My heart is breaking today for a very sweet 5 year old named Garrett and his family (his mom Emilie, who is my cousin, her husband Ryan and his 6 year old big sister). Garrett has been fighting a rare form of cancer since September (stage 4 Alveolar Fusion Negative Rhabdomyosarcoma). ARMS is a rare form of cancer that is attacking Garrett's temporal bone, cranial nerve, inner ear and after aggressive radiation and chemotherapy, has now spread to other areas of his body. The family recently found out that Garrett's cancer is resistant to treatment, and after cutting his Make a Wish trip to the Omaha zoo short, due to pain, they have learned the cancer has spread further, and unfortunately will not make it home with their sweet boy.Many tears have been shed for this 5 year old hero that keeps captivating our hearts with his contagious smile and bravery. Many, like myself, are unsure of how to help during such a devastating and unimaginable time.Please help me in supporting this family in their medical costs and future expenses that will inevitably come their way. Words are a loss! Garrett touched more lives during his short life than many of us can ever dream of reaching! #teamgarrett #garrettstrong Garret's Song: Champion of the World -Please click on link to listen to song written for Garrett KCCI's piece on Garrett -Please click to see Champion Garrett's piece that KCCI aired on June 15th 

 Testis or spermatic cord. Lesions occurring adjacent to the testis or spermatic cord and up to the internal inguinal ring should be removed by orchiectomy with resection of the spermatic cord, utilizing an inguinal incision with proximal vascular control (i.e., radical orchiectomy).[99] Resection of hemiscrotal skin is required when there is tumor fixation or invasion. Hemiscrotectomy has been recommended by the COG, German groups, and Italian groups when a previous transscrotal biopsy had been performed. By contrast, a retrospective German CWS study of 28 patients with embryonal rhabdomyosarcoma found a 5-year EFS rate of 91.7% in 12 patients with an initial transscrotal excision followed by hemiscrotectomy, while the 5-year EFS in 16 patients without subsequent hemiscrotectomy was 93.8%. All of these patients also received chemotherapy with vincristine, dactinomycin, an alkylator, and other agents.[100][Level of evidence: 3iiiDi] This area is controversial, and more data are needed. For patients with incompletely removed paratesticular tumors that require RT, temporarily repositioning the contralateral testicle into the adjacent thigh before scrotal radiation may preserve hormone production, but again, more data are needed.[101][Level of evidence: 3iiiC] A retrospective review of 49 patients with paratestis rhabdomyosarcoma referred to Memorial Sloan Kettering Cancer Center found that 20 patients had scrotal violation as a part of their original surgery. Fifteen of these patients underwent salvage surgery or radiation therapy; 11 of these patients had continuous progression-free survival, whereas four of the five patients who were treated without a salvage procedure recurred.[102][Level of evidence: 3iiiDiii] Paratesticular tumors have a relatively high incidence of lymphatic spread (26% in IRS-I and IRS-II),[82] and all patients with paratesticular primary tumors should have thin-cut abdominal and pelvic CT scans with IV contrast to evaluate nodal involvement. For patients who have Group I disease, are younger than 10 years, and in whom CT scans show no evidence of lymph node enlargement, retroperitoneal node biopsy/sampling is unnecessary, but a repeat CT scan every 3 months is recommended.[103,104] For patients with suggestive or positive CT scans, retroperitoneal lymph node sampling (but not formal node dissection) is recommended, and treatment is based on the findings of this procedure.[3,32,105] Staging ipsilateral retroperitoneal lymph node sampling is currently required for all children aged 10 years and older with paratesticular rhabdomyosarcoma on COG-STS studies. However, node dissection was not routine in Europe for adolescents with resected paratesticular rhabdomyosarcoma. Many European investigators relied on radiographic, rather than surgical-pathologic assessment, for retroperitoneal lymph node involvement.[99,103] In the International Society of Paediatric Oncology (SIOP) Malignant Mesenchymal Tumour (MMT) 89 and 95 studies, patients with paratesticular rhabdomyosarcoma were evaluated with imaging but did not undergo routine ipsilateral lymph node sampling.[106][Level of evidence: 2Di] Thirty-one percent of Stage N0 patients aged 10 years and older developed node relapse, compared with 8% of Stage N0 patients younger than 10 years (P = .0005). The SIOP MMT group subsequently recommended ipsilateral lymph node sampling for all patients aged 10 years and older. 
 
