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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65839_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65839_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65839_"><span class="title" itemprop="name">Childhood Rhabdomyosarcoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: April 8, 2022.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258466__323">This PDQ cancer information summary has current information about the treatment of childhood rhabdomyosarcoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258466__324">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000258466__1"><h2 id="_CDR0000258466__1_">General Information About Childhood Rhabdomyosarcoma</h2><div id="CDR0000258466__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258466__2">Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__7">Certain genetic conditions increase the risk of childhood rhabdomyosarcoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__15">A sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__19">Diagnostic tests and a biopsy are used to diagnose childhood rhabdomyosarcoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__23">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258466__2"><h3>Childhood rhabdomyosarcoma is a disease in which malignant (cancer) cells form in muscle tissue.</h3><p id="CDR0000258466__4"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">Rhabdomyosarcoma</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a>. Sarcoma is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> (such as muscle), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044013/" class="def">connective tissue</a> (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000443577/" class="def">tendon</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044190/" class="def">cartilage</a>), or bone. Rhabdomyosarcoma usually begins in muscles that are attached to bones and that help the body move, but it may begin in many places in the body. Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children.</p><p id="CDR0000258466__249">There are four main types of rhabdomyosarcoma:</p><ul id="CDR0000258466__250"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044497/" class="def">Embryonal</a>: This type occurs most often in the head and neck area or in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476624/" class="def">genital</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044093/" class="def">urinary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, but can occur anywhere in the body. It is the most common type of rhabdomyosarcoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641927/" class="def">Alveolar</a>: This type occurs most often in the arms or legs, chest, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, genital organs, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044185/" class="def">anal</a> area. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044298/" class="def">Spindle cell</a>/sclerosing: The spindle cell type occurs most often in the paratesticular (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testis</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615541/" class="def">spermatic cord</a>) area. There are two other spindle cell/sclerosing subtypes. One is more common in infants and is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000796908/" class="def">trunk</a> area. The other can affect children, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000776825/" class="def">adolescents</a>, and adults. It is often found in the head and neck area, and is more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046053/" class="def">aggressive</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044342/" class="def">Pleomorphic</a>: This is the least common type of rhabdomyosarcoma in children.</div></li></ul><p id="CDR0000258466__247">See the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> treatment summaries for information about other types of soft tissue sarcoma:</p><ul id="CDR0000258466__118"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000258102/">Soft Tissue Sarcoma</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000258672/">Childhood Soft Tissue Sarcoma</a>
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</div></li></ul></div><div id="CDR0000258466__7"><h3>Certain genetic conditions increase the risk of childhood rhabdomyosarcoma. </h3><p id="CDR0000258466__144">Anything that increases the risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. 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.</p><p id="CDR0000258466__332">Risk factors for rhabdomyosarcoma include having the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> diseases:</p><ul id="CDR0000258466__10"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046322/" class="def">Li-Fraumeni syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000782329/" class="def">Dicer1 syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045096/" class="def">Neurofibromatosis type 1</a> (NF1).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683344/" class="def">Costello syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304689/" class="def">Beckwith-Wiedemann syndrome</a>. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683528/" class="def">Noonan syndrome</a>.</div></li></ul><p id="CDR0000258466__285">Children who had a high birth weight or were larger than expected at birth may have an increased risk of embryonal rhabdomyosarcoma.</p><p id="CDR0000258466__251">In most cases, the cause of rhabdomyosarcoma is not known.</p></div><div id="CDR0000258466__15"><h3>A sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger. </h3><p id="CDR0000258466__17"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">Signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by childhood rhabdomyosarcoma or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. 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:</p><ul id="CDR0000258466__18"><li class="half_rhythm"><div>A lump or swelling that keeps getting bigger or does not go away. It may be painful. </div></li><li class="half_rhythm"><div>Crossed-eyes or bulging of the eye.</div></li><li class="half_rhythm"><div>Headache.</div></li><li class="half_rhythm"><div>Trouble <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urinating</a> or having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> movements.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a> in the urine.</div></li><li class="half_rhythm"><div>Bleeding in the nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>.</div></li></ul></div><div id="CDR0000258466__19"><h3>Diagnostic tests and a biopsy are used to diagnose childhood rhabdomyosarcoma.</h3><p id="CDR0000258466__21">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689569/" class="def">diagnostic tests</a> that are done depend in part on where the cancer forms. The following tests and procedures may be used:</p><ul id="CDR0000258466__22"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000798522/" class="def">health history</a></b>: 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.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">X-ray</a></b>: 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.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.<div id="CDR0000258466__325" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Computed%20tomography%20(CT)%20scan&p=BOOKS&id=579438_CDR0000775531.