21st Century Pediatric Cancer Sourcebook: Childhood Rhabdomyosarcoma (Embryonal, Alveolar, Anaplastic) - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - March 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
Questions? Suggestions? Comments? Concerns? Please contact the publisher directly at
Remember, the book retailer can't answer your questions, but we can!
* * * * * * * * * * *
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each person you share it with. If you're reading this book and did not purchase it, or it was not purchased for your use only, then you should return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
* * * * * * * * * * * *
IMPORTANT NOTE: Information in this e-book is not a substitute for professional medical advice. If you have or suspect that you have any illness, you must consult with a physician or professional healthcare provider! Call 911 and get to the nearest emergency room if you have serious or worsening symptoms.
This material represents a snapshot in time, with authoritative information formatted for ebook reading that was up-to-date at the moment of publication. For the latest cancer updates, please be sure to visit the NCI website:
From our Guide to Leading Medical Websites, here are three valuable sites with authoritative cancer information:
OncoLink * http://www.oncolink.upenn.edu/
eMedicine.com * http://www.emedicine.com/
American Cancer Society (ACS) * http://www.cancer.org/
* * * * * * * * * * * *
This is a privately authored news service and educational publication of Progressive Management. Our publications synthesize official government information with original material - they are not produced by the federal government. They are designed to provide a convenient user-friendly reference work to uniformly present authoritative knowledge that can be rapidly read, reviewed or searched. Vast archives of important data that might otherwise remain inaccessible are available for instant review no matter where you are. This e-book format makes a great reference work and educational tool. There is no other reference book that is as convenient, comprehensive, thoroughly researched, and portable - everything you need to know, from renowned experts you trust. For over a quarter of a century, our news, educational, technical, scientific, and medical publications have made unique and valuable references accessible to all people. Our e-books put knowledge at your fingertips, and an expert in your pocket!
PART ONE
Chapter 1A: Childhood Rhabdomyosarcoma
PART TWO
Chapter 1B Late Effects of Treatment for Childhood Cancer - Patient Version
Chapter 2B: Pediatric Supportive Care
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: When Someone You Love Is Being Treated For Cancer
Chapter 15B: Living Beyond Cancer: Finding a New Balance
Chapter 16B: Caring for the Caregiver
Chapter 17B: Young People With Cancer, A Handbook For Parents
Chapter 18B: When Cancer Returns
Chapter 19B: When Someone You Love Has Advanced Cancer / Support for Caregivers
Chapter 20B: Chemotherapy and You
Chapter 21B: Managing Chemotherapy Side Effects - Anemia
Chapter 22B: Managing Chemotherapy Side Effects - Appetite Changes
Chapter 23B: Managing Chemotherapy Side Effects - Bleeding Problems
Chapter 24B: Managing Chemotherapy Side Effects - Constipation
Chapter 25B: Managing Chemotherapy Side Effects - Memory Changes
Chapter 26B: Managing Chemotherapy Side Effects - Mouth and Throat Changes
Chapter 27B: Managing Chemotherapy Side Effects - Nerve Changes
Chapter 28B: Managing Chemotherapy Side Effects - Pain
Chapter 29B: Managing Chemotherapy Side Effects - Skin and Nail Changes
Chapter 30B: Managing Chemotherapy Side Effects - Swelling (Fluid retention)
Chapter 31B: Targeted Cancer Therapies
Chapter 33B : Follow-up Care After Cancer Treatment
Chapter 34B: Radiation Therapy and You
Chapter 36B: Understanding Radiation Therapy, What To Know About External Beam Radiation Therapy
Chapter 37B: Radiation Therapy for Cancer
Chapter 38B: Managing Radiation Therapy Side Effects - What To Do When Your Mouth or Throat Hurts
Chapter 39B: What To Do About Hair Loss (Alopecia)
Chapter 42B: Managing Radiation Therapy Side Effects - Changes When You Urinate
Chapter 43B: Managing Radiation Therapy Side Effects What To Do About Mild Skin Changes
Chapter 45B: General Cancer Information And Resources
Chapter 46B: Cancer And The Environment - What You Need to Know, What You Can Do
Chapter 48B: FDA Warning: Beware of Online Cancer Fraud
Chapter 49B: FDA Office of Oncology Drug Products
Chapter 50B: Understanding the HIPAA Privacy Rule
* * * * * * * * * * * *
Chapter 1A: Childhood Rhabdomyosarcoma
Last Modified: 11/19/2010
Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue. Certain genetic conditions increase the risk of childhood rhabdomyosarcoma. A possible sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger. Tests that examine the area of the body with symptoms are used to detect (find) and diagnose childhood rhabdomyosarcoma. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue.
