General Information About Childhood Rhabdomyosarcoma

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

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

There are three main types of rhabdomyosarcoma:

• Embryonal : This type occurs most often in the head and neck area or in thegenital orurinary organs. It is the most common type.
• Alveolar : This type occurs most often in the arms or legs, chest,abdomen , or genital oranalareas. It usually occurs during the teen years.
• Anaplastic: This type rarely occurs in children.

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

• Childhood Soft Tissue Sarcoma
• Ewing Sarcoma Family of Tumors
• Adult Soft Tissue Sarcoma

Certain genetic conditions increase the risk of childhood rhabdomyosarcoma.

Anything that increases the risk of getting a disease is called a risk factor . Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Parents who think their child may be at risk should discuss this with the child's doctor. Risk factors for rhabdomyosarcoma include having the following inherited diseases:

• Li-Fraumeni syndrome.
• Neurofibromatosis type 1(NF1).
• Beckwith-Wiedemann syndrome.
• Costello syndrome.
• Noonan syndrome.
• MEN2A syndrome.

High birth weight and larger than expected size at birth are linked with an increased risk of embryonal rhabdomyosarcoma.

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

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

Lumps and other symptoms may be caused by childhood rhabdomyosarcoma. The symptoms that occur depend on where the cancer forms. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A lump or swelling that keeps getting bigger or does not go away. It may be painful.
• Bulging of the eye.
• Headache.
• Troubleurinating or havingbowelmovements.
• Blood in theurine.
• Bleeding in the nose,throat ,vagina , orrectum.

Tests that examine the area of the body with symptoms are used to detect (find) and diagnose childhood rhabdomyosarcoma.

The following tests and procedures may be used:

• Physical exam andhistory: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• X-ray: An x-ray of the organs and bones inside the body. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen orpelvis , taken from different angles. The pictures are made by a computer linked to an x-ray machine. Adye may beinjected into avein or swallowed to help the organs ortissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Bone scan : A procedure to check if there are rapidly dividingcells , such as cancer cells, in the bone. A very small amount ofradioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by ascanner.
• Lumbar puncture : A procedure used to collectcerebrospinal fluid (CSF) from thespinal column to check for cancer cells. This is done by placing a needle between two bones in thespineand into the spinal column to remove a sample of CSF. This procedure is also called an LP or spinal tap.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called asonogram.
• Biopsy : The removal of cells or tissues so they can be viewed under amicroscope by apathologist to check for signs of cancer. The biopsy is done afterimaging tests are done. If rhabdomyosarcoma is found, the pathologist will determine the type. Because treatment depends on the type of rhabdomyosarcoma, patients should ask to havebiopsy samples checked by a pathologist who has experience indiagnosingrhabdomyosarcoma.
• Bone marrow aspiration andbiopsy : The removal ofbone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
• Light andelectron microscopy : Alaboratory testin which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
• Immunohistochemistry study: A laboratory test in which a substance such as anantibody , dye, orradioisotope is added to a sample of cancer tissue to test for certainantigens. This type of study is used to tell the difference between different types of cancer.

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

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

• Where in the body thetumorstarted.
• The size of the tumor at the time ofdiagnosis.
• Whether the tumor has been completely removed bysurgery.
• Whether the tumor has spread to nearbylymph nodesor distant parts of the body.
• The type of rhabdomyosarcoma.
• The patient's age and general health.
• Whether the tumor has just been diagnosed or hasrecurred(come back).

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

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

Stages of Childhood Rhabdomyosarcoma

After childhood rhabdomyosarcoma has been diagnosed, treatment is based on the stage of the cancer and whether cancer remains after surgery to remove the tumor.

The process used to find out if cancer has spread within the muscle or to other parts of the body is called staging . It is important to know the stage in order to plan treatment. The doctor will use results of the diagnostic tests to help determine the stage of the disease.

Treatment for childhood rhabdomyosarcoma is based on the stage and the amount of cancer that remains after surgery to remove the tumor . The pathologist will use a microscope to check the tissues , including lymph nodes , removed during surgery, and the edges of the areas where the cancer was removed. This is done to see if all the cancer cells were taken out during the surgery.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Throughtissue . Cancerinvadesthe surrounding normal tissue.
• Through thelymph system . Cancer invades the lymph system and travels through thelymph vesselsto other places in the body.
• Through theblood . Cancer invades theveins andcapillariesand travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis . The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Staging of childhood rhabdomyosarcoma is done in three related steps.

Childhood rhabdomyosarcoma is staged by using three different ways to describe the cancer:

• Astaging system.
• A grouping system.
• Arisk group.