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000775531.jpg" alt="Computed tomography (CT) scan; drawing shows a child lying on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Computed tomography (CT) scan. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a>, and lymph nodes. This procedure is also called nuclear magnetic resonance imaging (NMRI).<div id="CDR0000258466__326" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Magnetic%20resonance%20imaging%20(MRI)%20scan&p=BOOKS&id=579438_CDR0000775532.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000775532.jpg" alt="Magnetic resonance imaging (MRI) scan; drawing shows a child lying on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Magnetic resonance imaging (MRI) scan. The child lies on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body. The positioning of the child on the table depends on the part of the body being imaged.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774386/" class="def">radioactive glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.<div id="CDR0000258466__331" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Positron%20emission%20tomography%20(PET)%20scan&p=BOOKS&id=579438_CDR0000775456.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000775456.jpg" alt="Positron emission tomography (PET) scan; drawing shows a child lying on table that slides through the PET scanner." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do. </p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046499/" class="def">Bone scan</a></b>: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.<div id="CDR0000258466__327" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20scan&p=BOOKS&id=579438_CDR0000775451.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000775451.jpg" alt="Bone scan; drawing shows a child lying on a table that slides under the scanner, a technician operating the scanner, and a computer monitor that will show images made during the scan." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow, blood, and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for signs of cancer.<div id="CDR0000258466__328" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20marrow%20aspiration%20and%20biopsy&p=BOOKS&id=579438_CDR0000775458.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000775458.jpg" alt="Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> 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.</div></li></ul><p id="CDR0000258466__318">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, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045619/" class="def">biopsy samples</a> should be checked by a pathologist who has experience in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosing</a> rhabdomyosarcoma. </p><p id="CDR0000258466__319">One of the following types of biopsies may be used:</p><ul id="CDR0000258466__320"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045691/" class="def">Fine-needle aspiration (FNA) biopsy</a></b>: The removal of tissue or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> using a thin needle. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641799/" class="def">Core needle biopsy</a></b>: The removal of tissue using a wide needle. This procedure may be guided using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>, CT scan, or MRI.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335492/" class="def">Open biopsy</a></b>: The removal of tissue through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> (cut) made in the skin. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046712/" class="def">Sentinel lymph node biopsy</a></b>: The removal of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045876/" class="def">sentinel lymph node</a> during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045760/" class="def">lymphatic drainage</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">lymph</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a> to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes. Sentinel lymph node biopsy may be used for patients with rhabdomyosarcoma of the limbs or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000796908/" class="def">trunk</a> when enlarged lymph nodes are not found with imaging or physical exam.</div></li></ul><p id="CDR0000258466__321">The following tests may be done on the sample of tissue that is removed:</p><ul id="CDR0000258466__322"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044052/" class="def">Light</a> microscopy</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A laboratory test that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient’s tissue. The antibodies are usually linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460228/" class="def">FISH</a> (fluorescence in situ hybridization)</b>: A laboratory test used to look at and count <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a> in cells and tissues. Pieces of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> that contain fluorescent dyes are made in the laboratory and added to a sample of a patient’s cells or tissues. When these dyed pieces of DNA attach to certain genes or areas of chromosomes in the sample, they light up when viewed under a fluorescent microscope. The FISH test is used to help diagnose cancer and help plan treatment.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000783668/" class="def">Reverse transcription–polymerase chain reaction</a> (RT–PCR) test</b>: A laboratory test in which the amount of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> substance called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000662001/" class="def">mRNA</a> made by a specific gene is measured. An enzyme called reverse transcriptase is used to convert a specific piece of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046568/" class="def">RNA</a> into a matching piece of DNA, which can be amplified (made in large numbers) by another enzyme called DNA polymerase. The amplified DNA copies help tell whether a specific mRNA is being made by a gene. RT–PCR can be used to check the activation of certain genes that may indicate the presence of cancer cells. This test may be used to look for certain changes in a gene or chromosome, which may help diagnose cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000798756/" class="def">Cytogenetic analysis</a></b>: A laboratory test in which the chromosomes of cells in a sample of tissue are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working.</div></li></ul></div><div id="CDR0000258466__23"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258466__164">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> and treatment options depend on the following:</p><ul id="CDR0000258466__165"><li class="half_rhythm"><div>The patient's age. </div></li><li class="half_rhythm"><div>Where in the body the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> started.</div></li><li class="half_rhythm"><div>The size of the tumor at the time of diagnosis.</div></li><li class="half_rhythm"><div>Whether the tumor has been completely removed by surgery.</div></li><li class="half_rhythm"><div>The type of rhabdomyosarcoma (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044497/" class="def">embryonal</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641927/" class="def">alveolar</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044506/" class="def">spindle cell</a>/sclerosing, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044342/" class="def">pleomorphic</a>).