Surgery for Rhabdomyosarcoma

Surgery is an important part of diagnosing and treating rhabdomyosarcoma (RMS). Most people with RMS will get two types of surgery:

• A biopsy to diagnose the cancer
• Surgery to remove the tumor(s)

Biopsy surgery

If RMS is suspected, a biopsy is needed to know for sure. The type of biopsy needed will depend on a few things:

• Location and size of the tumor
• Person’s age and health
• Expertise of the doctor

It is important that the biopsy is done by a doctor who is experienced in diagnosing and treating RMS. See Tests for Rhabdomyosarcoma to learn more about biopsies.

Surgery to remove the tumor

Unless the cancer has spread to other parts of the body, surgery is usually the first step in treating RMS. Complete resection (removal) of the tumor, along with a rim of normal tissue, is the goal when it is possible. If there are cancer cells seen at the edges (margins) of the tumor removed during surgery, this means some cancer cells may have been left behind. In these cases, the surgeon may operate again to try to remove the rest of the cancer.

Surgery may be done even if it is clear that all of the cancer cannot be removed, because it may still help other treatments (chemotherapy and radiation) to work better.

During surgery, nearby lymph nodes might be biopsied to determine if the cancer has spread to these areas, especially if:

• Lymph nodes are bigger than normal on imaging tests
• The tumor is near the testicles in a boy who is 10 years of age or older
• The tumor is on an arm or leg
• The tumor is in the perineal or anal area

A tumor’s location may determine what type of surgeon is needed to remove it. For example, removing tumors in the head and neck area may require surgical teams with ENT (ear, nose, and throat) surgeons, plastic surgeons, maxillofacial surgeons, and neurosurgeons.

If a tumor is large or in a spot where removing it completely would have an impact on the person’s appearance or cause other problems, then surgery may be delayed until after chemotherapy and possibly radiation therapy to try to shrink it. In some cases, surgery might not be done at all (and radiation will be used instead).

What to expect with surgery

Surgery for RMS can vary a great deal from person to person based on the location and size of the tumor. The surgical team will discuss the planned surgery with you, but make sure you ask questions if there are any parts of it that are not clear to you.

If a biopsy was not done before the main operation, the surgeon may first take only a small sample of the tumor. The sample is checked right away to see if it is cancer. If it can be determined that it is cancer while the surgery is still going on, the surgeon may then try to remove the entire tumor. Nearby lymph nodes may also be removed 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 and checked as well.

During surgery, a bone marrow aspiration and biopsy may be done to see if the cancer has spread to the bones. Many times a central venous catheter (central line) may be put into one of the large veins in the chest during surgery as well. A central line is a thin tube placed in the vein for giving intravenous (IV) chemo and drawing blood, similar to an IV in the hand or arm, but central lines can stay in the body for months. Central lines can make getting chemo and blood draws easier and less painful. If you or your child gets a central line during treatment, the health care team will teach you how to care for it to reduce the risk of problems such as infections.

Possible risks and side effects

Surgery for RMS can be long and complex and depends on the location and size of the tumor, as well as the person’s health before surgery. Speak to your surgeon about the specific surgical risks for the planned surgery.

Complications of surgery can include:

• Problems with anesthesia
• Excess bleeding
• Infections
• Damage to blood vessels, organs, or nerves
• Changes in appearance or organ function that may require further surgery or therapy
• Scarring
• Pain

Surgery for relapsed or recurrent RMS

If RMS comes back in the same spot as the original tumor, surgery may be used again when possible. In rare cases, surgery may also be used for cancers that recur in other parts of the body, such as if there is a small recurrence in a lung.