Bone cancer chemotherapy is used either before or after the surgery to treat bone cancer. Our body has 206 bones. Bones shape up our body and help in the movement along with the muscles. Bone cancer is caused to the cells that make a bone.

Some common types of bone cancers are osteosarcoma, Ewing’s sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma and chordoma.

Chemotherapy for Bone Cancer

Chemotherapy for secondary bone cancer is normally given intravenously or in the form of tablets. It is commonly used for osteosarcoma, Ewing’s cancer and metastasized breast cancer to the bone.

Although chemotherapy is an important part of the treatment, surgery is the primary treatment for bone cancer. This surgery primarily involves removing the affected limb i.e. amputation, part of the limb or removing the bone and surrounding tissue without affecting the limb.

Chemotherapy is used as an adjuvant or pre-operative adjuvant therapy. Since bone cancers are normally secondary cancers formed due to metastasis, the drugs used for chemotherapy depend on the primary tumor where it originated. For example, if breast cancer spreads to the bones then drugs used for breast cancer would be used. Chemotherapy is done before the surgery to shrink the tumor to a smaller size. This is sometimes combined with radiation. This treatment can spare the limb amputation if the tumor reduces. Chemotherapy for bone cancer is also used after the surgery especially if the cancer has spread out of the bone to other areas.

Some common drugs used to treat bone cancer are methotrexate with calcium leucovorin, doxorubicin, cisplatin, ifosfamide, vincristine and etoposide. Usually, these drugs are given in combinations of 2-3 drugs in one cycle.

Causes of Bone Pain

• Bone pain is a side effect of certain biological response modifiers like filgrastim, pegfilgrastim and sargramostim.
• Bone pain occurs due to the cancer itself
• It occurs due to the damage caused to the nerves, soft tissues and bones.
• If metastatic breast cancer or prostrate cancer spreads to the bones, there would be increased bone pain
• Some hormonal medications like leuprolide, goserelin, tamoxifen, anastrozole cause bone pain initially.

Side Effects of Chemotherapy for Bone Cancer

Unfortunately, these drugs damage the healthy fast dividing cells along with the cancer cells due to which certain side effects are caused.

Most of these side effects are temporary i.e. they subside once the treatment is over. Some of them are controlled by medication and certain alternative therapies. Of course, these medications and therapies should be implemented only after consulting your doctor. Some common side effects are nausea and vomiting, loss of appetite, hair loss and mouth sores.

Chemotherapy drugs destroy the blood cells and the cells of bone marrow and hence lowered blood count is one of the major side effects that needs to be controlled at the earliest. Low blood cell counts lead to-

• Increased chance of infection due to reduction in white cells
• Bleeding or bruising due to shortage of platelets
• Fatigue, shortness of breath and anemia due reduced red blood cell count

Certain drugs cause specific side effects. Ifosfamide and cyclophosphamide cause bloody urine as they damage the cells lining the bladder that is called the hemorrhagic cystitis. There is a drug called mesna recommended before the chemotherapy to avoid this.

Cisplatin causes nerve damage or peripheral neuropathy i.e. numbness and tingling in hands and feet. It also causes kidney damage. Hence, it is essential to keep yourself hydrated by taking in plenty of fluids. Cisplatin causes hearing defects especially when hearing high-pitched sounds.

Doxorubicin gradually causes heart damage. Hence, it is essential to do a heart function test before giving this drug.

Bone cancer chemotherapy is usually effective in case of secondary cancers. Certain tests to check the functioning of heart, kidneys and blood counts should be done prior to beginning each cycle of chemotherapy to avoid adverse effects to these organs.