RMS is treated with combination of surgery, chemotherapy and radiation. Chemotherapy drugs are given in the hospital (by IV or orally) to kill cancer cells everywhere. Radiation is a series of x-ray treatments given to kill cancer cells in a specific area. Surgery is intended to remove the entire cancer, part of it, or for diagnosis by obtaining a biopsy of the lump or an involved lymph node. Exactly how each type of treatment helps to cure this cancer is unclear.
Since rhabdomyosarcoma is a rare cancer, patients should aim to find an expert. Ideally, you can find one in a nearby Children’s Oncology Group (COG). Clinical Trials may be a helpful option for a child with RMS.
Talk with an oncologist or urologic oncologist who has experience with treating this cancer.
Treating Bladder and Prostate RMS Tumors
First, biopsy of the bladder or prostate mass is needed to establish the diagnosis. Surgery has shifted from removal of the organs to a more conservative organ-sparing approach with similar outcomes. CT scan will show if cancer has spread to local lymph nodes. In this case open biopsy and removal of these nodes for examination will follow. Second, chemotherapy is used to shrink tumors. There are many helpful chemo drugs for this:
- Cyclophosphamide or ifosfamide
After chemotherapy, assessment of residual cancer will determine if radiation therapy will be needed. Not all residual lumps necessarily contain cancer cells. Second-look surgery and biopsy may be needed to know if residual cancer cells are present. If possible, only a portion of the bladder is removed (partial cystectomy). If the bladder is completely removed, then reconstruction is necessary. During the same operation, part of the intestine is reshaped to store urine. Sometimes a colostomy (bag for stool) and/or a urostomy (bag for urine) are used.
Treating Vaginal RMS
In 8o% of vaginal RMS cases, limited surgery and chemotherapy can cure this cancer. After chemotherapy, a biopsy can confirm if the cancer has been treated.
Treating Paratesticular RMS
This is mostly found in very young infants, or in teens. To rule out testis cancer in teens, a blood test should be done.
CT scan will show if RMS has spread to the lymph nodes. CT scan is accurate in the diagnosis of lymph node involvement in patients less than 10 years of age. Patients who are older than 10 years, surgery to remove all lymph nodes from the abdomen is necessary (in the side of tumor only) even if their CT scan showed no lymph node involvement. This surgery is called "retroperitoneal lymph node dissection or RPLND."