Diagnosis & Treatment of Rhabdomyosarcoma
Your child’s healthcare provider will ask about your child’s health history and symptoms. A physical exam will be performed to gauge overall health and check for signs of disease such as lumps. In addition, the doctor will look at your child’s medical history.
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How is Rhabdomyosarcoma Diagnosed?
To diagnose childhood rhabdomyosarcoma, the doctor will perform certain diagnostic tests and obtain a biopsy if necessary. The diagnostic tests utilized depend on where the cancer is located in the body and other factors. Common diagnostic tests used include:
- Imaging tests, including:
- X-ray: An X-ray is a type of energy beam that can pass through the body and onto a film to make a picture of areas inside the body. X-rays will be taken of the chest and the area where the tumor is located.
- EOS imaging: EOS imaging is a type of X-ray obtained by scanning a patient in either a standing or sitting position using a low dose of radiation. In children, EOS imaging simultaneously captures frontal and lateral full body images in just 15 seconds.
- Magnetic resonance imaging (MRI) scan: This procedure uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. Your child is not exposed to radiation during an MRI.
- Computed tomography (CT) scan: This type of scan uses a combination of X-rays and computer technology to create cross-sectional images of bones or other parts of the body.
- Bone scan: In this procedure, a very small amount of radioactive material is injected into a vein and travels through the bloodstream to collect in the bones affected by cancer. A scanner is used to detect the radioactive material.
- Positron emission tomography (PET) scan: In this type of imaging, a radioactive sugar is injected into a vein. A scanner detects the sugar to create detailed, computerized pictures of areas of the body.
- Blood and urine tests:
- Bone marrow aspiration: A procedure where the doctor removes a sample of bone marrow, blood and a small piece of bone by inserting a hollow needle into the hipbone
- Lumbar puncture: a procedure for the collection of cerebrospinal fluid (CSF) from the spinal column
If initial testing indicates the possibility of a rhabdomyosarcoma, a biopsy will be taken. A biopsy is the removal of cells or tissue samples that can be viewed under a microscope by a pathologist to check for signs of cancer. The types of biopsies used in the diagnosis of rhabdomyosarcoma include:
- Core needle biopsy: Removal of tissue with a wide needle that can be guided using ultrasound, CT scan or MRI
- Fine-needle aspiration (FNA) biopsy: Removal of tissue or fluid using a thin needle
- Open biopsy: Removal of tissue via an incision made in the skin
- Sentinel lymph node biopsy: A procedure for the surgical removal of the sentinel lymph node, which is the first lymph node to which cancer cells are likely to spread to from a primary tumor
How is Rhabdomyosarcoma Treated?
Treatment of rhabdomyosarcoma depends on the location of the cancer, the stage, grade and other factors. Rhabdomyosarcoma is treated with traditional therapies, including surgery, chemotherapy, radiation therapy, immunotherapy and supportive care. In addition, many pediatric patients with this cancer are treated as part of a clinical trial.
- Surgery
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Surgery is used to remove the tumor (also called resection). Whether surgery is performed and the type of surgery performed depends on the following factors:
- Where in the body the tumor started
- How the surgery will change the child's appearance
- How the surgery will change the child's important body functions
- How the tumor responded to chemotherapy or radiation therapy that may have been administered first (chemotherapy and radiation therapy may be used before surgery to shrink large tumors)
In most children with rhabdomyosarcoma, it is not possible to remove all of the tumor via surgery. After the surgeon removes as much of the cancer that can be seen at the time of the surgery, patients are often given chemotherapy to kill any cancer cells that may remain. Radiation therapy may also be administered.
- Chemotherapy
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Chemotherapy refers to therapy using strong medicines to kill cancer cells. Chemo is always used in the treatment of rhabdomyosarcoma. Some chemo medicines are taken orally, but most are administered intravenously. In both cases, the drugs enter the bloodstream and reach cancer cells throughout the body (systemic chemotherapy).
- Radiation Therapy
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High-energy X-rays or other types of radiation are often used to kill cancer cells or prevent them from growing. Radiation therapy may be used when the tumor cannot be fully removed via surgery. Radiation therapy and chemotherapy are often given together following surgery in order to kill any remaining cancer cells and prevent the cancer from returning.
The UH Proton Therapy Center is Cleveland’s first provider of proton therapy, an advanced type of radiation therapy used in the treatment of rhabdomyosarcoma and other types of cancers. Available only at select hospitals across the country, proton therapy delivers most of its energy to a very narrow field at the location of the tumor, resulting in less damage to surrounding healthy tissue. In comparison to other forms of radiation therapy, proton therapy can result in better quality of life during treatment and may reduce the risk of patients developing radiation-induced secondary cancers later in life.
- Immunotherapy
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Immunotherapy utilizes a person’s own immune system to help kill cancer cells. Most immunotherapeutic approaches are relatively new and in the clinical trial phase of development. These approaches offer hope for young cancer patients to receive effective treatments that may prevent the long-term, damaging side effects associated with more traditional cancer treatment methods such as chemotherapy and radiation.
The physician-scientists at the UH Rainbow’s Center for Pediatric Immunotherapy in the Angie Fowler Adolescent & Young Adult Cancer Institute are at the forefront of research efforts to find, test and develop new, targeted immunotherapy agents, which have unlimited potential and may represent the most effective type of anti-cancer treatment of the future.
Immunotherapies that have potential in the treatment rhabdomyosarcoma include:
- Vaccine therapy: This treatment 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 metastatic rhabdomyosarcoma.
- Immune checkpoint inhibitor therapy: This therapy utilizes the body’s immune system to kill cancer cells. Certain immune checkpoint inhibitors are being studied in the treatment of childhood rhabdomyosarcoma that returns or progresses after initial treatment.
- Supportive Care
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For the side effects of cancer and cancer treatments, your child’s care team will provide medicines and other treatments to relieve pain, fever, infection, nausea and vomiting. Managing and even preventing side effects is an important component of good cancer treatment.
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