Chemotherapy for soft tissue sarcoma
Chemotherapy uses drugs to treat many different types of cancer. It is most commonly given as an injection into a vein or as tablets or capsules.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.
Not everyone has chemotherapy. It depends on the risk of soft tissue sarcoma coming back and the type of sarcoma you have. Chemotherapy may not work well for some types of soft tissue sarcoma. Your doctor can tell you whether chemotherapy is a helpful treatment for you.
It may be given:
- after surgery, to try to reduce the risk of the cancer coming back (adjuvant treatment)
- before surgery, to shrink the tumour and make it easier to remove with surgery (neo-adjuvant treatment).
It may also be used to relieve symptoms and help control sarcoma that cannot be completely removed, or has spread to other parts of the body. It may help to improve your quality of life. This is called palliative treatment.
The drugs you have can depend on the type of sarcoma. You usually have a combination of drugs, but some are given on their own. If certain drugs do not work well for you, your doctor may talk to you about trying different ones.
The most commonly used drugs are:
- liposomal doxorubicin
The chemotherapy drugs are usually given by injection into a vein (intravenously). Some drugs can be given as tablets. You have chemotherapy as a session of treatment. You may have chemotherapy as an outpatient. Or you may need to go into hospital for a few days. Each treatment session is followed by a rest period of a few weeks. This is to allow your body to recover from any side effects.
Chemotherapy and the rest period make up a cycle of your treatment. The number of cycles you have will depend on the type of sarcoma you have and how well it responds to the treatment.
You can sometimes have chemotherapy directly into an arm or leg. It can help control sarcoma that cannot be removed with surgery or has come back in one area. This is called isolated limb perfusion.
Having the drugs directly into the affected limb means that very high doses can be given. The limb is isolated using a tight band. This is called a tourniquet. It stops the chemotherapy drugs going to other areas of the body. You are unlikely to get common chemotherapy side effects, such as feeling sick. The affected limb may swell and the skin may turn red.
Chemotherapy drugs cause side effects. But there are usually ways these can be controlled. Your doctor or nurse will give you information about the likely side effects of your treatment. They will also tell you what can be done to control and manage side effects.
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
- 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.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
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:
- 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.
Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. 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 often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse 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.
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 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.
Effects on the kidneys
This treatment can affect how your kidneys work. This is usually mild and goes back to normal after treatment finishes. You will have blood tests to check how well your kidneys are working. Tell your doctor or nurse if you have blood in your urine (pee) or you are passing urine less than usual.
It is important to drink at least 2 litres (3½ pints) of non-alcoholic fluid each day to help protect your kidneys.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes. But for some people they may never go away. Talk to your doctor if you are worried about this.
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
- 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.
Sometimes chemotherapy treatment causes an early menopause, and they may have symptoms such as hot flushes and sweats. Hormone replacement therapy (HRT) can often be given to replace the hormones that are no longer being produced. People with a gynaecological sarcoma may not be able to have HRT, because the cancer may be sensitive to hormones.
You may find it helpful to talk about all this with your doctor or a support organisation. You can also talk to one of our cancer support specialists for free on 0808 808 00 00.
Booklets and resources
Below is a sample of the sources used in our soft tissue sarcoma information. If you would like more information about the sources we use, please contact us at email@example.com
Gronchi A, Miah AB et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2021; 32, 11, 1348-1365 [accessed May 2022].
Casali PG, Blay JY et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2022; 33,1, 20-33 [accessed May 2022].
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by senior medical editor Fiona Cowie, Consultant Clinical Oncologist.
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