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:

Stage 1

In stage 1, cancer is any size, has not spread to lymph nodes, and is found in only one of the following "favorable" sites:

• Eye or area around the eye.
• Head and neck (but not in thetissue next to the brain andspinal cord).
• Gallbladder andbile ducts.
• In thetestes orvagina (but not in thekidney ,bladder , orprostate).

Rhabdomyosarcoma that occurs in a "favorable" site has a better prognosis. If the site where cancer occurs is not one of the favorable sites listed above, it is said to be an "unfavorable" site.

Pea, peanut, walnut, and lime show tumor sizes.

Stage 2

In stage 2, cancer is found in any one area not included in stage 1. The tumor is 5 centimeters or smaller and has not spread to lymph nodes.

Stage 3

In stage 3, cancer is found in any one area not included in stage 1 and one of the following is true:

• Thetumor is 5centimeters or smaller and cancer has spread to nearbylymph nodes.
• The tumor is larger than 5 centimeters and cancer may have spread to nearby lymph nodes.

Stage 4

In stage 4, the tumor may be any size and cancer may have spread to nearby lymph nodes . Cancer has also spread to distant parts of the body such as the lung , bone marrow, or bone.

The grouping system is based on whether the cancer has spread and how much cancer remains after surgery to remove the tumor:

Group I

Cancer was found only in the place where it started and it was completely removed by surgery . Tissue was taken from the edges of where the tumor was removed. The tissue was checked under a microscope by a pathologist and no cancer cells were seen.

Group II

Group II is divided into groups IIA, IIB, and IIC.

• IIA:Cancer was removed bysurgery but cancercells were seen when thetissue , taken from the edges of where thetumor was removed, was viewed under amicroscope by apathologist.
• IIB: Cancer had spread to nearbylymph nodesand the cancer and lymph nodes were removed by surgery.
• IIC: Cancer had spread to nearby lymph nodes and the cancer and lymph nodes were removed by surgery. Tissue was taken from the edges of where the tumor was removed. The tissue was checked under a microscope by a pathologist and no cancer cells were seen.

Group III

Cancer was partly removed by surgery and there are cancer cells (a lump or mass ) remaining that can be seen by x-ray or other imaging test . Cancer has not spread to distant parts of the body.

Group IV

Cancer had spread to distant parts of the body at the time of diagnosis.

The risk group is based on the staging system and the grouping system and is used to plan treatment.

The risk group describes the chance that rhabdomyosarcoma will recur (come back). The following risk groups are used:

Low-risk childhood rhabdomyosarcoma

Low-risk childhood rhabdomyosarcoma is one of the following:

• Anembryonal tumor of any size that is found in a "favorable" site. There may betumor remaining aftersurgery that can be seen without a microscope. Thecancer may have spread to nearbylymph nodes. The following areas are "favorable" sites:
  • Eye or area around the eye.
  • Head or neck (but not in thetissue next to the brain andspinal cord).
  • Gallbladder andbile ducts.
  • In thetestes orvagina (but not in thekidney ,bladder , orprostate).
• An embryonal tumor of any size that is not found in one of the "favorable" sites listed above. There may be tumor remaining after surgery that can be seen only with a microscope. The cancer may have spread to nearby lymph nodes.

Intermediate-risk childhood rhabdomyosarcoma

Intermediate-risk childhood rhabdomyosarcoma is one of the following:

• Anembryonal tumor of any size that is not found in one of the "favorable" sites listed above. There istumor remaining aftersurgery , that can be seen with or without a microscope. Thecancer may have spread to nearbylymph nodes.
• Analveolartumor 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.

High-risk childhood rhabdomyosarcoma

High-risk childhood rhabdomyosarcoma may be the embryonal type or the alveolar type. It may have spread to nearby lymph nodes and has spread to one or more distant parts of the body.

Recurrent Childhood Rhabdomyosarcoma

Recurrent childhood rhabdomyosarcoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the same place or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with childhood rhabdomyosarcoma.

Different types of treatments are available for children with rhabdomyosarcoma . Some treatments are standard (the currently used treatment), and some are being tested in clinical trials . A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

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.

Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.

Because rhabdomyosarcoma can form in many different parts of the body, many different kinds of treatments are used. Treatment will be overseen by a pediatric oncologist , a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with rhabdomyosarcoma and who specialize in certain areas of medicine . These may include the following specialists:

• Pediatric surgeon.
• Radiation oncologist.
• Pediatric hematologist.
• Pediatric nurse specialist.
• Geneticist or cancergenetics risk counselor.
• Social worker.
• Rehabilitation specialist.
• Psychologist.

Some cancer treatments cause side effects months or years after treatment has ended.

Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment for rhabdomyosarcoma may include:

• Physical problems.
• Changes in mood, feelings, thinking, learning, or memory.
• Second cancers(new types of cancer).

