Childhood Rhabdomyosarcoma Treatment (PDQ®)–Patient Version

SOFT TISSUE SARCOMA

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General Information About Childhood Rhabdomyosarcoma

KEY POINTS

Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue.
Certain genetic conditions increase the risk of childhood rhabdomyosarcoma.
A sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger.
Diagnostic tests and a biopsy are used to detect (find) and diagnose childhood rhabdomyosarcoma.
Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue.

Rhabdomyosarcoma is a type of sarcoma. Sarcoma is cancer of soft tissue (such as muscle), connective tissue (such as tendon or cartilage), or bone. Rhabdomyosarcoma usually begins in muscles that are attached to bones and that help the body move. Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children. It can begin in many places in the body.

There are three main types of rhabdomyosarcoma:

Embryonal: This type occurs most often in the head and neck area or in the genital orurinary organs. It is the most common type.
Alveolar: This type occurs most often in the arms or legs, chest, abdomen, genital organs, or anal area.
Anaplastic: This type rarely occurs in children.

See the following PDQ treatment summaries for more information about soft tissue sarcomas:

Certain genetic conditions increase the risk of childhood rhabdomyosarcoma.

Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. Risk factors for rhabdomyosarcoma include having the following inherited diseases:

Children who had a high birth weight or were larger than expected at birth may have an increased risk of embryonal rhabdomyosarcoma.

In most cases, the cause of rhabdomyosarcoma is not known.

A sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger.

Signs and symptoms may be caused by childhood rhabdomyosarcoma or by otherconditions. The signs and symptoms that occur depend on where the cancer forms. Check with your child's doctor if your child has any of the following:

A lump or swelling that keeps getting bigger or does not go away. It may be painful.
Bulging of the eye.
Headache.
Trouble urinating or having bowel movements.
Blood in the urine.
Bleeding in the nose, throat, vagina, or rectum.

Diagnostic tests and a biopsy are used to detect (find) and diagnose childhood rhabdomyosarcoma.

The following tests and procedures may be used:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
X-ray : An x-ray of the organs and bones inside the body, such as the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen or pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injectedinto a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
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Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
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Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
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Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.
Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
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Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
Lumbar puncture : A procedure used to collect cerebrospinal fluid (CSF) from thespinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs of cancer cells. This procedure is also called an LP or spinal tap.

If these tests show there may be a rhabdomyosarcoma, a biopsy is done. A biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Because treatment depends on the type of rhabdomyosarcoma,biopsy samples should be checked by a pathologist who has experience in diagnosingrhabdomyosarcoma.

One of the following types of biopsies may be used:

Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid using a thin needle.
Core needle biopsy : The removal of tissue using a wide needle. This procedure may be guided using ultrasound, CT scan, or MRI.
Open biopsy : The removal of tissue through an incision (cut) made in the skin.

The following tests may be done on the sample of tissue that is removed:

Light microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
Immunocytochemistry : A test that uses antibodies to check for certain antigens in a sample of cells. The antibody is usually linked to a radioactive substance or a dye that causes the cells to light up under a microscope. This type of test may be used to tell the difference between different types of soft tissue sarcoma.
Reverse transcription -polymerase chain reaction (RT-PCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes.
Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

Where in the body the tumor started.
The width of the tumor when the cancer was diagnosed.
Whether the tumor has spread to nearby lymph nodes or distant parts of the body.
Whether there are certain changes in the genes.
The type of rhabdomyosarcoma.
Whether the tumor has been completely removed by surgery.
Whether the tumor responds to chemotherapy and/or radiation therapy.
The patient's age and general health.
Whether the tumor has just been diagnosed or has recurred (come back).

For patients with recurrent cancer, prognosis and treatment depend on the following:

Where in the body the tumor recurred (came back).
Whether the tumor was treated with radiation therapy.
The size of the tumor when the cancer was diagnosed.
How much time passed between the end of cancer treatment and when the cancer recurred.

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Stages of Childhood Rhabdomyosarcoma