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. It may be given to treat soft tissue sarcomas:
- before surgery (neo-adjuvant treatment), to shrink the tumour and make it easier to remove
- after surgery (adjuvant treatment), to reduce the risk of the cancer coming back
- to help relieve symptoms and control a sarcoma that cannot be completely removed, or has spread to other parts of the body – this is called palliative treatment and may help improve quality of life.
Chemotherapy may not be an effective treatment for some types of soft tissue sarcoma. Your doctor can tell you if chemotherapy is used to treat the type of soft tissue sarcoma you have.
Chemotherapy drugs used to treat soft tissue sarcomas are usually given by injection into a vein (intravenously). They are also sometimes given as tablets.
The most commonly used drugs are:
Other drugs that may be used include:
Some of these drugs can be given on their own, but you will usually have a combination of two or more. A targeted therapy drug may also be given at the same time.
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 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 responds to the treatment.
We have more general information about having chemotherapy. This includes information about planning and preparing for chemotherapy
Chemotherapy can sometimes be given directly into an arm or leg. It can help control cancer that cannot be removed with surgery or has come back in one area. This is also called regional chemotherapy or isolated limb perfusion.
Giving the drugs directly into the affected limb means that very high doses can be given. The affected limb is isolated using a tight band (tourniquet). This stops the chemotherapy drugs going to other areas of the body. This means you are unlikely to get the common side effects of chemotherapy, such as feeling sick.
We have more information about having chemotherapy into a limb and the possible side effects of this treatment.
Regional chemotherapy is only done in some specialist centres in the UK.
Everyone reacts differently to chemotherapy. Some people may not have many side effects, and others may have more. The side effects we describe below will not affect everyone who is having this treatment.
We explain the most common side effects here. We have not included the side effects that are rare and unlikely to affect you. Talk to your cancer doctor, chemotherapy nurse or pharmacist if you have any side effects that are not listed here.
All these side effects may be difficult to cope with, but most of them will disappear 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 called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
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.
G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.
Your doctor may give you G-CSF:
- if the number of white blood cells is very low
- to stop the number of white blood cells getting low.
You have it as a small injection under the skin.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
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. This will make you feel more energetic and ease any breathlessness.
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.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth 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.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or 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. It is important to cover your head to protect your scalp 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. 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 operate machinery.