Rhabdomyosarcoma is a type of sarcoma. Sarcoma is cancer of soft tissue (such as muscle), connective tissue (such as tendon or cartilage), and bone. Rhabdomyosarcoma usually begins in muscles that are attached to bones and that help the body move. Rhabdomyosarcoma is the most common type of sarcoma found in the soft tissues of children. It can occur in many places in the body.
There are three main types of rhabdomyosarcoma:
Embryonal: This type occurs most often in the head and neck area or in the genital or urinary organs. It is the most common type.
Alveolar: This type occurs most often in the arms or legs, chest, abdomen, or genital or anal areas. It usually occurs during the teen years.
Anaplastic: This type rarely occurs in children.
Certain genetic conditions increase the risk of childhood rhabdomyosarcoma.
Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Parents who think their child may be at risk should discuss this with the child's doctor. Risk factors for rhabdomyosarcoma include having the following inherited diseases:
Li-Fraumeni syndrome.
Neurofibromatosis type 1 (NF1).
Beckwith-Wiedemann syndrome.
Costello syndrome.
Noonan syndrome.
High birth weight and larger than expected size at birth are linked with an increased risk of embryonal rhabdomyosarcoma.
In most cases, the cause of rhabdomyosarcoma is not known.
A possible sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger.
Lumps and other symptoms may be caused by childhood rhabdomyosarcoma. The symptoms that occur depend on where the cancer forms. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
A lump or swelling that keeps getting bigger or does not go away. It may be painful.
Bulging of the eye.
Headache.
Trouble urinating or having bowel movements.
Blood in the urine.
Bleeding in the nose, throat, vagina, or rectum.
Tests that examine the area of the body with symptoms are used to detect (find) and diagnose childhood rhabdomyosarcoma.
The following tests and procedures may be used:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
X-ray: An x-ray of the organs and bones inside the body. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen or pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
Lumbar puncture: A procedure used to collect cerebrospinal fluid (CSF) from the spinal column to check for cancer cells. This is done by placing a needle between two bones in the spine and into the spinal column to remove a sample of CSF. This procedure is also called an LP or spinal tap.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is done after imaging tests are done. If rhabdomyosarcoma is found, the pathologist will determine the type. Because treatment depends on the type of rhabdomyosarcoma, patients should ask to have biopsy samples checked by a pathologist who has experience in diagnosing rhabdomyosarcoma.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
Where in the body the tumor started.
The size of the tumor at the time of diagnosis.
Whether the tumor has been completely removed by surgery.
Whether the tumor has spread to nearby lymph nodes or distant parts of the body.
The type of rhabdomyosarcoma.
The patient's age and general health.
Whether the tumor has just been diagnosed or has recurred (come back).
For patients with recurrent cancer, prognosis and treatment depend on the following:
Where in the body the tumor recurred (came back).
How much time passed between the end of cancer treatment and when the cancer recurred.
Stages of Childhood Rhabdomyosarcoma
Key Points for This Section
After childhood rhabdomyosarcoma has been diagnosed, treatment is based on the stage of the cancer and whether cancer remains after surgery to remove the tumor.
There are three ways that cancer spreads in the body.
Staging of childhood rhabdomyosarcoma is done in three related steps.
The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body:
Stage 1
Stage 2
Stage 3
Stage 4
The grouping system is based on whether the cancer has spread and how much cancer remains after surgery to remove the tumor:
Group I
Group II
Group III
Group IV
The risk group is based on the staging system and the grouping system and is used to plan treatment.
Low-risk childhood rhabdomyosarcoma
Intermediate-risk childhood rhabdomyosarcoma
High-risk childhood rhabdomyosarcoma
After childhood rhabdomyosarcoma has been diagnosed, treatment is based on the stage of the cancer and whether cancer remains after surgery to remove the tumor.
The process used to find out if cancer has spread within the muscle or to other parts of the body is called staging. It is important to know the stage in order to plan treatment. The doctor will use results of the diagnostic tests 4 to help determine the stage of the disease.
Treatment for childhood rhabdomyosarcoma is based on the stage and the amount of cancer that remains after surgery to remove the tumor. The pathologist will use a microscope to check the tissues, including lymph nodes, removed during surgery, and the edges of the areas where the cancer was removed. This is done to see if all the cancer cells were taken out during the surgery.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Staging of childhood rhabdomyosarcoma is done in three related steps.
Childhood rhabdomyosarcoma is staged by using three different ways to describe the cancer:
A staging system.
A grouping system.
A risk group.
