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Rhabdomyosarcoma

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Treatments for rhabdomyosarcoma

If your child has rhabdomyosarcoma, the healthcare team will create a treatment plan just for your child. It will be based on your child’s health and specific information about the cancer. When deciding which treatments to offer for rhabdomyosarcoma, the healthcare team will consider the:

  • stage
  • type of rhabdomyosarcoma
  • risk group
  • location of the tumour

Types of treatments

Rhabdomyosarcoma is often treated with a combination of chemotherapy and local therapies, such as surgery, radiation therapy or both.

Chemotherapy is almost always used to treat rhabdomyosarcoma. It may be given before surgery to shrink the tumour so that it can be removed completely. It is usually given after surgery, whether or not all of the tumour was removed. It may also be used to treat rhabdomyosarcoma that has spread.

Surgery is commonly used to treat rhabdomyosarcoma. The goal of surgery is to try to completely remove the tumour. It is only used if the tumour can be removed without causing major damage or changing the way a person looks. If this isn’t possible, chemotherapy, radiation therapy or both may be given first to try to shrink the tumour.

Radiation therapy may be used along with chemotherapy to shrink the tumour before surgery. It may be used after surgery, along with chemotherapy, to treat a tumour that the surgeon can’t completely remove. It may also be used instead of surgery if surgery is not possible.

Treatments by location of the tumour

The healthcare team will plan treatments based on where the rhabdomyosarcoma developed in the body.

Around the eye

Rhabdomyosarcoma in the area around the eye (called the orbit) may be called orbital rhabdomyosarcoma. It is treated with chemotherapy and radiation therapy because it often responds well to these treatments.

Head and neck

Treatment for rhabdomyosarcoma in the head and neck often depends on whether or not it started in an area close to the meningesmeningesThe membranes that cover and protect the brain and spinal cord. (tissue surrounding the brain and spinal cord).

Rhabdomyosarcoma that develops in areas of the head and neck close to the meninges is called parameningeal rhabdomyosarcoma. This includes rhabdomyosarcoma that starts in the nasal passages, paranasal sinuses, middle ear and back of the upper throat. Tumours in these areas often can’t be removed with surgery because of their location. They are often treated with conformal radiation therapy and chemotherapy. If the rhabdomyosarcoma has spread to the brain and spinal cord (called the central nervous system, or CNS), then radiation therapy may be given to the brain and spinal cord in addition to treatments given to the primary tumour.

Rhabdomyosarcoma that develops in areas of the head and neck that are not close to the meninges is called non-parameningeal rhabdomyosarcoma. Doctors may use wide local excision to remove non-parameningeal rhabdomyosarcoma that is close to skin. They may also remove some lymph nodes from the same side of the neck as the tumour. Chemotherapy, sometimes with radiation therapy, is given after surgery. If the rhabdomyosarcoma can’t be completely removed with surgery, it is treated with chemotherapy and radiation therapy.

Around the anus

Rhabdomyosarcoma can develop in the anus (called perianal rhabdomyosarcoma). It can also develop in the area between the anus and the scrotum or vagina (called perineal rhabdomyosarcoma). Rhabdomyosarcoma in these areas is usually treated with surgery to remove as much tumour as possible, if this can be done without loss of function. Surgery is followed by chemotherapy and radiation therapy. If surgery would cause loss of function, rhabdomyosarcoma in this area is treated with chemotherapy and radiation therapy.

Biliary tract

The biliary tract includes the gallbladder and the bile ducts. Rhabdomyosarcoma in the biliary tract often can’t be completely removed with surgery. Surgery is used to remove as much of the tumour as possible. Chemotherapy and radiation therapy are given after surgery.

Around the testicles

Rhabdomyosarcoma that develops in the area near the testicles is called paratesticular rhabdomyosarcoma. It is treated with surgery to remove the testicle and spermatic cord. Doctors may do imaging tests, such as a CT scan, to determine if nearby lymph nodes should be removed and checked for cancer cells. In boys who are at least 10 years of age, surgical removal of nearby lymph nodes (a retroperitoneal lymph node dissection) is usually recommended. Chemotherapy is given after surgery. Radiation therapy may also be given if the surgeon couldn’t completely remove the tumour or if there are cancer cells in the lymph nodes.

