Chemotherapy (often referred to as "chemo") is the use of drugs to treat cancer. Chemotherapy is systemic therapy. This means that the drug enters the bloodstream and circulates to reach and destroy the cancer cells throughout the body. Chemotherapy is often a part of treatment for Ewing sarcoma and osteosarcoma, but is seldom used for other bone cancers. Chemotherapy may be useful for bone cancer that has spread through the bloodstream to the lungs and/or other organs. The drugs mainly used to treat bone cancer include:

• doxorubicin (Adriamycin)
• cisplatin or carboplatin
• etoposide
• ifosfamide
• cyclophosphamide
• methotrexate

Usually, several drugs (2 or 3) are given together. For example, a very common combination is cisplatin and doxorubicin. Other combinations are ifosfamide and etoposide or ifosfamide and doxorubicin

Side effects of chemotherapy

Chemotherapy kills cancer cells, but it will also damage some normal cells. Careful attention is given to avoid or minimize side effects. The side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of time they are taken.

Temporary side effects can include nausea and vomiting, loss of appetite, hair loss, and mouth sores. It is important to tell your cancer care team about any side effects you have so that they can be prevented or controlled.

Because chemotherapy can damage the blood-producing cells of the bone marrow and lymph nodes, patients may have low blood cell counts. Low blood cell counts can result in:

• increased chance of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (from a shortage of platelets)
• fatigue or shortness of breath (from low red blood cell counts)

Some side effects are specific to particular drugs. It's important to note that many of the serious side effects are rare, but possible. Discuss these with you cancer care team if you have concerns before treatment.

Ifosfamide and cyclophosphamide can cause bloody urine by damaging the lining of the bladder. This is called hemorrhagic cystitis. This problem can be prevented by giving a drug called mesna along with the chemotherapy.

Cisplatin may cause nerve damage (called neuropathy) leading to problems with numbness, tingling, and even pain in the hands and feet. Kidney damage (called nephropathy) can also occur after treatment with cisplatin. Giving lots of fluid before and after the drug is infused can help prevent this side effect. Cisplatin can sometimes cause problems with hearing (known as ototoxicity). Most often patients with this problem notice problems hearing high pitched sounds.

Doxorubicin (Adriamycin) can cause heart damage over time. The risk of this goes up as the total amount of the drug that is given goes up. Before giving doxorubicin, your doctor may order a test of your heart function to make sure that it is safe to give you this drug.

The doctors and nurses will watch closely for side effects. There are treatments for most side effects, but preventing significant side effects is more important. Most, if not all, of these side effects will eventually stop after the treatment is over. Do not hesitate to ask any questions about side effects with the cancer care team.

While you are being treated, your doctor will order some lab tests to be sure your liver, kidney, and bone marrow (which produces the cells in the blood) are functioning well.

• The complete blood count (CBC) includes levels of white blood cells, red blood cells, and platelets.

• Chemistry panels measure certain blood chemicals that tell doctors how well the liver and the kidneys are working. Some drugs used in chemotherapy can damage the kidneys and liver.

If one of the drugs that is being given can damage hearing, the doctor may order a hearing test (called an audiogram) before starting chemotherapy.

Last Medical Review: 07/14/2009
Last Revised: 07/14/2009