Chemotherapy for bone cancer

You may have chemotherapy as part of your treatment for primary bone cancer. This uses anti-cancer drugs to destroy cancer cells.

About chemotherapy for bone cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy is an important part of treatment for most:

It is not used often for other types of primary bone cancer.

Chemotherapy may be given:

  • before you have surgery or radiotherapy 
  • after surgery or radiotherapy
  • if the cancer comes back after treatment.

If you have osteosarcomas or Ewing sarcomas, you usually have chemotherapy before and after surgery.

Before chemotherapy, you may have tests to check your kidneys, heart and hearing.

  • Kidney test

    This test shows how well your kidneys are working. A small amount of mildly radioactive liquid is injected into a vein in your hand or arm. The liquid goes through your kidneys. You pass it out in your pee (urine). A few hours after the injection, a nurse takes blood samples from you.

  • Heart test

    You may have an ECG (electrocardiogram) which is an electrical trace of your heartbeat. You may also have an echo (echocardiogram) which is an ultrasound scan of your heart. Your cancer doctor or specialist nurse can explain more about these tests.

  • Hearing test (audiogram)

    A chemotherapy drug called cisplatin can affect how well you hear high-pitched sounds. If your treatment includes cisplatin, you may have hearing tests before and during your course of chemotherapy.

Having chemotherapy

Chemotherapy drugs for primary bone cancer are usually given by injection into a vein (intravenously). Some of the drugs used include:

Your cancer doctor or specialist nurse will tell you what drugs you will be given. You may have a combination of drugs.

Your chemotherapy is given as a session (cycle) of treatment. You may have chemotherapy as an outpatient, or you may need to go into hospital for a few days.

Each treatment is followed by a rest period of a few weeks. This is to allow your body to recover from any side effects. The number of cycles you have depends on the type of primary bone cancer you have and how it responds to the treatment.

We have more general information about having chemotherapy. This includes information about planning and preparing for chemotherapy.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

Chemotherapy for osteosarcoma

Osteosarcoma is usually treated with:

Children, teenagers and young adults (aged 30 or under) with osteosarcoma may be given a targeted therapy drug with the chemotherapy.

Chemotherapy for Ewing sarcoma

Ewing sarcoma is often treated with:

Side effects of chemotherapy

Everyone reacts differently to chemotherapy. Some people may not have many side effects, and others may have more. We explain the most common side effects here and have not included more rare side effects. Talk to your cancer doctor, chemotherapy nurse or pharmacist any side effects you have. Side effects may be difficult to cope with, but most of them will start to improve when your treatment finishes.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

Anaemia (low number of red blood cells)

If chemotherapy reduces the number of red blood cells in your blood, you may become very tired and feel you have no energy. You may also become breathless and feel dizzy and light-headed.

These symptoms happen because the red blood cells contain haemoglobin, which carries oxygen around the body.

If your haemoglobin is low, you may be offered a blood transfusion. You’ll feel more energetic and any breathlessness will be eased.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red or purple spots on the skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Feeling sick

You may feel sick in the first few days after treatment. Your doctor may give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Sore mouth and throat

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth or throat is sore:

  • tell your nurse or doctor – they can give you a mouthwash or medicines to help
  • try to drink plenty of fluids
  • avoid alcohol, tobacco, and foods that irritate your mouth and throat.

Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.

Hair loss

Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.

Scalp cooling is a way of lowering the temperature of your scalp to help reduce hair loss. Your nurse can tell you if this is an option for you.

Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.

Hair loss is almost always temporary and your hair will usually grow back after treatment ends.

Feeling tired

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.

If you feel sleepy, do not drive or use machinery.

Changes in hearing

Some chemotherapy drugs can affect your hearing. You may have a hearing test before you start treatment. During treatment, you may get ringing in your ears (tinnitus) and stop being able to hear some high-pitched sounds.

Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your cancer doctor if you notice any changes in your hearing.

Effects on nerves

Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, or a feeling like pins and needles. This is called peripheral neuropathy.

It is important to let your cancer doctor know if this happens. They may need to change the dose of the chemotherapy drug. Usually peripheral neuropathy slowly gets better when chemotherapy finishes, but sometimes it can be permanent.

Effects on the heart

This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
  • pain or tightness in your chest
  • breathlessness
  • dizziness
  • changes to your heartbeat.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.