Chemotherapy for soft tissue sarcomas
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy drugs work by disrupting the growth of cancer cells.
Chemotherapy may sometimes be given in the following ways:
Before surgery to shrink the tumour, making it easier to remove. This is known as neo-adjuvant treatment.
After surgery to reduce the risk of the cancer coming back. This is called adjuvant treatment.
To help control symptoms and improve a person’s quality of life if the cancer can’t be removed or has spread to other parts of the body. This is called palliative treatment. In some people, the chemotherapy will achieve this. Unfortunately, for other people, the chemotherapy will not shrink the cancer and they will have the side effects of the treatment with little benefit.
Chemotherapy is sometimes combined with radiotherapy.
Certain types of soft tissue sarcoma are always treated with chemotherapy. For other types it is very rarely used. Your doctor can tell you whether chemotherapy will be used to treat your type of soft tissue sarcoma.
Chemotherapy drugs are usually given by injection into a vein (intravenously) but can sometimes be given as tablets. The most commonly used drugs for soft tissue sarcomas are:
Other drugs which may be used include:
These drugs can be given on their own, or two or more may be given together in combination.
Chemotherapy is given as a session (or cycle) of treatment. It may be given as an outpatient or you may need to be admitted to hospital for a few days. Each treatment is followed by a rest period of a few weeks to allow your body to recover from any side effects. The number of cycles you have will depend on the type of sarcoma you have and how well it’s responding to the drugs.
Side effects of chemotherapy
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Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won’t affect everyone who is having this treatment.
We have outlined the most common side effects but haven’t included those that are rare and unlikely to affect you. If you do notice any effects that aren’t listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Chemotherapy can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If your number of white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia. This begins a few days after treatment. The number of white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
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 check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of blood cells (blood count) is still low.
Bruising and bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you notice any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn’t controlled or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem for you.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Some people find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Occasionally during treatment, you may get a strange, metallic or bitter taste in your mouth. Some people find sucking on a strongly flavoured sweet or mint helps to disguise this. You may also notice that food tastes different, but taste changes will usually fade after treatment finishes.
Not all chemotherapy drugs cause hair loss. Hair may be lost completely or may just thin. You can ask your doctor if the drugs you are having are likely to cause hair loss.
It may be possible to reduce the amount of hair that you lose by using scalp cooling. Cooling the scalp during chemotherapy means that less chemotherapy reaches the hair follicles, and so the hair is less likely to fall out.
If you do lose your hair, you may want to wear a wig. You can ask your doctor or nurse to arrange for you to see a wig specialist. You may prefer to wear a bandana, hat or scarf.
If your hair does fall out, it will almost always grow back over a period of 3-6 months once the chemotherapy has finished.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Side effects can be hard to deal with, but they usually disappear gradually when your treatment finishes.
Your ability to become pregnant or father a child is likely to be affected by having chemotherapy. It’s important to discuss fertility with your doctor before starting treatment, as it may be possible for men to store sperm and women to store eggs or embryos for use in the future.
Some women may find that chemotherapy treatment causes an early menopause, and they may have symptoms such as hot flushes and sweats. In many cases, HRT (hormone replacement therapy) can be given to replace the hormones that are no longer being produced. Women with gynaecological sarcomas may not be able to have HRT because the cancer may be sensitive to hormones.
You may find it helpful to talk all this through with your doctor or a support organisation.
It’s not advisable to become pregnant or father a child while having chemotherapy as it may harm the developing baby. It’s important to use effective contraception during your treatment and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.