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Treating Rhabdomyosarcoma TOPICS

Surgery for rhabdomyosarcoma

Unless it is known that the cancer has spread to distant parts of the body, surgery is usually the first step in treating rhabdomyosarcoma (RMS). Complete resection (removal) of the main tumor, along with some surrounding normal tissue, is the goal whenever possible. If there are cancer cells at the edges (margins) of the removed specimen (meaning that some cancer cells may remain in the body at the tumor site), the surgeon may operate again to try to remove the remaining cancer.

In some cases, surgery may be done even if it is clear that all of the cancer can’t be removed because it may help other treatments (chemotherapy and radiation) to work better.

During surgery, nearby lymph nodes may be biopsied to determine if the cancer has spread to these areas, especially if the main tumor is near the testicles in older boys or is on an arm or leg.

Completely removing head and neck tumors may require special surgical teams with ENT (ear, nose, and throat) surgeons, plastic surgeons, maxillofacial surgeons, and neurosurgeons. If the tumor is large or is in a spot where removing it completely would severely affect the child’s appearance or cause other problems, then surgery may be delayed until after a few courses of chemotherapy and possibly radiation therapy to try to shrink it, or surgery may not be done at all.

What to expect with surgery

The type and extent of surgery can vary a great deal based on the location and size of the tumor. RMS can appear in many parts of the body, so it’s not possible to describe here all of the different types of operations that might be done. Your child’s surgical team will discuss the planned surgery with you, but make sure you ask questions if there are any parts of it that aren’t clear to you.

The biopsy is generally the first surgery done for RMS. How it is done, how long recovery takes, and how it affects later treatment depend on many factors. The type of biopsy used is based on imaging test results, location and size of the tumor, the patient’s age and health, and the expertise of the doctor. (For a description of biopsy types, see “How is rhabdomyosarcoma diagnosed?”)

Before any surgery, someone from the surgical team will talk with your family and examine your child to make sure he or she is physically ready for it. Blood will be drawn for lab tests to make sure the bone marrow and other organs are working well and to ensure matched units of blood will be ready in case your child needs a transfusion during surgery. A parent or guardian will need to sign consent forms, giving permission for the surgery, anesthesia, and possible blood transfusions.

You will be given instructions about what your child can eat and do before and after surgery. The medical team will need to know if your child has any allergies, especially to medicines.

Your child may not be allowed to eat or drink for several hours before the surgery. This is to avoid potential complications that might result from having food in the stomach while under anesthesia.

An intravenous (IV) access line will be started in a vein (usually in the arm). Your child will be given a hospital gown and will lie down on a special table, which is then taken to the pre-operative holding area. Anesthesia may be started in this area or the operating room.

If the diagnosis of RMS was not confirmed by a biopsy before the main operation, the surgeon may first take only a small sample of the tumor. The sample is given to a pathologist right away to see if it is cancer or not. If the pathologist can determine that it is cancer while your child is still on the operating table, the surgeon may try to remove the entire tumor and may also remove some of the nearby lymph nodes to check for spread of the cancer. If the surgeon suspects the disease has spread to another part of the body, a piece of the possible metastatic tumor may be removed as well.

A bone marrow aspiration and biopsy may also be done, and a central venous access line (a thin catheter) may be inserted into one of the large vessels in the chest to help make it easier to give chemotherapy and other medicines later.

Once the surgery is over, your child will be taken to the recovery area and closely monitored until fully awake. Your child will then be returned to his or her hospital room.

Possible risks and side effects

Possible complications of surgery depend on the location and extent of the operation and the child’s health beforehand. Serious complications, although rare, can include problems with anesthesia, excessive bleeding, wound infections, and pneumonia. Most children will have some pain after the operation, but this can usually be helped with medicines if needed.

The physical changes after surgery can range from little more than a scar to changes in appearance or in how some parts of the body function, which may require physical rehabilitation.

For more information on surgery as a treatment for cancer, see our document, Understanding Cancer Surgery: A Guide for Patients and Families.

Last Medical Review: 08/13/2013
Last Revised: 08/13/2013