The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body:
Stage 1
In stage 1, cancer is any size, has not spread to lymph nodes, and is found in only one of the following "favorable" sites:
Eye or area around the eye.
Head and neck (but not in the tissue next to the brain and spinal cord).
Gallbladder and bile ducts.
In the testes or vagina (but not in the kidney, bladder, or prostate).
Rhabdomyosarcoma that occurs in a "favorable" site has a better prognosis. If the site where cancer occurs is not one of the favorable sites listed above, it is said to be an "unfavorable" site.
Stage 2
In stage 2, cancer is found in any one area not included in stage 1. The tumor is 5 centimeters or smaller and has not spread to lymph nodes.
Stage 3
In stage 3, cancer is found in any one area not included in stage 1 and one of the following is true:
The tumor is 5 centimeters or smaller and cancer has spread to nearby lymph nodes.
The tumor is larger than 5 centimeters and cancer may have spread to nearby lymph nodes.
Stage 4
In stage 4, the tumor may be any size and cancer may have spread to nearby lymph nodes. Cancer has also spread to distant parts of the body such as the lung, bone marrow, or bone.
The grouping system is based on whether the cancer has spread and how much cancer remains after surgery to remove the tumor:
Group I
Cancer was found only in the place where it started and it was completely removed by surgery. Tissue was taken from the edges of where the tumor was removed. The tissue was checked under a microscope by a pathologist and no cancer cells were seen.
Group II
Group II is divided into groups IIA, IIB, and IIC.
IIA: Cancer was removed by surgery but cancer cells were seen when the tissue, taken from the edges of where the tumor was removed, was viewed under a microscope by a pathologist.
IIB: Cancer had spread to nearby lymph nodes and the cancer and lymph nodes were removed by surgery.
IIC: Cancer had spread to nearby lymph nodes and the cancer and lymph nodes were removed by surgery. Tissue was taken from the edges of where the tumor was removed. The tissue was checked under a microscope by a pathologist and no cancer cells were seen.
Group III
Cancer was partly removed by surgery and there are cancer cells (a lump or mass) remaining that can be seen by x-ray or other imaging test. Cancer has not spread to distant parts of the body.
Group IV
Cancer had spread to distant parts of the body at the time of diagnosis.
The risk group is based on the staging system and the grouping system and is used to plan treatment.
The risk group describes the chance that rhabdomyosarcoma will recur (come back). The following risk groups are used:
Low-risk childhood rhabdomyosarcoma
Low-risk childhood rhabdomyosarcoma is one of the following:
An embryonal tumor of any size that is found in a "favorable" site. There may be tumor remaining after surgery that can be seen without a microscope. The cancer may have spread to nearby lymph nodes. The following areas are "favorable" sites:
Eye or area around the eye.
Head or neck (but not in the tissue next to the brain and spinal cord).
Gallbladder and bile ducts.
In the testes or vagina (but not in the kidney, bladder, or prostate).
An embryonal tumor of any size that is not found in one of the "favorable" sites listed above. There may be tumor remaining after surgery that can be seen only with a microscope. The cancer may have spread to nearby lymph nodes.
Intermediate-risk childhood rhabdomyosarcoma
Intermediate-risk childhood rhabdomyosarcoma is one of the following:
An embryonal tumor of any size that is not found in one of the "favorable" sites listed above. There is tumor remaining after surgery, that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes.
An alveolar tumor of any size in a "favorable" or "unfavorable" site. There may be tumor remaining after surgery that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes.
High-risk childhood rhabdomyosarcoma
High-risk childhood rhabdomyosarcoma may be the embryonal type or the alveolar type. It may have spread to nearby lymph nodes and has spread to one or more distant parts of the body.
Recurrent Childhood Rhabdomyosarcoma
Recurrent childhood rhabdomyosarcoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with childhood rhabdomyosarcoma.
Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
Some cancer treatments cause side effects months or years after treatment has ended.
Three types of standard treatment are used:
Surgery
Radiation therapy
Chemotherapy
New types of treatment are being tested in clinical trials.
High-dose chemotherapy with stem cell transplant
Immunotherapy
Targeted therapy
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for patients with childhood rhabdomyosarcoma.
Different types of treatments are available for children with rhabdomyosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
Because rhabdomyosarcoma can form in many different parts of the body, many different kinds of treatments are used. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with rhabdomyosarcoma and who specialize in certain areas of medicine. These may include the following specialists:
Pediatric surgeon.
Radiation oncologist.
Pediatric hematologist.
Pediatric nurse specialist.
Geneticist or cancer genetics risk counselor.
Social worker.
Rehabilitation specialist.
Psychologist.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment for rhabdomyosarcoma may include:
Physical problems.