</div></li><li class="half_rhythm"><div>Whether there are certain changes in the genes.</div></li><li class="half_rhythm"><div>Whether the tumor had spread to other parts of the body at the time of diagnosis.</div></li><li class="half_rhythm"><div>Whether the tumor was in the lymph nodes at the time of diagnosis.</div></li><li class="half_rhythm"><div>Whether the tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responds</a> to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.</div></li></ul><p id="CDR0000258466__283">For patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent cancer</a>, prognosis and treatment also depend on the following:</p><ul id="CDR0000258466__284"><li class="half_rhythm"><div>Where in the body the tumor recurred (came back).</div></li><li class="half_rhythm"><div>How much time passed between the end of cancer treatment and when the cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a>.</div></li><li class="half_rhythm"><div>Whether the cancer was previously treated with radiation therapy.</div></li></ul></div></div><div id="CDR0000258466__26"><h2 id="_CDR0000258466__26_">Stages of Childhood Rhabdomyosarcoma</h2><div id="CDR0000258466__26.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258466__27">After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__265">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__314">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__235">Staging of childhood rhabdomyosarcoma is done in three parts.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__31">The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258466__36">Stage 1</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__39">Stage 2</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__42">Stage 3</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__45">Stage 4</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258466__166">The grouping system is based on whether the cancer has spread and whether all the cancer was removed by surgery:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258466__208">Group I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__211">Group II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__214">Group III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__217">Group IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258466__171">The risk group is based on the staging system and the grouping system.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258466__229">Low-risk childhood rhabdomyosarcoma</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__231">Intermediate-risk childhood rhabdomyosarcoma</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__233">High-risk childhood rhabdomyosarcoma</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258466__477">Sometimes childhood rhabdomyosarcoma continues to grow or comes back after treatment.</a></div></li></ul></div><div id="CDR0000258466__27"><h3>After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery. </h3><p id="CDR0000258466__29">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or to other
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parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. It is important to know the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> in order to plan treatment. The doctor will use results of the <a href="#CDR0000258466__19">diagnostic tests</a> to help find out the stage of the disease.</p><p id="CDR0000258466__255">Treatment for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> is based in part on the stage and sometimes on the amount of cancer that remains after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> will use a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to check the tissues removed during surgery, including tissue samples from the edges of the areas where the cancer was removed and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. This is done to see if all the cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> were taken out during the surgery.</p></div><div id="CDR0000258466__265"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000258466__265_md_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000258466__265_md_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000258466__314"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000258466__314_md_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer cells break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000258466__314_md_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000258466__316">The metastatic tumor is the same type of cancer as the primary tumor. For example, if rhabdomyosarcoma spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually rhabdomyosarcoma cells. The disease is metastatic rhabdomyosarcoma, not lung cancer.</p><div id="CDR0000258466__473" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000258466__235"><h3>Staging of childhood rhabdomyosarcoma is done in three parts.</h3><p id="CDR0000258466__245"> Childhood rhabdomyosarcoma is staged by using three different ways to describe the cancer:</p><ul id="CDR0000258466__253"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689095/" class="def">staging system</a>.</div></li><li class="half_rhythm"><div>A grouping system.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000711109/" class="def">risk group</a>.</div></li></ul></div><div id="CDR0000258466__31"><h3>The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body:</h3><div id="CDR0000258466__36"><h4>Stage 1</h4><p id="CDR0000258466__38">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 1, the tumor is any size, may have spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, and is found in only one of the following "favorable" sites:</p><ul id="CDR0000258466__156"><li class="half_rhythm"><div>Eye or area around the eye.</div></li><li class="half_rhythm"><div>Head and neck (but not in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> near the ear, nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641960/" class="def">sinuses</a>, base of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">Gallbladder</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile ducts</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046638/" class="def">Ureters</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367406/" class="def">Testes</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>.</div></li></ul><p id="CDR0000258466__254"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">Rhabdomyosarcoma</a> that forms in a "favorable" site has a better <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>. If the site where cancer occurs is not one of the favorable sites listed above, it is said to be an "unfavorable" site.</p><div id="CDR0000258466__256" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Tumor%20sizes%20are%20often%20measured%20in%20centimeters%20(cm)%20or%20inches&p=BOOKS&id=579438_CDR0000415526.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000415526.jpg" alt="Drawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).</p></div></div></div><div id="CDR0000258466__39"><h4>Stage 2</h4><p id="CDR0000258466__41">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 2, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in an "unfavorable" site (any one area not described as "favorable" in stage 1). The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is no larger than 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> and has not spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.
