Surgical Procedures: Surgery and Staging for Rhabdomyosarcoma

Rhabdomyosarcoma is cancer of the muscle tissue. It can happen in almost any part of the body. This cancer most often affects children under 10 years of age but can be seen in patients of any age. There are a few types of rhabdomyosarcoma:

• Embryonal: Starts in the head and neck, genitals (vagina, prostate, testicles), or urinary organs and often affects children under the age of 5.
• Alveolar rhabdomyosarcoma: Tends to start in the trunk, arms, and legs. It affects children of all ages but is more common in older children and teens.
• Anaplastic: Not common in children but more so in adults.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For rhabdomyosarcoma, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about your health history.

Imaging: Radiology tests can look inside your body to see the cancer and if it has spread. These tests can be:

• Chest X-Ray.
• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).
• Bone scan.
• Ultrasound.

Procedures: These may be:

• Bone marrow aspiration and biopsy: A hollow needle is used to remove bone marrow, blood, and a small piece of bone from both hip bones to test for cancer. Other bones may also be tested.
• Lumbar puncture (LP): This tests the cerebrospinal fluid (CSF) for cancer. A hollow needle is used to remove a sample of the CSF through the space between spinal bones.

Biopsies: These may be:

• Fine needle aspiration: A small needle is used to remove tissue.
• Core needle biopsy: A larger needle is used to remove tissue. An ultrasound, CT scan, or MRI may be used to help find the mass that needs to be biopsied.
• Open biopsy: A surgeon uses an incision (cut) to remove tumor tissue and some lymph nodes if needed.
• Sentinel lymph node biopsy: Surgery to find, remove, and test the sentinel lymph node (where cancer cells spread first).

Each case is given a stage, a group, and a risk category.

• Stage is defined by the tumor size, location (favorable versus unfavorable), and whether there is metastasis (spread to other areas of the body). Stages go from 1 to 4.
• The group is defined by whether the cancer is metastatic and how much of the tumor was removed during surgery. It is described as group I (1) through IV (4).
• Risk category is defined by the stage and grouping. Risk category can be low, intermediate, and high-risk.

Surgery is often used to treat rhabdomyosarcoma. The type of surgery used depends on the size and location of the cancer. Your care team will talk to you about the specifics of your surgery.

What are the risks of surgery for rhabdomyosarcoma?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia: Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure.
• Bleeding.
• Blood clots.
• Infection.

Before surgery, your care team will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from surgery to treat rhabdomyosarcoma depends on the procedure you had. A hospital stay may be needed.

You will be told how to care for your surgical incisions (cuts) and will be given any other instructions before leaving the hospital.

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention, and/or other conditions.

Your provider will talk to you about any changes you will have to make to your activity level, based on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as you were told to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.