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. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is used to treat childhood rhabdomyosarcoma. A type of surgery called wide local excision is often done. A wide local excision is the removal of tumor and some of the normal tissue around it, including the lymph nodes. When an extra amount of normal tissue is removed from around the tumor, it is called an en bloc removal of a cuff of normal tissue. 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:

• Where in the body the tumor started.
• The effect the surgery will have on the way the child will look.
• The effect the surgery will have on the child's important body functions.
• How the tumorresponded tochemotherapy orradiation therapythat may have been given first.

For most children with rhabdomyosarcoma, complete removal of the tumor by surgery is not possible.

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 genital areas is usually a biopsy. Chemotherapy, and sometimes radiation therapy, may be given before surgery to shrink large tumors.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients will be given chemotherapy, with or without radiation therapy, after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. The type and amount of radiation therapy and when it is given depend on where in the body the tumor started, how much tumor remained after surgery, and the age of the child.

Types of external radiation therapy include the following:

• Conformal radiation uses a computer to create a3-dimensional picture of the tumor. Theradiationbeams are shaped to fit the tumor.
• Intensity-modulated radiation therapy(IMRT) uses images created by a computer that show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles.
• Fractionated stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to a tumor, causing less damage to nearby healthy tissue. The totaldoseof radiation is divided into several small doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy. It may be used for rhabdomyosarcomas of the head and neck.
• Proton-beam therapy is a type of high-energy,external radiation therapy that uses streams ofprotons(small, positively-charged particles of matter) to kill tumor cells.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs 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 injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved for Rhabdomyosarcoma for more information.

New types of treatment are being tested in clinical trials.

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 NCI Web site.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system 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 type of cancer treatment is also called biologic therapy or biotherapy.

Targeted therapy

Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy is a type of targeted therapy being studied in the treatment of childhood rhabdomyosarcoma. Monoclonal antibody therapy uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial 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 standard treatment.

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.

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.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

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 side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order 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. This is sometimes called re-staging.

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 condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Childhood Rhabdomyosarcoma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Previously Untreated Childhood Rhabdomyosarcoma

Surgery options

Childhood rhabdomyosarcoma may be treated with chemotherapy and/or radiation therapy before or after surgery. Treatment with surgery may include the following:

Rhabdomyosarcoma of the head and neck

• Fortumors of the head and neck that are not near the brain andspinal cord and not in or near the eye: Treatment may includesurgery (wide local excision ). Somelymph nodes may be removed from the same side of the neck as the tumor. Surgery will be followed bychemotherapy with or withoutradiation therapy.
• For tumors of the head and neck that are in or near the eye: Abiopsy of the tumor is done, followed by chemotherapy and radiation therapy. If the tumor remains or comes back after treatment with chemotherapy and radiation therapy, surgery to remove the eye and sometissuesaround the eye may be needed.
• For tumors of the head and neck that cannot be removed by surgery: Chemotherapy and radiation therapy are given.

Rhabdomyosarcoma of the arms or legs

• Fortumors of the arms or legs:Surgery (wide local excision and en bloc removal of a cuff of normaltissue ) may be done. For tumors in the arms,lymph nodes near the tumor and in the armpit area are removed. For tumors in the legs, lymph nodes near the tumor and in thegroin area are removed. Asecond surgery may be done to remove any remaining tumorcells.

Rhabdomyosarcoma of the chest or abdomen

• Fortumors in thechest wall orabdominal wall:Surgery (wide local excision ) may be done. Asecond surgery may be done to remove any remaining tumorcells.
• For tumors of the chest orabdomen , including theretroperitoneum andpelvis :Chemotherapy , and sometimes radiation therapy, is given to shrink the tumor first, followed by surgery (wide local excision). The surgery is done to remove as much of the remaining tumor as is safely possible.
• For tumors of thegallbladder orbile ducts: Surgery is done to remove as much of the tumor as is safely possible, followed by chemotherapy.
• For tumors of the muscles ortissues around theanus or between thevulva and the anus or thescrotum and the anus: Surgery is done to remove as much of the tumor as is safely possible and some nearbylymph nodes, followed by chemotherapy.

Rhabdomyosarcoma of the area near the testicles

• Rhabdomyosarcoma of thetesticular area is usually treated withsurgery to remove thetesticle andspermatic cord . Sometimes abiopsy of thelymph nodes in the back of theabdomen is done, especially if the lymph nodes are enlarged or the child is older than 9 years.CT scans may be done every 3 months after surgery to see if thecanceris growing in nearby lymph nodes.