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</p></div><div id="CDR0000258466__42"><h4>Stage 3</h4><p id="CDR0000258466__44">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 3, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is found in an "unfavorable" site (any one area not described as "favorable" in stage 1) and one of the following is true:
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</p><ul id="CDR0000258466__248"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is no larger than 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> and cancer has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li><li class="half_rhythm"><div>The tumor is larger than 5 centimeters and cancer may have spread to nearby lymph nodes.</div></li></ul></div><div id="CDR0000258466__45"><h4>Stage 4</h4><p id="CDR0000258466__47">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> 4, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> may be any size and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415317/" class="def">distant</a> parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>, or bone.</p></div></div><div id="CDR0000258466__166"><h3>The grouping system is based on whether the cancer has spread and whether all the cancer was removed by surgery:</h3><div id="CDR0000258466__208"><h4>Group I</h4><p id="CDR0000258466__210"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> was found only in the place where it started and it was completely removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">Tissue</a> was taken from the edges of where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> was removed. This tissue was checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> and no cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> were found.</p></div><div id="CDR0000258466__211"><h4>Group II</h4><p id="CDR0000258466__213">Group II is divided into groups IIA, IIB, and IIC.</p><dl id="CDR0000258466__170" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">IIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> was removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> but cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> were seen when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, taken from the edges of where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> was removed, was viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">IIB: Cancer had spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and the cancer and lymph nodes were removed by surgery.</p></dd><dt>-</dt><dd><p class="no_top_margin">IIC: Cancer had spread to nearby lymph nodes, the cancer and lymph nodes were removed by surgery, and at least one of the following is true:<ul id="CDR0000258466__333"><li class="half_rhythm"><div>Tissue taken from the edges of where the tumor was removed was checked under a microscope by a pathologist and cancer cells were seen.</div></li><li class="half_rhythm"><div>The furthest lymph node from the tumor that was removed was checked under a microscope by a pathologist and cancer cells were seen.</div></li></ul></p></dd></dl></div><div id="CDR0000258466__214"><h4>Group III</h4><p id="CDR0000258466__216"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> was partly removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> but there is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> remaining that can be seen with the eye. </p></div><div id="CDR0000258466__217"><h4>Group IV</h4><p id="CDR0000258466__219"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> had spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415317/" class="def">distant</a> parts of the body when the cancer was <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>.</p><ul id="CDR0000258466__313"><li class="half_rhythm"><div>Cancer cells are found by an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging test</a>; or</div></li><li class="half_rhythm"><div>There are cancer cells in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, or in fluid in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>; or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> are found in those areas.</div></li></ul></div></div><div id="CDR0000258466__171"><h3>The risk group is based on the staging system and the grouping system.</h3><p id="CDR0000258466__227">The risk group describes the chance that rhabdomyosarcoma will <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> (come back). Every child treated for rhabdomyosarcoma should receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> to decrease the chance cancer will recur. The type of anticancer drug, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>, and the number of treatments given depends on whether the child has low-risk, intermediate-risk, or high-risk rhabdomyosarcoma. </p><p id="CDR0000258466__334">The following risk groups are used:</p><div id="CDR0000258466__229"><h4>Low-risk childhood rhabdomyosarcoma</h4><p id="CDR0000258466__198">Low-risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> is one of the following:</p><ul id="CDR0000258466__175"><li class="half_rhythm"><div>An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044497/" class="def">embryonal tumor</a> of any size that is found in a "favorable" site. There may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> remaining after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> that can be seen with or without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. The following areas are "favorable" sites:
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<dl id="CDR0000258466__221" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Eye or area around the eye.</p></dd><dt>-</dt><dd><p class="no_top_margin">Head or neck (but not in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> near the ear, nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641960/" class="def">sinuses</a>, base of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> , <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>).</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">Gallbladder</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile ducts</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046638/" class="def">Ureter</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367406/" class="def">Testes</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>.</p></dd></dl>
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</div></li><li class="half_rhythm"><div>An embryonal tumor of any size that is not found in a "favorable" site. There may be tumor remaining after surgery that can be seen only with a microscope. The cancer may have spread to nearby lymph nodes.</div></li></ul></div><div id="CDR0000258466__231"><h4>Intermediate-risk childhood rhabdomyosarcoma</h4><p id="CDR0000258466__200">Intermediate-risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> is one of the following:</p><ul id="CDR0000258466__174"><li class="half_rhythm"><div>An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044497/" class="def">embryonal tumor</a> of any size that is not found in one of the "favorable" sites listed above. There is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> remaining after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>, that can be seen with or without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li><li class="half_rhythm"><div>An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641927/" class="def">alveolar</a> tumor of any size in a "favorable" or "unfavorable" site. There may be tumor remaining after surgery that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes.</div></li></ul></div><div id="CDR0000258466__233"><h4>High-risk childhood rhabdomyosarcoma</h4><p id="CDR0000258466__202">High-risk childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> may be the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044497/" class="def">embryonal</a> type or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641927/" class="def">alveolar</a> type. It may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and has spread to one or more of the following:</p><ul id="CDR0000258466__343"><li class="half_rhythm"><div>Other parts of the body that are not near where the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> first formed.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">Fluid</a> around the brain or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>.</div></li><li class="half_rhythm"><div> Fluid in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</div></li></ul></div></div><div id="CDR0000258466__477"><h3>Sometimes childhood rhabdomyosarcoma continues to grow or comes back after treatment.