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Surgery is an important part of treatment for most rhabdomyosarcomas. Most people with RMS will get two types of surgery:

• The biopsy to diagnose the cancer
• The surgical treatment to remove the tumor(s)

Biopsy surgery

If RMS is suspected, a biopsy is needed to know for sure. The type of biopsy needed will depend on the results of imaging tests, the location and size of the tumor, the patient's age and health, and the expertise of the doctor. How the biopsy is done can affect later treatment, so it's important that the biopsy is done by a doctor who is experienced in diagnosing and treating RMS. See Tests for Rhabdomyosarcoma to learn more about biopsies.

Surgery to remove the tumor

Unless it is clear that the cancer has spread to distant parts of the body, surgery is usually the first step in treating RMS. Complete resection (removal) of the main tumor, along with some surrounding normal tissue, is the goal whenever possible. If there are cancer cells at the edges (margins) of the removed specimen (meaning that some cancer cells may have been left behind), the surgeon may operate again to try to remove the remaining cancer.

In some cases, surgery may be done even if it's clear that all of the cancer can’t be removed, because it may still help other treatments (chemotherapy and radiation) to work better.

During surgery, nearby lymph nodes might be biopsied to determine if the cancer has spread to these areas, especially if:

• The main tumor is near the testicles in a boy who is 10 years of age or older
• The main tumor is on an arm or leg

Some types of surgery might need to be done by special surgeons. For example, removing tumors in the head and neck area may require surgical teams with ENT (ear, nose, and throat) surgeons, plastic surgeons, maxillofacial surgeons, and neurosurgeons.

If a tumor is large or is in a spot where removing it completely would severely affect the patient’s appearance or cause other problems, then surgery may be delayed until after chemotherapy and possibly radiation therapy to try to shrink it, or surgery might not be done at all (and radiation will be used instead).

What to expect with surgery

The type and extent of surgery can vary a great deal based on the location and size of the tumor. RMS can appear in many parts of the body, so it’s not possible to describe here all of the different types of operations that might be done. The surgical team will discuss the planned surgery with you, but make sure you ask questions if there are any parts of it that aren’t clear to you.

If the diagnosis of RMS wasn't confirmed by a biopsy before the main operation, the surgeon may first take only a small sample of the tumor. The sample is checked right away to see if it is cancer or not. If it can be determined that it is cancer while the surgery is still going on, the surgeon may try to remove the entire tumor and also remove some of the nearby lymph nodes to check for spread of the cancer. If the surgeon suspects the disease has spread to another part of the body, a piece of the possible metastatic tumor may be removed and checked as well.

A bone marrow aspiration and biopsy may also be done during the surgery, and a central venous catheter (a thin tube) may be put into one of the large veins in the chest. One end of the catheter stays in the vein, while the other end lies just under or outside the skin. This can help the health care team give chemo and other drugs and draw blood samples without having to stick needles into the veins each time. The catheter usually stays in place for several months, and can make having chemo less painful. If such a device is put in, the health care team will teach you how to care for it to reduce the risk of problems such as infections.

Possible risks and side effects

Short-term risks and side effects: Depending on where the tumor is, surgery for RMS can be a long and complex operation. Serious short-term side effects are not common, but they can include reactions to anesthesia, excess bleeding, blood clots, and infections. Pain is common after the operation, and the patient might need strong pain medicines for a while after surgery as the site heals.

Long-term side effects: The long-term side effects of surgery depend mainly on where the tumor is and what type of operation is done. Physical changes after surgery can range from little more than a scar to changes in appearance or in how some parts of the body function, which may require physical rehabilitation.