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Chemotherapy for Bone Cancer

Primary Bone Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

Photo of intravenous drug bag

When might chemotherapy be used for primary bone cancer?

Chemotherapy is an important part of the treatment for some types of bone cancers, such as osteosarcoma and Ewing sarcoma, but it is not usually helpful for some other types of bone cancer. Whether or not you need chemo, and what type of chemo you need, will depend mainly on these factors:

  • The type of bone cancer you have

  • The stage (extent) of the cancer

  • The goal of treatment

  • Your general health

  • What treatments you have had in the past, if any

Your healthcare provider may recommend chemo to treat bone cancer in any of the following situations:

Chemotherapy might be recommended before surgery in some cases. This is called neoadjuvant chemotherapy. This might shrink the tumor and make it easier to remove.

Your doctor might recommend chemotherapy after surgery. This is called adjuvant chemotherapy. This can often help lower the risk that the cancer will come back.

Chemotherapy might also be used if surgery can’t be done for some reason, or if the cancer has spread to other parts of the body or returned after treatment.

How is chemotherapy given for primary bone cancer?

Before treatment starts, you will meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines such as chemotherapy. The doctor will discuss your treatment options with you and explain what you might expect. 

Chemotherapy medicines for bone cancer are usually given by IV (intravenously), through a small needle that has been put into a vein. The doctor might advise minor surgery before chemo. This is done to put a thin, soft tube called a CVC (central venous catheter) into a large vein in your chest. This makes it easier to give the chemo. One end of the catheter stays in your vein, while the other end lies just under or outside your skin.

Chemotherapy is often done as an outpatient visit to a hospital, healthcare provider's office, or clinic. This means you can go home the same day. In some cases, you may need to stay in the hospital during treatment.

You get chemotherapy in cycles over a period of time. That means you may take the medicine for a set amount of time and then you have a rest period. Each period of treatment and rest is 1 cycle. You may have several cycles. Your healthcare provider will discuss your chemotherapy schedule with you.

What types of medicines are used to treat primary bone cancer?

These are some common chemo medicines used to treat bone cancer:

  • Carboplatin

  • Cisplatin

  • Cyclophosphamide

  • Doxorubicin

  • Etoposide

  • Ifosfamide

  • Methotrexate

  • Vincristine

Often 2 or 3 of these medicines are combined.

What are common side effects of chemotherapy?

Side effects of chemotherapy depend on the type and amount of medicines you’re taking. They vary from person to person. Ask your doctor or nurse for details about the side effects for the medicines you are getting. Below is a list of the some of the most common side effects from chemotherapy for bone cancer:

  • Hair loss

  • Nausea and vomiting

  • Mouth sores

  • Diarrhea. 

  •  Loss of appetite or changes in the way things taste

  • Increased risk of infection from low white blood cell counts

  • Bleeding and bruising more easily 

  • Extreme tiredness (fatigue) 

Some other side effects can also be seen with certain chemo medicines. For example: 

  • Cisplatin and carboplatin can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in your hands and feet. Cisplatin can also affect hearing and can damage the kidneys.

  • Ifosfamide and cyclophosphamide can damage the bladder, which may lead to blood in the urine. Your doctor may give you a second medicine to help prevent this. Drinking plenty of fluids can also help.  

Possible long-term or late side effects

Some chemotherapy medicines can also have long-term side effects. Or there may be side effects that don’t show up until many years later. This is very important for bone cancer, which often occurs in children, teens, or young adults. Examples of possible long-term problems include:

  • Effects on fertility. Some chemo medicines can affect a person’s ability to have children later in life. Talk to your cancer care team about the risks of infertility with treatment, and ask if there are options for preserving fertility.

  • Second cancers. Some chemo medicines can increase the risk of second cancers, such as leukemias, later in life.

  • Long-term damage to other organs. Some chemo medicines can cause long-term damage to the heart or other organs.

Because of these risks, if you’ve been treated for bone cancer, it's very important to see your doctor regularly. You should also follow the proper follow-up guidelines to look for any problems.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your `healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.

Primary Bone Cancer: Treatment Choices

There are various treatment choices for primary bone cancer (cancer that starts in the bones). Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your doctor is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than 1, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.

Understanding the goals of treatment for primary bone cancer

For many primary bone cancers, the goal of treatment is to cure the cancer. If cure is not possible, treatment may be used to shrink the cancer or keep it under control for as long as possible. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of bone cancer treatment can include 1 or more of these things:

  • Remove the cancer in the bone

  • Remove or destroy tumors in other parts of the body

  • Kill or stop the growth or spread of bone cancer cells

  • Prevent or delay the cancer's return

  • Ease symptoms from the cancer, such as pain or pressure on organs

Types of treatment for primary bone cancer

Most people with primary bone cancer will have more than 1 treatment. The treatments you have depend on your age, general health, and the type and stage of bone cancer. Here is an overview of each type of treatment:

  • Surgery. This is the main treatment for most bone cancers.Often a biopsy is done first to take a tissue sample from the tumor and see if it is cancer. If it is cancer, then surgery is done to remove the tumor and some of the normal-looking tissue around it. This is done to make sure all of the cancer is removed. The surgeon will try not to harm your appearance. If the tumor is in an arm or leg (limb), the surgeon will try not to affect your limb function. Depending on where the tumor is and its size, this can be challenging. Sometimes, major reconstructive surgery is needed. Surgery to remove (amputate) an arm or leg is sometimes needed. But in some cases it may be the best option.

  • Chemotherapy or other medicines. These treatments use medicines to kill cancer cells.  Chemotherapy can be used to shrink tumors before they are removed by surgery. It might also be given after surgery, to lower the chance the cancer will come back. The medicines may also be used on tumors that can’t be surgically removed. Or the medicines can be used on tumors that have spread to distant places in your body. In some cases, medicines called targeted therapies can help treat certain types of bone tumors.

  • Radiation therapy. This treatment kills cancer cells using high-energy X-rays or other types of radiation. In most cases, radiation therapy is not the main treatment for bone cancer. But sometimes it is used on tumors that can’t be removed. It may also be used in the area where the tumor was removed, to kill any cancer that may have been left behind. Radiation can also ease symptoms of bone cancer.

  • Supportive care. Your healthcare provider may advise therapies that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment options may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.