Changes in mood, feelings, thinking, learning, or memory.
Second cancers (new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child.
Three types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is used to treat childhood rhabdomyosarcoma. A type of surgery called wide local excision is often done. A wide local excision is the removal of tumor and some of the normal tissue around it, including the lymph nodes. When an extra amount of normal tissue is removed from around the tumor, it is called an en bloc removal of a cuff of normal tissue. A second surgery may be needed to remove all the cancer. Whether surgery is done and the type of surgery done depends on the following:
Where in the body the tumor started.
The effect the surgery will have on the way the child will look.
The effect the surgery will have on the child's important body functions.
How the tumor responded to chemotherapy or radiation therapy that may have been given first.
For most children with rhabdomyosarcoma, complete removal of the tumor by surgery is not possible.
Rhabdomyosarcoma can form in many different places in the body and the surgery will be different for each site. Surgery to treat rhabdomyosarcoma of the eye or genital areas is usually a biopsy. Chemotherapy, and sometimes radiation therapy, may be given before surgery to shrink large tumors.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients will be given chemotherapy, with or without radiation therapy, after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. The type and amount of radiation therapy and when it is given depend on where in the body the tumor started, how much tumor remained after surgery, and the age of the child.
Types of external radiation therapy include the following:
Conformal radiation uses a computer to create a 3-dimensional picture of the tumor. The radiation beams are shaped to fit the tumor.
Intensity-modulated radiation therapy (IMRT) uses images created by a computer that show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles.
Fractionated stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to a tumor, causing less damage to nearby healthy tissue. The total dose of radiation is divided into several small doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy. It may be used for rhabdomyosarcomas of the head and neck.
Proton-beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Immunotherapy
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biologic therapy or biotherapy.
Targeted therapy
Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of childhood rhabdomyosarcoma. Monoclonal antibody therapy uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options for Childhood Rhabdomyosarcoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Previously Untreated Childhood Rhabdomyosarcoma
Surgery options
Childhood rhabdomyosarcoma may be treated with chemotherapy and/or radiation therapy before or after surgery. Treatment with surgery may include the following:
Rhabdomyosarcoma of the head and neck
For tumors of the head and neck that are close to the skin and not in or near the eye: Treatment may include surgery (wide local excision). Some lymph nodes may be removed from the same side of the neck as the tumor. Surgery will be followed by chemotherapy with or without radiation therapy.
For tumors of the head and neck that are in or near the eye: A biopsy of the tumor is done, followed by chemotherapy and radiation therapy. If the tumor remains or comes back after treatment with chemotherapy and radiation therapy, surgery to remove the eye and some tissues around the eye may be needed.
For tumors of the head and neck that cannot be removed by surgery: Chemotherapy and radiation therapy are given.
Rhabdomyosarcoma of the arms or legs
For tumors of the arms or legs: Surgery (wide local excision and en bloc removal of a cuff of normal tissue) may be done. For tumors in the arms, lymph nodes near the tumor and in the armpit area are removed. For tumors in the legs, lymph nodes near the tumor and in the groin area are removed. A second surgery may be done to remove any remaining tumor cells.
Rhabdomyosarcoma of the chest or abdomen
For tumors in the chest wall or abdominal wall: Surgery (wide local excision) may be done. A second surgery may be done to remove any remaining tumor cells.
For tumors of the chest or abdomen, including the retroperitoneum: Chemotherapy, and sometimes radiation therapy, is given to shrink the tumor first, followed by surgery (wide local excision). The surgery is done to remove as much of the remaining tumor as is safely possible.
For tumors of the gallbladder or bile ducts: Surgery is done to remove as much of the tumor as is safely possible, followed by chemotherapy.
For tumors of the muscles or tissues around the anus or between the vulva and the anus or the scrotum and the anus: Surgery is done to remove as much of the tumor as is safely possible and some nearby lymph nodes, followed by chemotherapy.
Rhabdomyosarcoma of the area near the testicles
Rhabdomyosarcoma of the testicular area is usually treated with surgery to remove the testicle and spermatic cord. Sometimes a biopsy of the lymph nodes in the back of the abdomen is done, especially if the lymph nodes are enlarged or the child is older than 9 years. CT scans may be done every 3 months after surgery to see if the cancer is growing in nearby lymph nodes.
Rhabdomyosarcoma of the bladder and prostate
For tumors that are only at the top of the bladder: Surgery (wide local excision) is done.
