Chemotherapy (chemo) uses strong 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.

Chemotherapy is an important part of the treatment for some types of bone cancers, such as osteosarcoma and Ewing sarcoma. It's not usually helpful for other types of bone cancer because they tend to be resistant to it. 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 personal choices

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

Before surgery. 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.

After surgery. Your healthcare provider might suggest chemotherapy aftersurgery. This is called adjuvant chemotherapy. This can often help lower the chance that the cancer will come back.

If surgery cannot be done. 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.

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

Chemotherapy medicines for bone cancer are usually given through a small, flexible tube (called and IV) that has been put into a vein. The healthcare provider might advise minor surgery before you get chemotherapy. This is done to put a thin, soft tube called a central venous catheter (CVC) into a large vein in your chest. This makes it easier to give the chemotherapy. 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 one cycle. You may have several cycles. Your healthcare provider will discuss your chemotherapy schedule with you.

These are some common medicines used to treat bone cancer:

• Cisplatin

• Cyclophosphamide

• Doxorubicin

• Etoposide

• Ifosfamide

• Methotrexate

• Vincristine

Often two or three of these medicines are combined.

Side effects of chemotherapy depend on the type and amount of medicines you’re taking. They vary from person to person. Ask your healthcare provider 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 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 healthcare provider 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 chemotherapy 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 chemotherapy medicines can increase the risk of second cancers, such as leukemias, later in life.

• Long-term damage to other organs. Some chemotherapy 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 healthcare provider regularly. You should also follow the proper follow-up guidelines to look for any problems.

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

Talk with your healthcare providers about what signs to watch out for and when you should call your healthcare team. 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 wwatch out forill 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.