</h3><p id="CDR0000258466__479"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">Progressive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that continues to grow, spread, or get worse. Progressive disease may be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">sign</a> that the cancer has become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350245/" class="def">refractory</a> to treatment. </p><p id="CDR0000258466__480"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> childhood rhabdomyosarcoma is cancer that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, bone, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. Less often, rhabdomyosarcoma may come back in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a> in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000776825/" class="def">adolescent</a> females or in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p></div></div><div id="CDR0000258466__50"><h2 id="_CDR0000258466__50_">Treatment Option Overview</h2><div id="CDR0000258466__50.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258466__51">There are different types of treatment for patients with childhood rhabdomyosarcoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__55">Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__59">Three types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258466__61">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__65">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__68">Chemotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258466__83">New types of treatment are being tested in clinical trials.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258466__276">Immunotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__280">Targeted therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258466__223">Treatment for childhood rhabdomyosarcoma may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__267">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__269">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258466__271">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258466__51"><h3>There are different types of treatment for patients with childhood rhabdomyosarcoma.</h3><p id="CDR0000258466__53">Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain information on new treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.</p><p id="CDR0000258466__257">Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000258466__55"><h3>Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. </h3><p id="CDR0000258466__57">Because <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> can form in many different parts of the body, many different kinds of treatments are used. Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a>, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who are experts in treating children with rhabdomyosarcoma and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000258466__58"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">Pediatric surgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318822/" class="def">Pediatric hematologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046245/" class="def">Pediatric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046551/" class="def">radiologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723337/" class="def">Geneticist</a> or cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044961/" class="def">genetics risk counselor</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li></ul></div><div id="CDR0000258466__59"><h3>Three types of standard treatment are used:</h3><div id="CDR0000258466__61"><h4>Surgery</h4><p id="CDR0000258466__63"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (removing the cancer in an operation) is used to treat childhood rhabdomyosarcoma. A type of surgery called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446983/" class="def">wide local excision</a> is often done. A wide local excision is the removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> and some of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> around it, including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. A second surgery may be needed to remove all the cancer. Whether surgery is done and the type of surgery done depends on the following:</p><ul id="CDR0000258466__252"><li class="half_rhythm"><div>Where in the body the tumor started. </div></li><li class="half_rhythm"><div>The effect the surgery will have on the way the child will look.</div></li><li class="half_rhythm"><div>The effect the surgery will have on the child's important body functions.</div></li><li class="half_rhythm"><div>How the tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responded</a> to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> that may have been given first.</div></li></ul><p id="CDR0000258466__279">In most children with rhabdomyosarcoma, it is not possible to remove all of the tumor by surgery. </p><p id="CDR0000258466__222">Rhabdomyosarcoma can form in many different places in the body and the surgery will be different for each site. Surgery to treat rhabdomyosarcoma of the eye or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476624/" class="def">genital</a> areas is usually a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a>. Chemotherapy, and sometimes radiation therapy, may be given before surgery to shrink large tumors.</p><p id="CDR0000258466__203">After the doctor removes all the cancer that can be seen at the time of the surgery, patients will be given chemotherapy after surgery to kill any cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that are left. Radiation therapy may also be given. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p></div><div id="CDR0000258466__65"><h4>Radiation therapy</h4><p id="CDR0000258466__67">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or stop them from growing. There are two types of radiation therapy: </p><ul id="CDR0000258466__329"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the area of the body with cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include the following:<dl id="CDR0000258466__330" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270731/" class="def">Conformal radiation therapy</a>: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045582/" class="def">3-dimensional</a> (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of radiation to reach the tumor and causes less damage to nearby healthy tissue. </p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335073/" class="def">Intensity-modulated radiation therapy</a> (IMRT): IMRT is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044487/" class="def">3-dimensional (3-D) radiation therapy</a> that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.</p></dd><dt>-</dt><dd><p class="no_top_margin">Volumetrical modulated arc therapy (VMAT): VMAT is type of 3-D radiation therapy that uses a computer to make pictures of the size and shape of the tumor. The radiation machine moves in a circle around the patient once during treatment and sends thin beams of radiation of different intensities (strengths) at the tumor. Treatment with VMAT is delivered faster than treatment with IMRT.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386233/" class="def">Stereotactic body radiation therapy</a>: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270726/" class="def">Proton beam radiation therapy</a>: Proton-beam therapy is a type of high-energy, external radiation therapy. A radiation therapy machine aims streams of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044715/" class="def">protons</a> (tiny, invisible, positively-charged particles) at the cancer cells to kill them. This type of treatment may cause less damage to nearby healthy tissue.</p></dd></dl></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer. It is used to treat cancer in areas such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044974/" class="def">vulva</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>, head, or neck. Internal radiation therapy is also called brachytherapy, internal radiation, implant radiation, or interstitial radiation therapy. This approach involves special technical skills and is offered in only a few medical centers.</div></li></ul><p id="CDR0000258466__297">The type and amount of radiation therapy and when it is given depends on the age of the child, the type of rhabdomyosarcoma, where in the body the tumor started, how much tumor remained after surgery, and whether there is tumor in the nearby lymph nodes. </p><p id="CDR0000258466__335">External radiation therapy is usually used to treat childhood rhabdomyosarcoma but in certain cases internal radiation therapy is used.