Riad, aged 7 years, was diagnosed with a non-metastatic naso-pharyngeal rhabdomysosarcoma. After baseline toxicity screening and insertion of a central line, Riad started chemotherapy to shrink the primary tumour.

Chemotherapy was administered over several days (as an inpatient) at 3 weekly intervals during which Riad’s renal and liver function and his full blood count were monitored for signs of toxicity. Following chemotherapy, the bone marrow becomes temporarily suppressed reaching its nadir around day 7–10 before recovery by day 21 when the next course of chemotherapy can be given.

Between treatment courses Riad was discharged home but his parents were advised that if he developed signs of infection or became unwell he would have to return to hospital for supportive care. Riad was closely observed for any complications, for example infection, weight loss, nutritional problems, nausea and vomiting and bone marrow suppression – these were addressed with the relevant interventions of antibiotics, nutritional support, anti-emetics and blood products. Potential organ toxicity was also monitored.

Following several courses of chemotherapy, reassessment was performed to ensure the cancer was responding to treatment; once the tumour had shrunk to a satisfactory size surgery was performed.

Riad then had further courses of chemotherapy and a course of radiotherapy to clear any remaining cancerous cells, improving his overall chance of survival. Radiotherapy to the naso-pharyngeal area has potential complications including impaired growth of the surrounding tissue and an increased chance of dental caries. The involvement of specialist healthcare professionals to help manage these issues is paramount.

Following a final assessment to ensure no evidence of disease, Riad was followed up at regular intervals to observe for late effects or evidence of relapse. This became less frequent and after five years he moved to annual appointments in long-term follow up.

• What is a rhabdomyosarcoma? Look for materials that parents may access on the web about such a condition.
• What do you understand by the term metastatic disease?
• What strategies would you use to communicate with Riad about his illness and care (think of age and cognitive development)?
• What would the main health promotion activities be in Riad’s case?
• List the healthcare professionals you think may be involved in Riad’s treatment/care (not exhaustive)