Rhabdomyosarcoma of the bladder and prostate

• Fortumors that are only at the top of thebladder :Surgery (wide local excision) is done.
• For tumors of theprostate or other parts of the bladder:Chemotherapy andradiation therapy are given first to shrink the tumor. Abiopsy is done and ifcancer cells remain, surgery to remove the tumor is done. Surgery may include removal of the prostate, part of the bladder, orpelvic exenteration without removal of therectum . (This may include removal of the lowercolon and bladder. In girls, thecervix ,vagina ,ovaries , and nearbylymph nodesmay be removed).

Rhabdomyosarcoma of the vagina, vulva, or uterus

• Rhabdomyosarcoma of thevagina andvulva is usually treated withchemotherapy andradiation therapy.
• Rhabdomyosarcoma of theuterus is usually treated with chemotherapy and radiation therapy. Sometimessurgery may be needed to remove any remainingcancer cells.

Rhabdomyosarcoma in unusual areas

• Fortumors of the brain:Surgery to remove the tumor followed byradiation therapy andchemotherapy.
• For tumors of thelarynx (voice box): Abiopsyof the tumor is followed by chemotherapy and radiation therapy. Surgery is usually not done, so that the voice is not harmed.
• Fortumors of thediaphragm : A biopsy of the tumor is followed by chemotherapy to shrink the tumor. Surgery may be done later to remove any remainingcancer cells.
• For tumors of thekidney: Surgery is done to remove as much of the tumor as is safely possible.
• For tumors of theovary :Combination chemotherapymay be followed by surgery to remove the remaining tumor.

Metastatic rhabdomyosarcoma

• Metastatic rhabdomyosarcoma is not usually treated withsurgery other than abiopsy fordiagnosis.

Chemotherapy options

Every child treated for rhabdomyosarcoma should receive chemotherapy . The dose of the chemotherapy and the number of treatments given depend on the child's risk group, as follows:

Low-risk patients

• Combination chemotherapy , with or withoutradiation therapy.

Intermediate-risk patients

• Combination chemotherapy.
• Aclinical trial of combination chemotherapy withradiation therapy.

High-risk patients

• Combination chemotherapy.
• Aclinical trial of new combinations of anticancerdrugs , with and withouttargeted therapy (monoclonal antibody).
• A clinical trial ofimmunotherapy.

Radiation therapy options

Radiation therapy may be used if childhood rhabdomyosarcoma tumor cells remain after surgery , after chemotherapy , or if the tumor is of the alveolar type.

Treatment may include certain kinds of radiation therapy that cause less damage to normal tissue and lessen late effects of treatment. These include:

• Conformal radiation therapy.
• Intensity-modulated radiation therapy.
• Fractionated stereotactic radiation therapy.
• Proton-beam therapy.
• Aclinical trial ofbrachytherapy (internal radiation therapy) forcancer in areas such as thevagina ,vulva ,bladder ,prostate, head, or neck.
• A clinical trial ofsecond-look surgeryafter chemotherapy is given to decrease the amount of radiation therapy that will be needed.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with previously untreated childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Recurrent Childhood Rhabdomyosarcoma

Treatment options for recurrent childhood rhabdomyosarcoma are based on many factors, including where in the body the cancer has come back, what type of treatment the patient had before, and the needs of the individual child. Treatment may include one or more of the following:

• Chemotherapywith one or more anticancer agents.
• Surgery.
• Radiation therapy.
• Aclinical trial of differentschedules andcombinations of chemotherapy.
• A clinical trial of new chemotherapyregimens.
• A clinical trial of new anticancerdrugs.
• A clinical trial oftargeted therapy.
• A clinical trial ofhigh-dose chemotherapy followed bystem cell transplant using the patient's ownstem cells.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Childhood Rhabdomyosarcoma

For more information from the National Cancer Institute about childhood rhabdomyosarcoma, see the following:

• Childhood Rhabdomyosarcoma Home Page
• Soft Tissue Sarcomas
• Drugs Approved for Rhabdomyosarcoma
• Understanding Cancer Series: Targeted Therapies(Advances in Targeted Therapies)
• Targeted Cancer Therapies

For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer
• Childhood Cancers
• CureSearch for Children's Cancer
• Late Effects of Treatment for Childhood Cancer
• Adolescents and Young Adults with Cancer
• Young People with Cancer: A Handbook for Parents
• Care for Children and Adolescents with Cancer
• Understanding Cancer Series: Cancer
• Cancer Staging
• Coping with Cancer: Supportive and Palliative Care
• Questions to Ask Your Doctor About Cancer
• Cancer Library
• Information for Survivors/Caregivers/Advocates

Changes to This Summary (02 / 03 / 2012)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

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PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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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 are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

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Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

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." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The PDQ database contains listings of groups specializing in clinical trials.

The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Last Revised: 2012-02-03

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If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.

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