</p></div><div id="CDR0000258466__68"><h4>Chemotherapy</h4><p id="CDR0000258466__70">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>).</p><p id="CDR0000258466__336">Chemotherapy may also be given to shrink the tumor before surgery in order to save as much healthy tissue as possible. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045800/" class="def">neoadjuvant</a> chemotherapy.</p><p id="CDR0000258466__298">Every child treated for rhabdomyosarcoma should receive systemic chemotherapy to decrease the chance the cancer will recur. The type of anticancer drug, dose, and the number of treatments given depends on the age of the child and whether the child has low-risk, intermediate-risk, or high-risk rhabdomyosarcoma.</p><p id="CDR0000258466__288">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/rhabdomyosarcoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Rhabdomyosarcoma</a> for more information.</p></div></div><div id="CDR0000258466__83"><h3>New types of treatment are being tested in clinical trials.</h3><p id="CDR0000258466__262">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258466__276"><h4>Immunotherapy</h4><p id="CDR0000258466__278"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">biologic therapy</a>. There are different types of immunotherapy:</p><ul id="CDR0000258466__465"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">Vaccine therapy</a> is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> rhabdomyosarcoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a> therapy uses the body's immune system to kill cancer cells. Two types of immune checkpoint inhibitors are being studied in the treatment of childhood rhabdomyosarcoma that has come back after treatment:<ul id="CDR0000258466__466"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777030/" class="def">CTLA-4</a> is a protein on the surface of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a> that helps keep the body’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. When CTLA-4 attaches to another <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">Ipilimumab</a> is being studied in the treatment of childhood rhabdomyosarcoma that has come back or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">progressed</a> during treatment. <div id="CDR0000258466__475" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=579438_CDR0000776560.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000776560.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of the T-cell receptor (TCR) to antigen and MHC proteins on the antigen-presenting cell (APC) and the binding of CD28 on the T cell to B7-1/B7-2 on the APC. It also shows the binding of B7-1/B7-2 to CTLA-4 on the T cell, which keeps the T cells in the inactive state. The panel on the right shows immune checkpoint inhibitor (anti-CTLA antibody) blocking the binding of B7-1/B7-2 to CTLA-4, which allows the T cells to be active and to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as B7-1/B7-2 on antigen-presenting cells (APC) and CTLA-4 on T cells, help keep the body’s immune responses in check. When the T-cell receptor (TCR) binds to antigen and major histocompatibility complex (MHC) proteins on the APC and CD28 binds to B7-1/B7-2 on the APC, the T cell can be activated. However, the binding of B7-1/B7-2 to CTLA-4 keeps the T cells in the inactive state so they are not able to kill tumor cells in the body (left panel). Blocking the binding of B7-1/B7-2 to CTLA-4 with an immune checkpoint inhibitor (anti-CTLA-4 antibody) allows the T cells to be active and to kill tumor cells (right panel).</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777027/" class="def">PD-1</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797389/" class="def">PD-L1</a> inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">Nivolumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a> are types of PD-1 inhibitors that are being studied in the treatment of childhood rhabdomyosarcoma that has come back or progressed during treatment.</div></li></ul></div></li></ul><div id="CDR0000258466__464" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=579438_CDR0000774646.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65839/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000258466__474" class="box"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000258466__280"><h4>Targeted therapy</h4><p id="CDR0000258466__338"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. There are different types of targeted therapy:</p><ul id="CDR0000258466__339"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000753869/" class="def">mTOR inhibitors</a> stop the protein that helps cells divide and survive. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045513/" class="def">Sirolimus</a> is a type of mTOR inhibitor therapy being studied in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> rhabdomyosarcoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitors</a> block signals that cancer cells need to grow and divide. MK-1775, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000743915/" class="def">cabozantinib-s-malate</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000768872/" class="def">palbociclib</a> are tyrosine kinase inhibitors being studied in the treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> or recurrent rhabdomyosarcoma.</div></li></ul></div></div><div id="CDR0000258466__223"><h3>Treatment for childhood rhabdomyosarcoma may cause side effects.</h3><p id="CDR0000258466__223_md_76">To learn more about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that begin during treatment for cancer, visit <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a>.</p><p id="CDR0000258466__225"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> from cancer treatment that begin after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer treatment for rhabdomyosarcoma may include:</p><ul id="CDR0000258466__242"><li class="half_rhythm"><div>Physical problems that affect the following:<ul id="CDR0000258466__481"><li class="half_rhythm"><div>Teeth, eye, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045692/" class="def">gastrointestinal</a> function.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046399/" class="def">Fertility</a> (ability to have children).</div></li></ul></div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer).</div></li></ul><p id="CDR0000258466__243">Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child and the types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> to expect after cancer treatment has ended. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information.)</p></div><div id="CDR0000258466__267"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258466__267_md_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258466__267_md_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258466__267_md_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258466__269"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258466__269_md_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258466__269_md_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000258466__271"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258466__271_md_55">As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258466__271_md_56">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). </p></div></div><div id="CDR0000258466__93"><h2 id="_CDR0000258466__93_">Treatment of Childhood Rhabdomyosarcoma </h2><p id="CDR0000258466__299">The treatment of newly diagnosed childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> often includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>. The order that these treatments are given depends on where in the body the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> started, the size of the tumor, the type of tumor, and whether the tumor has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or other parts of the body. See the <a href="#CDR0000258466__50">Treatment Option Overview</a> section of this summary for more information about surgery, radiation therapy, and chemotherapy used to treat children with rhabdomyosarcoma.</p><h4><span class="title">Rhabdomyosarcoma of the brain and head and neck</span></h4><ul id="CDR0000258466__300"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797669/" class="def">brain</a>: Treatment may include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>For tumors of the head and neck that are in or near the eye: Treatment may include chemotherapy and radiation therapy. If the tumor remains or comes back after treatment with chemotherapy and radiation therapy, surgery to remove the eye and some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> around the eye may be needed.