Key Points
                    - After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery.     - There are three ways that cancer spreads in the body.    - Cancer may spread from where it began to other parts of the body.    - Staging of childhood rhabdomyosarcoma is done in three parts.    - 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     - Stage 2     - Stage 3     - Stage 4        - The grouping system is based on whether the cancer has spread and whether all the cancer was removed by surgery:         - Group I     - Group II     - Group III     - Group IV        - The risk group is based on the staging system and the grouping system.         - Low-risk childhood rhabdomyosarcoma     - Intermediate-risk childhood rhabdomyosarcoma     - High-risk childhood rhabdomyosarcoma
                
                
                    After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery.
                    The process used to find out if cancer has spread within the tissue 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 find out the stage of the disease.   Treatment for childhood rhabdomyosarcoma is based in part on the stage and sometimes on the amount of cancer that remains after surgery to remove the tumor. The pathologist will use a microscope to check the tissues removed during surgery, including tissue samples from the edges of the areas where the cancer was removed and the lymph nodes. 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.
                    Cancer can spread through tissue, the lymph system, and the blood:         - Tissue. The cancer spreads from where it began by growing into nearby areas.     - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.     - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
                
                 
                    Cancer may spread from where it began to other parts of the body.
                    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.         - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.    - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.        The metastatic tumor is the same type of cancer as the primary tumor. For example, if rhabdomyosarcoma spreads to the lung, the cancer cells in the lung are actually rhabdomyosarcoma cells. The disease is metastatic rhabdomyosarcoma, not lung cancer.
                
                
                    Staging of childhood rhabdomyosarcoma is done in three parts.
                    Childhood rhabdomyosarcoma is staged by using three different ways to describe the cancer:         - A staging system.    - A grouping system.    - A risk 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, the tumor is any size, may have 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 the tissue next to the brain and spinal cord).     -  Gallbladder and bile ducts.     -  Ureters or urethra.     -  Testes, ovary, vagina, or uterus.            Rhabdomyosarcoma that forms 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.        Stage 2    In stage 2, cancer is found in an "unfavorable" site (any one area not described as "favorable" in stage 1). The tumor is no larger than 5 centimeters and has not spread to lymph nodes.        Stage 3    In stage 3, cancer is found in an "unfavorable" site (any one area not described as "favorable" in stage 1) and one of the following is true:             - The tumor is no larger than 5 centimeters and cancer has spread to nearby lymph 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 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 whether all the cancer was removed by surgery:
                    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 found.       Group II    Group II is divided into groups IIA, IIB, and IIC.            - IIA: Cancer was removed by surgery but cancer cells were seen when the tissue, taken from the edges of where the tumor was removed, was viewed under a microscope by a pathologist.     - IIB: Cancer had spread to nearby lymph nodes and the cancer and lymph nodes were removed by surgery.     - IIC: Cancer had spread to nearby lymph nodes, the cancer and lymph nodes were removed by surgery, and at least one of the following is true:                  - Tissue taken from the edges of where the tumor was removed was checked under a microscope by a pathologist and cancer cells were seen.       - The furthest lymph node from the tumor that was removed was checked under a microscope by a pathologist and cancer cells were seen.                         Group III     Cancer was partly removed by biopsy or surgery but there is tumor remaining that can be seen with the eye.        Group IV     Cancer had spread to distant parts of the body when the cancer was diagnosed.            - Cancer cells are found by an imaging test; or     - There are cancer cells in the fluid around the brain, spinal cord, or lungs, or in fluid in the abdomen; or tumors are found in those areas.
                
                
                    The risk group is based on the staging system and the grouping system.
                    The risk group describes the chance that rhabdomyosarcoma will recur (come back). Every child treated for rhabdomyosarcoma should receive chemotherapy to decrease the chance cancer will recur. The type of anticancer drug, dose, and the number of treatments given depends on whether the child has low-risk, intermediate-risk, or high-risk rhabdomyosarcoma.    The following risk groups are used:     Low-risk childhood rhabdomyosarcoma    Low-risk childhood rhabdomyosarcoma is one of the following:            - An embryonal tumor of any size that is found in a "favorable" 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. The following areas are "favorable" sites:                   - Eye or area around the eye.       - Head or neck (but not in the tissue near the ear, nose, sinuses, or base of the skull).       -  Gallbladder and bile ducts.       -  Ureter or urethra.       -  Testes, ovary, vagina, or uterus.                 - An embryonal tumor of any size that is not found in a "favorable" site. 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:            - An embryonal tumor of any size that is not found in one of the "favorable" sites listed above. There is tumor remaining after surgery, that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes.     - An alveolar tumor 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 of the following:            - Other parts of the body that are not near where the tumor first formed.     -  Fluid around the brain or spinal cord.     -  Fluid in the lung or abdomen.