 Bladder or prostate. Bladder preservation is a major goal of therapy for patients with tumors arising in the bladder and/or prostate. Two reviews provide information about the historical, current, and future treatment approaches for patients with bladder and prostate rhabdomyosarcomas.[107,108] In rare cases, the tumor is confined to the dome of the bladder and can be completely resected. Otherwise, to preserve a functional bladder in patients with gross residual disease, chemotherapy and RT have been used in North America and some parts of Europe to reduce tumor bulk,[109,110] followed, when necessary, by a more limited surgical procedure such as partial cystectomy.[111] Early experience with this approach was disappointing, with only 20% to 40% of patients with bladder/prostate tumors alive and with functional bladders 3 years after diagnosis (3-year OS was 70% in IRS-II).[111,112] The later experience from IRS-III and IRS-IV, which used more intensive chemotherapy and RT, showed 55% of patients alive with functional bladders at 3 years postdiagnosis, with 3-year OS exceeding 80%.[110,113,114] Patients with a primary tumor of the bladder/prostate who present with a large pelvic mass resulting from a distended bladder caused by outlet obstruction at diagnosis receive RT to a volume defined by imaging studies after initial chemotherapy to relieve outlet obstruction. This approach to therapy remains generally accepted, with the belief that more effective chemotherapy and RT will continue to increase the frequency of bladder salvage. The initial surgical procedure in most patients consists of a biopsy, which often can be performed using ultrasound guidance or cystoscopy, or by a direct-vision transanal route. In selected cases in one series, bladder-conserving surgery plus brachytherapy for boys with prostate or bladder-neck rhabdomyosarcoma led to excellent survival, bladder preservation, and short-term functional results.[38][Level of evidence: 3iiiB] For patients with biopsy-proven, residual malignant tumor after chemotherapy and RT, appropriate surgical management may include partial cystectomy, prostatectomy, or exenteration (usually approached anteriorly with preservation of the rectum). Very few studies have objective long-term assessments of bladder function, and urodynamic studies are important to obtain accurate evaluation of bladder function.[115] An alternative strategy, used in European SIOP protocols, has been to avoid major radical surgery when possible and omit external-beam RT if complete disappearance of tumor can be achieved by chemotherapy and conservative surgical procedures. The goal is to preserve a functional bladder and prostate without incurring the late effects of RT or having to perform a total cystectomy/prostatectomy. From 1984 to 2003, 172 patients with nonmetastatic bladder and/or bladder/prostate rhabdomyosarcoma were accrued in a SIOP-MMT study. Of the 119 survivors, 50% had no significant local therapy, and only 26% received RT. The 5-year OS rate was 77%.[116][Level of evidence: 3iiA] Another alternative strategy in highly selected patients is to perform conservative surgery followed by brachytherapy at a specialized center.[117]; [118][Level of evidence: 3iiDiii]; [119][Level of evidence: 3iiiA] A prospective, nonrandomized analysis of this strategy reported the outcomes of 100 children. The 5-year disease-free survival rate was 84%, and the overall survival rate was 91%. At last follow-up, most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy, three patients for a nonfunctional bladder and two patients for relapse. In patients who have been treated with chemotherapy and RT for rhabdomyosarcoma arising in the bladder/prostate region, the presence of well-differentiated rhabdomyoblasts in surgical specimens or biopsies obtained after treatment does not appear to be associated with a high risk of recurrence and is not an indication for a major surgical procedure such as total cystectomy.[113,120,121] One study suggested that in patients with residual bladder tumors with histologic evidence of maturation, additional courses of chemotherapy should be given before cystectomy is considered.[113] Surgery should be considered only if malignant tumor cells do not disappear over time after initial chemotherapy and RT. Because of very limited data, it is unclear whether this situation is analogous for patients with rhabdomyosarcoma arising in other parts of the body. 
 
 Kidney. The kidney is rarely the primary site for sarcoma. Ten patients were identified from among 5,746 eligible patients enrolled on IRSG protocols, including six with embryonal rhabdomyosarcoma and four with undifferentiated sarcoma. The tumors were large (mean widest diameter, 12.7 cm), and anaplasia was present in four (67%) patients. Of the patients with embryonal rhabdomyosarcoma, three Group I and Group II patients survived, one Group III patient died of infection, and two Group IV patients died of recurrent disease; these children were 5.8 and 6.1 years old at diagnosis. This very limited experience concluded that the kidney is an unfavorable site for primary sarcoma.[122]
– A funeral with snow cones, bouncy houses, fireworks, and a fiery burial ceremony straight out of Thor will be held Saturday in Van Meter, Iowa, and it's all the brainchild of the child who will be honored there. The Des Moines Register reports on the recent passing of 5-year-old Garrett Matthias, who died July 6 after a nearly yearlong battle with a rare, aggressive cancer. Over the past few months, Garrett and his parents had some frank discussions about death, and at one point Garrett noted, "Why are funerals so sad? I'm going to have bouncy houses at mine." An idea was born, and together the family started planning Garrett's send-off when his cancer was declared terminal in June. That included writing Garrett's obituary, which he helped his parents with by answering queries you might see on an "about you" questionnaire. The now-viral obituary details his favorite superheroes—including, of course, Thor—things he loves (playing with his sister, thrash metal) and hates ("dirty stupid cancer"), and what he would have wanted to be as an adult: a pro boxer. It also lays out what he intended to do once he died. "I am going to be a gorilla and throw poo at Daddy!" he notes, adding he wanted to be "made into a tree so I can live in it when I'm a gorilla." His parents say they're going to do just that, "once [they] figure out how the hell to get his ashes made into a tree." Garrett's final signoff on the obituary: "See ya later, suckas! The Great Garrett Underpants." "Those are his words verbatim," dad Ryan Matthias tells WHO. "When I read it, I'm just like 'wow.' Sounds like Garrett just yapping at me." A GoFundMe for the Matthias family has so far raised more than $33,000; Garrett's full obituary is here.