Unless the cancer has clearly spread to distant parts of the body, surgery is usually the first step in treating rhabdomyosarcoma. Complete resection (removal) of the main tumor, along with a margin of normal tissue, is the goal whenever possible. If there are cancer cells at the 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.

Complete removal of 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 it may not be done at all.

What to expect during surgery

The type and extent of surgery can vary a great deal depending on the location and size of the tumor.

The biopsy is generally the first surgery done for rhabdomyosarcoma. 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 child's age and health, and the expertise of the doctor. The main goal of surgery is to completely remove the cancer in an effort to avoid future surgery. But as mentioned before, this is not always an option.

To help prepare your child for surgery, several issues must be addressed. Someone from the surgical team will talk with your family and examine your child to make sure he or she is physically ready for surgery. Blood will be drawn for lab tests to make sure that healthy blood levels are present and to ensure matched blood will be available 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. The team will calculate the dose of anesthesia based on your child's body size.

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

An intravenous (IV) access line will be started in a vein (usually in the arm). If an IV line is already in place, this site may be used to give the anesthesia and a second IV line may be started after anesthesia is given to reduce discomfort. Your child will be given a hospital gown, be placed on a stretcher, and taken to the pre-operative holding area. Anesthesia may be started in this area or the operating room.

If the diagnosis was not confirmed (by a needle 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 look at and determine if it is cancerous or not. If the pathologist can determine that it is cancerous while your child is still on the operating table, the surgeon may remove the entire tumor and may also remove some of the nearby lymph nodes to check for spread of the cancer.

Other procedures may also be done at this time. A bone marrow aspiration and biopsy may be done, and a central venous access line (a thin catheter) may be inserted into one of the large vessels in the chest to deliver chemotherapy and other medicines later. If the surgeon suspects the disease has spread to another part of the body, a second incision to get a piece of the possible metastatic tumor may be done as well.

Once the procedure is finished, 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.

For more information on surgery as a treatment for cancer, see the separate American Cancer Society document, Surgery.

Last Medical Review: 09/08/2009
Last Revised: 09/08/2009