For tumors of the prostate or other parts of the bladder: Chemotherapy and radiation therapy are given first to shrink the tumor. A biopsy is done and if cancer cells remain, surgery to remove the tumor is done. Surgery may include removal of the prostate, part of the bladder, or pelvic exenteration without removal of the rectum. (This may include removal of the lower colon and bladder. In girls, the cervix, vagina, ovaries, and nearby lymph nodes may be removed).
Rhabdomyosarcoma of the vagina, vulva, or uterus
Rhabdomyosarcoma of the vagina and vulva is usually treated with chemotherapy and radiation therapy.
Rhabdomyosarcoma of the uterus is usually treated with chemotherapy and radiation therapy. Sometimes surgery may be needed to remove any remaining cancer cells.
Rhabdomyosarcoma in unusual areas
For tumors of the brain: Surgery to remove the tumor followed by radiation therapy and chemotherapy.
For tumors of the larynx (voice box): A biopsy of the tumor is followed by chemotherapy and radiation therapy. Surgery is usually not done, so that the voice is not harmed.
For tumors of the diaphragm: A biopsy of the tumor is followed by chemotherapy to shrink the tumor. Surgery may be done later to remove any remaining cancer cells.
For tumors of the kidney: Surgery is done to remove as much of the tumor as is safely possible.
For tumors of the ovary: Combination chemotherapy may be followed by surgery to remove the remaining tumor.
Metastatic rhabdomyosarcoma
Metastatic rhabdomyosarcoma is not usually treated with surgery other than a biopsy for diagnosis. However, if the cancer has spread to the lungs, chemotherapy and radiation therapy are given to shrink the tumor, followed by surgery to remove any remaining cancer cells in the lung.
Chemotherapy options
Every child treated for rhabdomyosarcoma should receive chemotherapy. The dose of the chemotherapy and the number of treatments given depend on the child's risk group, as follows:
Low-risk patients
Combination chemotherapy, with or without radiation therapy.
A clinical trial of different doses and schedules of combination chemotherapy, with or without radiation therapy.
Intermediate-risk patients
Combination chemotherapy.
A clinical trial of combination chemotherapy with radiation therapy.
High-risk patients
Combination chemotherapy.
A clinical trial of new combinations of anticancer drugs, with and without targeted therapy (monoclonal antibody).
A clinical trial of immunotherapy.
Radiation therapy options
Radiation therapy may be used if childhood rhabdomyosarcoma tumor cells remain after surgery, after chemotherapy, or if the tumor is of the alveolar type.
Treatment may include certain kinds of radiation therapy that cause less damage to normal tissue and lessen late effects of treatment. These include:
Conformal radiation therapy.
Intensity-modulated radiation therapy.
Fractionated stereotactic radiation therapy.
Proton-beam therapy.
A clinical trial of brachytherapy (internal radiation therapy) for cancer in areas such as the vagina, vulva, bladder, prostate, head, or neck.
A clinical trial of second-look surgery after chemotherapy is given to decrease the amount of radiation therapy that will be needed.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with previously untreated childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent Childhood Rhabdomyosarcoma
Treatment options for recurrent childhood rhabdomyosarcoma are based on many factors, including where in the body the cancer has come back, what type of treatment the patient had before, and the needs of the individual child. Treatment may include one or more of the following:
Chemotherapy with one or more anticancer agents.
Surgery.
Radiation therapy.
A clinical trial of different schedules and combinations of chemotherapy.
A clinical trial of new chemotherapy regimens.
A clinical trial of new anticancer drugs.
A clinical trial of targeted therapy.
A clinical trial of high-dose chemotherapy followed by stem cell transplant using the patient's own stem cells.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Glossary Terms
abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
alveolar rhabdomyosarcoma (al-VEE-oh-lur RAB-doh-MY-oh-sar-KOH-muh)
A soft tissue tumor that is most common in older children and teenagers. It begins in embryonic muscle cells (cells that develop into muscles in the body). It can occur at many places in the body, but usually occurs in the trunk, arms, or legs. Also called ARMS.
anal (AY-nul)
Having to do with the anus. The anus is the opening of the rectum (last part of the large intestine) to the outside of the body.
anaplastic (A-nuh-PLAS-tik)
A term used to describe cancer cells that divide rapidly and have little or no resemblance to normal cells.
antibody (AN-tee-BAH-dee)
A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.
antigen (AN-tih-jen)
Any substance that causes the body to make a specific immune response.
Beckwith-Wiedemann syndrome (... VEE-duh-mahn SIN-drome)
A rare, overgrowth disorder in which babies are large at birth and may develop low blood sugar. Other common symptoms are a large tongue, large internal organs, and defects of the abdominal wall near the navel. Beckwith-Wiedemann syndrome increases the risk of developing certain cancers, especially Wilms tumor.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.