What are the common side effects of bone cancer treatment?

Bone cancer treatment can cause a range of side effects that vary depending on the type of treatment, the patient's age, and their overall health. Common side effects include physical problems affecting the heart, lungs, hearing, fertility, and bones, as well as neurological issues and the potential for developing secondary cancers.

It is important to discuss potential side effects with your healthcare team before starting treatment, as they can provide guidance on how to manage them.

Chemotherapy Side Effects

Chemotherapy uses anti-cancer drugs to kill cancer cells. It is often used for patients with newly diagnosed Ewing sarcoma and osteosarcoma before surgery [1]. Chemotherapy can lead to side effects such as mouth sores, upset stomach, diarrhea, severe fatigue, and poor appetite [2]. It also increases the risk of infection, bleeding problems, and skin issues [2].

• Oral Care: Chemotherapy may cause dry mouth or sores, increasing the risk of infection. It is advised to clean teeth and gums two to three times daily with a soft toothbrush and use dental floss gently once a day. The mouth can be rinsed with a solution of salt and sodium bicarbonate four times daily, avoiding mouthwash that contains alcohol [2].
• Preventing Infection: Extreme caution should be taken to avoid infection for up to a year or more after chemotherapy. This includes regular hand washing, avoiding undercooked or spoiled foods, staying away from crowded places, and avoiding contact with pets or gardening [2].

Radiation Therapy Side Effects

Radiation therapy uses high-energy X-rays to kill cancer cells and may be used in combination with surgery or in specific cases after surgery [1]. Side effects of radiation therapy depend on the area being treated and the radiation dose. For example, side effects of radiation therapy in the head and neck area, as in some cases of chordoma in children, can include headaches, double vision, nasal congestion, difficulty speaking or swallowing, and neck or back pain [3]. It is important to discuss potential side effects specific to the treatment area with your doctor.

Surgery Side Effects

Surgery is the standard treatment for bone cancer, where the surgeon removes the entire tumor [1]. Although significant improvements in surgical techniques allow for limb preservation in most cases, most patients undergoing limb-sparing surgery require reconstructive surgery to restore limb function [1]. Side effects of surgery may include general complications of any surgical procedure, such as pain at the surgical site, risks of infection, and bleeding. In some cases, surgery may require amputation of the limb, which affects quality of life.

Long-term Side Effects

People who have been treated for bone cancer have an increased probability of developing late effects as they age. These late effects depend on the type of treatment and the patient's age at the time of treatment. This can include physical problems affecting the heart, lungs, hearing, fertility, and bones, as well as neurological issues and the potential for developing secondary cancers such as acute myeloid leukemia, myelodysplastic syndrome, or radiation-induced sarcoma [1].

When to Call the Doctor?

It is essential to contact the healthcare team if any of the following symptoms appear after chemotherapy or any other bone cancer treatment:

• Signs of infection such as fever, chills, or sweating [2].
• Diarrhea that does not resolve or is accompanied by blood [2].
• Severe nausea and vomiting [2].
• Inability to eat or drink [2].
• Severe weakness [2].
• Redness, swelling, or drainage from any site where an intravenous line was inserted [2].
• New rash or blisters [2].
• Jaundice (yellowing of the skin or whites of the eyes) [2].
• Abdominal pain [2].
• A very severe headache or one that does not go away [2].
• A cough that is getting worse [2].
• Difficulty breathing while resting or performing simple tasks [2].
• Burning during urination [2].

For more information on bone cancer, its types, symptoms, and diagnosis, you can visit the page Bone Cancer: Types, Symptoms, and Early Diagnosis (Arabic).

Medical references

• Primary Bone Cancer
• After chemotherapy - discharge
• Childhood Chordoma (PDQ®)–Patient Version