Bladder or prostate

Rhabdomyosarcoma in the bladder or prostate is usually removed with surgery. Chemotherapy, with or without radiation therapy, is often given before surgery to shrink the tumour so that less of the bladder or prostate needs to be removed and they will work as normally as possible. If surgery to remove the tumour can be done without losing function (for example, if the tumour is only in the top of the bladder), then surgery is done first and followed with chemotherapy.

Vulva, vagina, uterus, ovary or cervix

Rhabdomyosarcoma that occurs in the vulva, vagina, uterus, ovary or cervix usually responds well to chemotherapy. Chemotherapy is usually given first, and then surgery is done to completely remove the tumour, if possible. For rhabdomyosarcoma in the uterus, radiation therapy may be used along with chemotherapy.

Arm, leg, hand or foot

Surgery may be used to treat rhabdomyosarcoma in an extremity (arm, leg, hand or foot) if it is possible to remove the tumour without affecting how the limb works. Doctors may do imaging tests, such as a CT scan, to determine if nearby lymph nodes should be removed and checked for cancer cells. For children at least 10 years of age, regional lymph node sampling by surgery is usually done. Chemotherapy, with or without radiation therapy, is often given after surgery.

If surgery is not possible, chemotherapy and radiation therapy may be used first to try to shrink the tumour so that it may be removed with surgery. In rare cases, doctors may need to remove, or amputate, the affected limb if they can’t remove the tumour with surgery and it does not respond to chemotherapy and radiation therapy.

Rhabdomyosarcoma in a hand or foot is often treated with chemotherapy and radiation therapy rather than surgery. This is because surgery can affect how well the hand or foot works.

Chest, abdomen or pelvis

If possible, surgery is done to remove rhabdomyosarcoma in the chest or abdomen. Chemotherapy, with or without radiation therapy, is given after surgery. For larger tumours, chemotherapy, with or without radiation therapy, may be given before surgery to shrink the tumour and make it easier to remove.

Rhabdomyosarcoma in the pelvis is often difficult to remove with surgery. If it is possible to remove the tumour, surgery may be done. If the tumour is large, chemotherapy, with or without radiation therapy, may be given first to shrink the tumour before surgery. Some tumours in the pelvis may be locally treated with radiation therapy after surgical biopsy, in addition to chemotherapy.

Rhabdomyosarcoma in the diaphragm is treated with chemotherapy and radiation therapy. Surgery may or may not be done after these treatments.

Treatments for metastatic rhabdomyosarcoma

Metastatic rhabdomyosarcoma means that the cancer has spread to other parts of the body. Radiation therapy may be used to treat rhabdomyosarcoma that has spread to the brain, spinal cord or lungs. Radiation therapy may also be used to treat the area where the cancer started (called the primary site). Chemotherapy may also be used to treat metastastic rhabdomysarcoma. Sometimes, both the primary site and the sites of metastases are treated with radiation, and, occasionally, by surgical removal.

Treatments for recurrent rhabdomyosarcoma

Treatments for rhabdomyosarcoma that comes back after treatment are based on:

  • if the cancer recurs in the area where it started (called a local recurrence) or in another part of the body (called a distant metastasis, or a distant recurrence)
  • what treatments the child has already had
  • how much time has passed since the child’s last treatment

Treatment for recurrent rhabdomyosarcoma may involve chemotherapy, surgery, radiation therapy or a combination of these treatments.

Surgery may be used to remove a tumour that comes back in the same spot as the original tumour. Sometimes surgery may be used to remove cancer that recurs in the lung, lymph node or elsewhere.

Chemotherapy is often used to treat rhabdomyosarcoma that comes back in a different part of the body than the original tumour. The drugs given will depend on what chemotherapy the child has already received.

Radiation therapy may be used to treat recurrent rhabdomyosarcoma if it wasn’t already given to the area where the cancer recurs.

Follow-up care

Follow-up after treatment is an important part of cancer care. Your child will need to have regular follow-up visits, especially in the first 3 years after treatment has finished. These visits allow your healthcare team to monitor your child’s progress and recovery from treatment.

Clinical trials

Many children with rhabdomyosarcoma will be treated in a clinical trial that is tailored to the type of tumour and risk group. The clinical trial protocol, or plan, outlines the treatments that will be used. Find out more about clinical trials.

Questions to ask about treatment

To make the decisions that are right for your child, ask the healthcare team questions about treatment.

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