When, where and how you have chemotherapy for soft tissue sarcomas and the possible side effects.
How chemotherapy works
Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.
When you might have chemotherapy
Chemotherapy before surgery is called neoadjuvant chemotherapy. It's not a common treatment for all types of soft tissue sarcomas, but you might have it to shrink a tumour before surgery to make it easier for your surgeon to completely remove it.
For sarcomas in a limb, it might mean that you can have just the tumour removed (limb sparing surgery), rather than having the whole limb or part of it removed (an amputation).
You usually have chemotherapy before surgery if you have a Ewing's sarcoma and a type of rhabdomyosarcoma called embryonal rhabdomyosarcoma
For some types of soft tissue sarcomas radiotherapy may be better at shrinking the tumour before suurgery. Doctors are also looking into combining radiotherapy and chemotherapy before surgery but this is not yet standard treatment.
Occasionally people have chemotherapy to shrink their sarcoma before surgery using a technique called isolated limb perfusion. This is a way of giving chemotherapy into just one arm or leg. It's complicated to do and is only available as a treatment for sarcoma at a couple of hospitals in the UK at the moment.
There's a risk of any cancer coming back after surgery. Your doctor might suggest chemotherapy after surgery if you have a high risk of the sarcoma coming back,
This aims to reduce the risk and is called adjuvant therapy. The aim is to kill off any cancer cells that might have been left behind after your operation but are too small to see.
A chemotherapy drug called doxorubicin could lower the risk of sarcoma coming back for some people after surgery. Combining doxorubicin with ifosfamide can lower the risk further but has more side effects.
Overall, research in this area suggests that adjuvant chemotherapy is only likely to help people with the highest risk of their sarcoma coming back. Research is continuing to try to improve the results of chemotherapy treatment for sarcoma.
You might have chemotherapy to try to shrink the cancer that was left behind after the operation if your surgeon couldn't remove it all. But it is more usual to have radiotherapy in this situation.
The aim of treatment is to try and slow down the growth of the cancer. Even if the chemotherapy shrinks it completely, there is a high risk of the cancer coming back at some time in the future.
You might have chemotherapy to try to shrink a cancer, control its growth, or relieve any symptoms it is causing if surgery isn't possible. You may have radiotherapy as well.
How you have chemotherapy
You usually have chemotherapy as a course of several cycles of treatment. Depending on the drug or combination of drugs, each treatment lasts from a few hours to a few days. Treatments for sarcoma can be given weekly or every 2, 3 or 4 weeks, depending on the drugs and your treatment plan.
You usually have this treatment into the bloodstream or by tablets.
Drugs into your bloodstream
You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Never stop taking a cancer drug without talking to your specialist first.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for the few days that you’re having the drugs. The team caring for you can help reduce your side effects.
When you go home
Chemotherapy for soft tissue sarcomas can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Clinical trials for chemotherapy
Your doctor or nurse may ask you to take part in a clinical trial to test new chemotherapy drugs. This is because it is important for doctors to find out which treatments work best. They aim to get the best results with the fewest side effects.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you take any supplements or if you’re prescribed them by alternative or complementary therapy practitioners.
It’s uncertain how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful.
Some studies seem to suggest that fish oil preparations may make chemotherapy drugs work less well. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.