Surgery for rhabdomyosarcoma
Most children with rhabdomyosarcoma will have surgery. Surgery may be done to:
- do a biopsy to diagnose rhabdomyosarcoma
- remove all or as much of the tumour as possible
The type of surgery used depends mainly on:
- the location of the tumour
- the size of the tumour
- where the cancer has spread
- how the tumour responds to chemotherapy or radiation therapy if it is given before surgery
- the child’s overall health
Doctors usually do a wide local excision to remove the tumour along with a margin of healthy tissue around it. The goal of surgery is to completely remove the tumour, but this isn’t always possible.
Rhabdomyosarcoma responds very well to chemotherapy and radiation therapy. One or both of these treatments may be given before surgery to try to shrink the tumour. Shrinking the tumour means that surgeons can remove less tissue during surgery to remove the tumour.
Sometimes rhabdomyosarcoma develops in an area of the body where it is difficult 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 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.
Surgery for rhabdomyosarcoma is often done by an orthopedic (bone and muscle) surgeon who specializes in treating children with this type of cancer. Some types of surgery may need to be done by specialized surgeons. Tumours in the head and neck may require ear, nose and throat (ENT) surgeons (also called otolaryngologists), plastic surgeons, maxillofacial (jaw and face) surgeons and neurosurgeons (brain surgeons).
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Wide local excision is the most common surgery used to treat rhabdomyosarcoma. 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 rhabdomyosarcoma. The surgeon will try to remove all the tissue from or near the biopsy site along with the tumour.
For rhabdomyosarcoma that occurs around the testicles or in an arm or leg, surgeons often take a biopsy sample from 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 with wide local excision. Chemotherapy is usually given after the first surgery to help control and shrink the tumour before the second surgery.
Depending on how much tissue they need to remove, doctors may use a graft to replace it. A graft is skin or tissue taken from another part of the body. Graft surgery is often done at the same time as the surgery to remove the cancer.
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Side effects can happen with any type of treatment for rhabdomyosarcoma, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.
Side effects can develop 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 location of the surgery, how much tissue was removed during surgery and the child’s overall health. Other treatments can also affect side effects from surgery. For example, tissue treated with radiation may not heal well after surgery.
Surgery for rhabdomyosarcoma may cause:
Tell the healthcare team if your child has these side effects or others you think might be from surgery. The sooner they are aware of any problems, the sooner they can suggest ways to help your child deal with them.
American Cancer Society. Rhabdomyosarcoma. 2014: http://www.cancer.org/cancer/rhabdomyosarcoma/.
Hendershot, E . Rhabdomyosarcoma. Tomlinson, D. & Kline, N. E. (Eds.). Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.9: pp.66-70.
National Cancer Institute. Childhood RhabdomyosarcomaTreatment (PDQ®) Health Professional Version. 2015: http://www.cancer.gov/cancertopics/pdq/treatment/childrhabdomyosarcoma/HealthProfessional/page1.
Wexler LH, Meyer WH, & Helman LJ . Rhabdomyosarcoma. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 31: pp. 923-953.
Zinger Kotsubo C . Rhabdomyosarcoma. Baggott C, Fochtman D, Foley GV, Patterson K (eds.). Nursing Care of Children and Adolescents with Cancer and Blood Disorders. 4th ed. APHON; 2011: 31:1054-1070.