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
Chemotherapy before surgery is called neoadjuvant chemotherapy. It's not a common treatment for 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 soft tissue Ewing sarcoma and a type of rhabdomyosarcoma called embryonal rhabdomyosarcoma.
For some types of soft tissue sarcoma, radiotherapy may be better at shrinking the tumour before surgery. Doctors are also looking into combining radiotherapy and chemotherapy before surgery. But this is not yet a standard treatment.
Occasionally people have chemotherapy using a technique called isolated limb perfusion (ILP). This is a way of giving chemotherapy into just one arm or leg. You might have it:
- before surgery to shrink sarcomas
- after radiotherapy, if further radiotherapy is not possible
- as part of palliative care for sarcomas that can’t be removed with surgery
ILP is complicated to do and is only available as a treatment in a few hospitals in the UK.
Chemotherapy 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.
You might also have it after surgery if your sarcoma is more sensitive to chemotherapy. This means the cancer cells are more likely to be killed by chemotherapy.
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.
If your sarcoma was not completely removed
Sometimes, a surgeon is not able to remove all of the cancer. In this situation you might have radiotherapy to shrink the cancer that is left behind. Some people have chemotherapy (instead of radiotherapy) to shrink the cancer.
The aim of treatment is to try and slow down the growth of the cancer. Unfortunately, even if the chemotherapy shrinks it completely, there is a risk of the cancer coming back at some time in the future.
Chemotherapy to relieve symptoms
If surgery is not possible, you might have chemotherapy to
- try to shrink a cancer
- control its growth
- relieve any symptoms
You may have radiotherapy as well as chemotherapy.
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.
Types of chemotherapy
There are a number of chemotherapy drugs used to treat soft tissues sarcoma. You usually have a combination of 2 or 3 drugs together, but you might just have one.
The type of drugs you have depends on different factors. These factors include your risk of the cancer coming back and whether you have other medical conditions, such as heart problems.
Examples of chemotherapy for soft tissue sarcoma include:
- Ifosfamide (Mitoxana)
- Etoposide (Etopophos, Vepesid)
- Gemcitabine (Gemzar)
- Docetaxel (Taxotere)
- Trabectedin (Yondelis)
Check what the name of your regimen is with your doctor or nurse, then take a look at our A to Z list of cancer drugs.
How you have chemotherapy
You usually have treatment into your bloodstream (intravenously).
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line you might have treatment through a thin short tube (a cannula). The cannula goes into a vein in your arm each time you have treatment.
You might have some drugs as capsules.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that 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
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
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
- diarrhoea or constipation
- hair loss
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 a few days or so. Your treatment team can help to manage any side effects that you have.
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.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They 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.