Surgery for rhabdomyosarcoma

Last medical review:

Most children with rhabdomyosarcoma (RMS) will have surgery either to do a biopsy or to remove a tumour. The type of surgery depends mainly on where the tumour started, the size of the tumour, how well the tumour responds to chemotherapy or radiation therapy (if it is given before surgery) and the child's overall health.

The goal of surgery is to completely remove the tumour, but this isn't always possible. Sometimes RMS develops in an area of the body where it is hard to do surgery, such as close to vital organs, blood vessels or nerves. Sometimes surgery can't be done because it will affect how the child looks (their appearance) or how well that part of the body will work after surgery. In these cases, surgery may only be used to collect a biopsy sample rather than remove the tumour, and other treatments may be used instead.

Before surgery, chemotherapy, radiation therapy or both may be given to try to shrink the tumour to make it easier to remove. One or both of these treatments may also be used after surgery if the tumour was not able to be completely removed. RMS responds very well to chemotherapy and radiation therapy.

The following types of surgery may be used to treat RMS. Your child may also have other treatments before or after surgery.

Wide local excision

Wide local excision is the most common surgery to treat RMS. The surgeon removes the tumour and some normal tissue around it. The amount of healthy tissue removed depends on the location and stage of the RMS. The surgeon will try to remove all of the tissue from or near the biopsy area along with the tumour.

For RMS around the testicles or in the arm or leg, surgeons often take a biopsy sample from nearby lymph nodes or remove lymph nodes to find out if the cancer has spread to them.

A second surgery is sometimes needed to make sure all of the cancer was removed. Chemotherapy is usually given after the first surgery to help destroy or control the growth of any cancer cells left behind before the second surgery is done.

Reconstructive surgery

After the tumour is removed, reconstructive surgery may be needed to repair damage to the body or to improve the child's appearance.

A skin graft is a piece of healthy skin taken from one part of the body and placed over the surgical wound. Graft surgery is usually done at the same time as the surgery to remove the cancer.

Side effects

Side effects can happen with any type of treatment for RMS, but every child's experience is different. Some children have many side effects. Other children have only a few side effects.

If your child develops side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type and area of surgery, how much tissue was removed and the child's overall health.

Surgery for RMS may cause these side effects:

Tell the healthcare team if your child has these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Questions to ask about surgery

Find out more about surgery and side effects of surgery. To make the decisions that are right for your child, ask the healthcare team questions about surgery.

Expert review and references

  • Paul Nathan, MD, MSc, FRCPC
  • Normand Laperriere, MD, FRCPC
  • PDQ® Pediatric Treatment Editorial Board . Childhood Rhabdomyosarcoma Treatment (PDQ®) – Patient Version . Bethesda, MD : National Cancer Institute ; 2019 :
  • American Cancer Society. Treating Rhabdomyosarcoma. 2018:
  • Rhabdomyosarcoma. Provincial Health Services Authority. Musculoskeletal and Sarcoma. Vancouver, BC: Friday, March 20, 2020.
  • American Society of Clinical Oncology (ASCO). Rhabdomyosarcoma - Childhood: Types of Treatment. 2018:
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma (Version 6.2019). 2020:
  • PDQ® Pediatric Treatment Editorial Board . Childhood Rhabdomyosarcoma Treatment (PDQ®) – Health Professional Version . Bethesda, MD : National Cancer Institute ; 2020 :
  • Singer S, Tap WD, Kirsch DG, Crago AM. Soft tissue sarcoma. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 88:1400–1450.
  • Cripe TP . Medscape Reference: Pediatric Rhabdomyosarcoma. WebMD LLC; 2018:
  • Princess Margaret Cancer Centre . Princess Margaret Cancer Centre Clinical Practice Guidelines - Sarcoma, Soft Tissue Sarcoma . 2019 :
  • Wexler LH, Skapek SX, Helman LJ. Rhabdomyosarcoma. Pizzo PA, Poplack DG, eds.. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016: 31:798–827.