Skull Base Rhabdomyosarcoma in Children

What is skull base rhabdomyosarcoma in children?

Rhabdomyosarcoma is a type of cancer. It starts in cells that grow into skeletal muscle cells. The cells are called rhabdomyoblasts. Skeletal muscles control all of a person’s voluntary muscle movements. The cancer is most common in children under age 10, but it is rare. It can form anywhere in the body. A skull base rhabdomyosarcoma forms in the head and neck. It grows in the area where the spine connects to the skull (skull base). It may grow in other parts of the head as well. This includes the eyes, nose, throat, or sinuses.

There are two main types of rhabdomyosarcoma:

• Embryonal. This is the most common type. It’s more common in younger children. It’s the most likely type to affect the base of the skull.
• Alveolar.  This is more common in older children and teenagers. It’s more likely to affect the trunk, arms, or legs. This type grows more quickly. It’s more likely to spread to other areas of the body (metastasize).

What causes skull base rhabdomyosarcoma in a child?

The exact cause of is not known. Changes in the genetic material in cells (DNA) may cause the cells to turn into cancer.

Which children are at risk for skull base rhabdomyosarcoma?

Some health conditions that are passed down through families (genetic) increase a child's risk. These include:

• Li-Fraumeni syndrome
• Neurofibromatosis
• Beckwith-Wiedemann syndrome
• Costello syndrome

A child who has had radiation therapy for any cancer of the head is also at a higher risk.

What are the symptoms of skull base rhabdomyosarcoma in a child?

Symptoms depend on the location and the size and of the tumor. The symptoms can occur a bit differently in each child. They can include:

• Problems with the sense of smell
• Trouble with vision
• Trouble with eye movement
• Bulging of the eye
• Numbness or weakness of the face
• Trouble hearing, ringing in the ears (tinnitus), ear pain, or dizziness
• Trouble swallowing
• Headache or sinus congestion

Symptoms of rhabdomyosarcoma that has spread may include:

• A lump or swelling in the neck
• Bone pain
• Weakness
• Cough
• Weight loss

The symptoms can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is skull base rhabdomyosarcoma diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child. This will include a neurological exam. The exam tests reflexes, muscle strength, eye and mouth movement, and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may have tests such as:

• CT scan. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body. Your child may drink contrast dye or it may be injected into your child's vein. The contrast makes the cancer cells easier to see.
• MRI. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein. It helps cancer cells be seen more clearly.
• Lumbar puncture. A needle is placed into the spinal canal in the lower back. This is the area around the spinal cord. A small sample of cerebrospinal fluid (CSF) is removed. CSF is the fluid around the brain and spinal cord.  The sample is checked for cancer cells. 
• Biopsy. Tumor cells are removed and sent to a lab for testing. This is done to see the type of tumor and how quickly it’s likely to grow. This may be done with surgery.

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging cancer, but most range from stage 1 to stage 4. Talk with your child's healthcare provider about the stage of your child's cancer and what it means.

How is skull base rhabdomyosarcoma treated in a child?

If your child has been diagnosed with skull base rhabdomyosarcoma, you may want your child to see another oncologist. This means to get a second opinion. Your insurance company may require a second opinion.

Because the cancer is so rare, it's important for your child to be treated at a center that specializes in the disease. Treatment will depend on the location, stage, and other factors. The cancer can be treated with any of the below:

• Surgery. The goal of surgery is to fully remove the tumor. This is called resection. The surgery will be done to avoid loss of function and deformation as possible. A surgeon who specializes in the body area of tumor growth may be needed. This may be a head and face (craniofacial) surgeon, or an ear, nose, and throat (otolaryngologist) doctor. It may be a brain surgeon (neurosurgeon). Or it may be another type of doctor. 
• Chemotherapy. These are medicines that kill cancer cells. They are always used to treat rhabdomyosarcoma. Some medicines may be given by mouth. But most are given through a vein (IV).
• Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It may be used when a tumor is hard to remove with surgery. Radiation therapy is usually given along with chemotherapy.
• Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 
• Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

• Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
• Ongoing follow-up care during and after treatment is needed.
• New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of skull base rhabdomyosarcoma in a child?

A child may have complications from the tumor or from treatment. They may include:

• Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight
• Problems after surgery, such as infection, bleeding, and problems with general anesthesia
• Infection and bleeding from chemotherapy
• Delayed growth and development
• Learning problems
• Problems with reproduction (infertility)
• Return of the cancer
• Growth of other cancers

How can I help my child live with skull base rhabdomyosarcoma?

A child with skull base rhabdomyosarcoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye doctor (ophthalmologist) for vision problems.

Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, he or she may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems. 

You can help your child manage his or her treatment in many ways. For example:

• Your child may have trouble eating. A dietitian may be able to help.
• Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
• If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
• Get emotional support for your child. Find a counselor or child support group can help.
• Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that get worse
• New symptoms
• Side effects from treatment

Key points about skull base rhabdomyosarcoma in children

• A skull base rhabdomyosarcoma forms in the head and neck, around the area where the spine connects to the skull (skull base).
• Symptoms include problems with the sense of smell, eye sight, hearing, swallowing, and facial weakness.
• Treatment includes surgery, chemotherapy, and radiation therapy.
• Because the cancer is so rare, it's important for your child to be treated at a center that specializes in the disease.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.