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Rhabdomyosarcoma (Childhood) General Information What is rhabdomyosarcoma? Rhabdomyosarcoma is a disease in which cancer (malignant) cells begin growing in muscle tissue. Rhabdomyosarcoma is a type of a sarcoma, which means a cancer of the bone, soft tissues, or connective tissue (e.g., tendon or cartilage). Rhabdomyosarcoma begins in the soft tissues in a type of muscle called striated muscle. It can occur anywhere in the body. There are several types of sarcoma that are found in children and young adults. The cancer cells must be looked at under a microscope to tell which type of sarcoma it is. Rhabdomyosarcoma is the most common type of sarcoma found in the soft tissues of children. (Refer to Adult Soft Tissue Sarcoma Treatment; Childhood Soft Tissue Sarcoma Treatment; and Ewing's Family of Tumors Treatment for more information.) If your child has symptoms of a sarcoma, your child's doctor may order x-rays and other tests. Your child's doctor may also cut out a small piece of tissue and have it looked at under the microscope to see if there are any cancer cells. This is called a biopsy. Your child's chance of recovery (prognosis) and choice of treatment depend on where the cancer is located, how far it has spread, how the cells look under the microscope (histology), the type of therapy administered, and how much of the cancer can be removed by surgery. Stage Information Stages of childhood rhabdomyosarcoma: Once childhood rhabdomyosarcoma is found, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging. Your doctor needs to know how far the cancer has spread to plan treatment. There are several staging systems for childhood rhabdomyosarcoma. The treatment options in this summary are based on size, location, and how far and where the cancer has spread. Stage I Cancer is found in the eye, head and/or neck, or near the sex organs and bladder. Stage II Cancer is located in only 1 area (but in none of the areas in Stage 1), is smaller than 2 inches (5 cm) in size, and has not spread to the lymph nodes. Stage III Cancer is located in only 1 area (but in none of the areas in Stage 1), is greater than 2 inches (5 cm) in size, and may have spread to the lymph nodes found near the cancer. Stage IV Cancer has spread and is found in more than 1 place at the time of diagnosis. Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the area where it started or in another part of the body. Treatment Option Overview How childhood rhabdomyosarcoma is treated: There are treatments for all patients with childhood rhabdomyosarcoma. Three types of treatment are used, most often in combination with each other: -surgery -chemotherapy (using drugs to kill cancer cells) -radiation therapy (using high-energy x-rays or other high-energy rays to kill cancer cells) Surgery is a common treatment for rhabdomyosarcoma. Depending on where the cancer is, your child's doctor will take out as much of the cancer as possible, along with some of the normal tissue around it. If the cancer is in a place where it cannot be removed, surgery may be limited to taking out only a small piece of the cancer (biopsy). Surgery is usually followed by chemotherapy and radiation therapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by mouth in the form of a pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Clinical trials are testing radiation given in several small doses per day (hyperfractionated radiation therapy). Bone marrow transplantation is a treatment being studied for recurrent rhabdomyosarcoma. Sometimes rhabdomyosarcoma becomes resistant to treatment with standard doses of radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen and high-dose chemotherapy with or without radiation therapy is given to treat the cancer. The marrow that was taken out is then thawed and given back through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. Treatment By Stage Treatment for childhood rhabdomyosarcoma depends on where the cancer is, how far it has spread, and what the cancer cells look like under a microscope. Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. A large cooperative group clinical trial comparing new treatments with standard treatments is ongoing in most parts of the country for all stages of rhabdomyosarcoma. Previously Untreated (Stages 1-4) Childhood Rhabdomyosarcoma If the cancer can be removed, your child's treatment will probably be surgery followed by chemotherapy. Radiation therapy may also be given if there is cancer left following surgery. If the cancer cannot be removed with surgery, your child's treatment will probably be chemotherapy plus radiation therapy, followed, if needed, by surgery. Clinical trials are testing new chemotherapy drugs, new ways of giving radiation therapy, and autologous bone marrow transplantation following high-dose chemotherapy (for patients whose cancer has spread to other parts of the body). Recurrent Childhood Rhabdomyosarcoma Your child's treatment depends on how much of the cancer can be removed by surgery, where the cancer came back, and the treatment your child received before. Your child's treatment may be chemotherapy. Clinical trials are testing new chemotherapy agents followed by autologous bone marrow transplantation. The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals. The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation. The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. 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