be very upsetting. Your doctor or nurse will be able to tell you if the drugs you’re having are likely to cause hair loss.
If you lose your hair during chemotherapy, you can often cover your head by wearing wigs, hats or scarves. Hospital inpatients are entitled to a free wig from the NHS, and your doctor or nurse will be able to arrange for a wig specialist to visit you. People being treated as outpatients may have to pay for their wigs.
If you lose your hair due to chemotherapy, it will grow back over a few months once your treatment is finished.
Chemotherapy affects everyone differently. Some people are able to lead a fairly normal life during their treatment, but many people find they become very tired and have to take things much more slowly. Feeling tired all the time can be very frustrating and difficult to cope with, especially for people who normally have a lot of energy.
Try to cut down on any unnecessary activities and give yourself time to rest. You may want to ask family and friends to help you with things that you haven’t got the energy to do, for example doing the housework or walking the dog.
The tiredness will ease once the chemotherapy is over, but it can often be three or four months until you feel back to normal, and for some people it can take longer.
Your ability to become pregnant or father a child may be affected by some of the chemotherapy drugs used to treat bone tumours. It’s important to discuss fertility with your doctor or nurse before starting treatment, as it may be possible for men to store sperm, and for women to store embryos or eggs.
Some women who have chemotherapy have an earlier menopause than they would otherwise have done. This means they no longer have as many years of fertility left. Your doctor can tell you if you may be affected in this way.
Changes in hearing
Some chemotherapy drugs can affect your ability to hear high-pitched sounds. You may also have ringing in your ears (tinnitus). This usually gets better when the treatment ends, although for some people it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.
Although all these side effects may be difficult to cope with, most of them will disappear once your treatment is over.
Contraception during chemotherapy
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It’s not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat bone tumours, as they may harm the developing baby. You can discuss this with your doctor or chemotherapy nurse.
We have more information about chemotherapy and its side effects, as well as information about individual chemotherapy drugs and their particular side effects.