Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. As the drugs are carried in the blood, they can reach cancer cells all over the body.

Chemotherapy may sometimes be given before surgery, to shrink the tumour and make it easier to remove. This is known as neo-adjuvant treatment.

Chemotherapy may also sometimes be used after surgery, to try to destroy any cancer cells that were too small to be removed, or which may have spread to other parts of the body. This is known as adjuvant treatment.

Certain types of soft tissue sarcomas are always treated with chemotherapy. For other types it is very rarely used. Your doctor can tell you whether chemotherapy will be used to treat your type of soft tissue sarcoma.

Chemotherapy drugs are usually given by injection into a vein (intravenously) but sometimes can be given as tablets. The most commonly used chemotherapy drugs for soft tissue sarcomas are doxorubicin and ifosfamide.

Chemotherapy is given as a session (or cycle) of treatment, which usually lasts a few days. This is followed by a rest period of a few weeks to allow your body to recover from any side effects of the treatment.

The number of cycles you have will depend on the type of sarcoma you have and how well it is responding to the drugs. If doxorubicin is given on its own you will be given it as an outpatient. You will usually be given any other types of chemotherapy as an inpatient, which means spending a few days in hospital.

Chemotherapy can cause unpleasant side effects, but it affects everyone differently and any side effects that do occur can often be well controlled with medicines.

Lowered resistance to infection

Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more likely to get an infection. This effect can begin about seven days after treatment has been given and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next course of chemotherapy is due.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before each cycle of chemotherapy, to make sure that your cells have recovered. If necessary, you may be given antibiotics to treat any infection. Occasionally it may be necessary to delay your treatment if your blood count is still low. We can send you information about how to avoid an infection if you have reduced immunity.

Bruising or bleeding

The chemotherapy can also reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells)

While having chemotherapy, you may become anaemic. This may make you feel tired and breathless.

Feeling sick

Some of the drugs used to treat soft tissue sarcomas may make people feel sick (nauseous) and vomit. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor can prescribe these for you. Let your doctor know if you still feel sick, as they can prescribe other types of anti-sickness drugs for you.

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly.

Taste changes

You may notice that your food tastes different. Your taste will usually go back to normal after the treatment finishes. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet – our section on eating well has some useful tips on coping with eating problems.

Hair loss

Unfortunately, hair loss is a common side effect of some chemotherapy drugs. You can ask your doctor whether the drugs you are taking are likely to make your hair fall out.

It may be possible to reduce the amount of hair that you lose by using scalp cooling. Cooling the scalp during chemotherapy means that fewer chemotherapy drugs reach the hair follicles, and so the hair is less likely to fall out. We can send you information about scalp cooling.

People who lose their hair often cover up by wearing wigs, hats or scarves. Your nurses can arrange for you to see a wig-fitter to help you choose a style and colour that suits you. If your hair falls out, it will grow back over a period of 3–6 months once your treatment has finished.

Tiredness

You may feel tired and have a general feeling of weakness. It is important to allow yourself plenty of time to rest.

Although they may be hard to bear at the time, these side effects will disappear over a few months once your treatment is over.

Fertility

Your ability to become pregnant or father a child may be affected by some of the chemotherapy drugs used to treat sarcomas. It is important to discuss fertility with your nurse or doctor before starting treatment as it may be possible for men to store sperm and women to store eggs or embryos for use in the future.

Some women may find that the chemotherapy treatment causes an early menopause, and they may have the signs of the menopause, such as hot flushes and sweats. In many cases, HRT (hormone replacement therapy) can be given to replace the hormones that are no longer being produced. Women with gynaecological sarcomas may not be able to have HRT because the cancer may be sensitive to hormones.

You may find it helpful to talk all this through with your doctor or one of the support organisations.

Contraception

It is not advisable to become pregnant or father a child while having any of the chemotherapy drugs used to treat sarcomas, as they may harm the developing foetus. It is important to use effective contraception during your treatment and for up to a year afterwards. You can discuss this with your doctor or specialist nurse.

Condoms should be used during sex within the first 48 hours after chemotherapy, to protect your partner from any of the drug that may be present in semen or vaginal fluid. Again, you can discuss this with your doctor.

It is important to remember that chemotherapy affects different people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.