</div></li><li class="half_rhythm"><div>For tumors of the head and neck that are near the ear, nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641960/" class="def">sinuses</a>, or base of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> but not in or near the eye: Treatment may include radiation therapy and chemotherapy.</div></li><li class="half_rhythm"><div>For tumors of the head and neck that are not in or near the eye and not near the ear, nose, sinuses, or base of the skull: Treatment may include chemotherapy, radiation therapy, and surgery to remove the tumor.</div></li><li class="half_rhythm"><div>For tumors of the head and neck that cannot be removed by surgery: Treatment may include chemotherapy and radiation therapy including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386233/" class="def">stereotactic body radiation therapy</a>.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046026/" class="def">larynx</a> (voice box): Treatment may include chemotherapy and radiation therapy. Surgery to remove the larynx is usually not done, so that the voice is not harmed.</div></li></ul><h4><span class="title">Rhabdomyosarcoma of the arms or legs</span></h4><ul id="CDR0000258466__301"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>. If the tumor was not completely removed, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045875/" class="def">second surgery</a> to remove the tumor may be done. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may also be given.</div></li><li class="half_rhythm"><div>For tumors of the hand or foot, radiation therapy and chemotherapy may be given. The tumor may not be removed because it would affect the function of the hand or foot.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044435/" class="def">Lymph node dissection</a> (one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> are removed and a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> is checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>). <dl id="CDR0000258466__302" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">For tumors in the arms, lymph nodes near the tumor and in the armpit area are removed.</p></dd><dt>-</dt><dd><p class="no_top_margin">For tumors in the legs, lymph nodes near the tumor and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a> area are removed.</p></dd></dl></div></li></ul><h4><span class="title">Rhabdomyosarcoma of the chest, abdomen, or pelvis</span></h4><ul id="CDR0000258466__303"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> in the chest or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> (including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall): <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446983/" class="def">wide local excision</a>) may be done. If the tumor is large, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> are given to shrink the tumor before surgery.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>: Surgery (wide local excision) may be done. If the tumor is large, chemotherapy is given to shrink the tumor before surgery. Radiation therapy may be given after surgery.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> of the tumor is followed by chemotherapy and radiation therapy to shrink the tumor. Surgery may be done later to remove any remaining <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">gallbladder</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile ducts</a>: A biopsy of the tumor is followed by chemotherapy and radiation therapy. Surgery may be done later to remove any remaining cancer cells.</div></li><li class="half_rhythm"><div>For tumors of the muscles or tissues around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a> or between the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044974/" class="def">vulva</a> and the anus or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046573/" class="def">scrotum</a> and the anus: Surgery may be done to remove as much of the tumor as possible and some nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, followed by chemotherapy and radiation therapy.</div></li></ul><h4><span class="title">Rhabdomyosarcoma of the kidney</span></h4><ul id="CDR0000258466__304"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove as much of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> as possible. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> may also be given.</div></li></ul><h4><span class="title">Rhabdomyosarcoma of the bladder or prostate</span></h4><ul id="CDR0000258466__305"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> that are only at the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446983/" class="def">wide local excision</a>) is done.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a> or bladder (other than the top of the bladder): <dl id="CDR0000258466__312" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> are given first to shrink the tumor. If <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> remain after chemotherapy and radiation therapy, the tumor is removed by surgery. Surgery may include removal of the prostate, part of the bladder, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322874/" class="def">pelvic exenteration</a> without removal of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>. (This may include removal of the lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> and bladder. In girls, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046133/" class="def">cervix</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, and nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> may be removed).</p></dd><dt>-</dt><dd><p class="no_top_margin">Chemotherapy is given first to shrink the tumor. Surgery to remove the tumor, but not the bladder or prostate, is done. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">external radiation therapy</a> may be given after surgery.</p></dd><dt>-</dt><dd><p class="no_top_margin">Surgery to remove the tumor, but not the bladder or prostate. Internal radiation therapy is given after surgery.</p></dd></dl></div></li></ul><h4><span class="title">Rhabdomyosarcoma of the area near the testicles</span></h4><ul id="CDR0000258466__306"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicle</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615541/" class="def">spermatic cord</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> may be checked for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, especially if the lymph nodes are large. Patients older than 10 years with no sign of enlarged lymph nodes in the back of the abdomen should have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373937/" class="def">nerve-sparing</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044257/" class="def">retroperitoneal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044435/" class="def">lymph node dissection</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> may be given if the tumor cannot be completely removed by surgery. </div></li></ul><h4><span class="title">Rhabdomyosarcoma of the vulva, vagina, uterus, or ovary</span></h4><ul id="CDR0000258466__307"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044974/" class="def">vulva</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>: Treatment may include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the tumor. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">external radiation therapy</a> may be given after surgery.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>: Treatment may include chemotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>. Sometimes surgery may be needed to remove any remaining <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>.</div></li><li class="half_rhythm"><div>For tumors of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a>: Treatment may include chemotherapy followed by surgery to remove any remaining tumor.</div></li></ul><h4><span class="title">Clinical Trials For Childhood Rhabdomyosarcoma</span></h4><ul id="CDR0000258466__476"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000434624/" class="def">temsirolimus</a>.</div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000743915/" class="def">cabozantinib-s-malate</a>.</div></li></ul><p id="CDR0000258466__344">
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<i>
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<b>Metastatic rhabdomyosarcoma</b>
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</i>
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</p><p id="CDR0000258466__340">Treatment, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, is given to the site where the tumor first formed. If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to the brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, radiation therapy may also be given to the sites where the cancer has spread.</p><p id="CDR0000258466__341">The following treatment is being studied for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a>: </p><ul id="CDR0000258466__345"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">vaccine therapy</a>).</div></li></ul><p id="CDR0000258466__TrialSearch_93_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258466__114"><h2 id="_CDR0000258466__114_">Treatment of Progressive or Recurrent Childhood Rhabdomyosarcoma</h2><p id="CDR0000258466__482">For information about the treatments listed below, see the <a href="#CDR0000258466__59">Treatment Option Overview</a> section.</p><p id="CDR0000258466__151"> Treatment options for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">progressive</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a> are based on many factors, including where in the body the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has come back, what type of treatment the child had before, and the needs of the child. </p><p id="CDR0000258466__342">Treatment of progressive or recurrent rhabdomyosarcoma may include one or more of the following:</p><ul id="CDR0000258466__116"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000434624/" class="def">temsirolimus</a>. </div></li><li class="half_rhythm"><div>A clinical trial of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045513/" class="def">sirolimus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">ipilimumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">pembrolizumab</a>).</div></li><li class="half_rhythm"><div>A clinical trial of targeted therapy with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a> (MK-1775, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000743915/" class="def">cabozantinib-s-malate</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000768872/" class="def">palbociclib</a>) and chemotherapy.</div></li><li class="half_rhythm"><div>A clinical trial that checks a sample of the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.</div></li><li class="half_rhythm"><div>New therapies being studied in early stage clinical trials should be considered for
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patients with recurrent rhabdomyosarcoma.</div></li></ul><p id="CDR0000258466__TrialSearch_114_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258466__258"><h2 id="_CDR0000258466__258_">To Learn More About Childhood Rhabdomyosarcoma</h2><p id="CDR0000258466__259">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood rhabdomyosarcoma, see the following: </p><ul id="CDR0000258466__287"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/soft-tissue-sarcoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Soft Tissue Sarcoma Home Page</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/rhabdomyosarcoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Rhabdomyosarcoma</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Immunotherapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a>
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</div></li></ul><p id="CDR0000258466__258_md_44">For more childhood cancer information and other general cancer resources, visit:</p><ul id="CDR0000258466__258_md_45"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors, Caregivers, and Advocates</a>
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</div></li></ul></div><div id="CDR0000258466__AboutThis_1"><h2 id="_CDR0000258466__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258466__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258466__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258466__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258466__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258466__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood rhabdomyosarcoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258466__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258466__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000258466__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258466__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258466__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258466__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258466__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258466__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258466__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258466__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Rhabdomyosarcoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/soft-tissue-sarcoma/patient/rhabdomyosarcoma-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/soft-tissue-sarcoma/patient/rhabdomyosarcoma-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389279]</p><p id="CDR0000258466__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000258466__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258466__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258466__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258466__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65839</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389279" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389279</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65839/?report=reader">PubReader</a></li><li><a href="/books/NBK65839/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65839" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65839" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version. 2022 Apr 8. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm">NBK65839.26</span> April 8, 2022 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65839.25/">NBK65839.25</a></span> December 22, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65839.24/">NBK65839.24</a></span> August 28, 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href="/books/NBK65839.14/">NBK65839.14</a></span> December 6, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65839.13/">NBK65839.13</a></span> September 1, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65839.12/">NBK65839.12</a></span> May 15, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65839.11/">NBK65839.11</a></span> March 6, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65839.10/">NBK65839.10</a></span> January 27, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65839.9/">NBK65839.9</a></span> December 9, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65839.8/">NBK65839.8</a></span> December 2, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65839.7/">NBK65839.7</a></span> May 25, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65839.6/">NBK65839.6</a></span> May 18, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65839.5/">NBK65839.5</a></span> December 18, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65839.4/">NBK65839.4</a></span> October 30, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65839.3/">NBK65839.3</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65839.2/">NBK65839.2</a></span> September 18, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65839.1/">NBK65839.1</a></span> August 6, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000258466__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Rhabdomyosarcoma</a></li><li><a href="#CDR0000258466__26" ref="log$=inpage&link_id=inpage">Stages of Childhood Rhabdomyosarcoma</a></li><li><a href="#CDR0000258466__50" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258466__93" ref="log$=inpage&link_id=inpage">Treatment of Childhood Rhabdomyosarcoma </a></li><li><a href="#CDR0000258466__114" ref="log$=inpage&link_id=inpage">Treatment of Progressive or Recurrent Childhood Rhabdomyosarcoma</a></li><li><a href="#CDR0000258466__258" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Rhabdomyosarcoma</a></li><li><a href="#CDR0000258466__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65802/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909939" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Chordoma (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31909947" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31593394" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Mesothelioma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information 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class="invert">Review</span> Childhood Craniopharyngioma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Craniopharyngioma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389279" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" 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