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What is Ewing's Sarcoma?

The Causes, Symptoms, Diagnosis and Treatment of Ewing's Sarcoma

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Updated July 09, 2009

Ewing's sarcoma is a type of bone cancer that primarily affects children and young adults. It is a rare type of cancer, affecting about 250 children in the United States each year. Ewing's sarcoma is most often diagnosed in adolescents between the ages of 10 and 20.

Ewing's sarcoma affects the bone, but it can also affect the soft tissue surrounding the bone. It is most commonly found in the arms or legs but can be found elsewhere in the body, such as the pelvis, ribs, or spine.

Symptoms of Ewing's Sarcoma

Symptoms of Ewing's sarcoma vary based on the location of the tumor and whether it has spread. Common symptoms include:
  • pain at the tumor site
  • swelling around the site of the tumor; skin may or may not be red
  • fever
  • unintended weight loss
  • fatigue
  • loss of appetite
When a tumor affects the spine, symptoms like incontinence or paralysis may occur. Tumors can also affect nerve pathways, causing feelings of numbness and tingling. Fractures can also occur as a result of weakening of the bone.

Diagnosing Ewing's Sarcoma

Unfortunately, it is not uncommon for there to be a delay in diagnosing Ewing's sarcoma. The symptoms are very similar to those of other less severe illnesses. Pain and swelling are often thought to be related to an injury, but it is the persistence of symptoms that raise red flags for physicians. The initial complaint of non-specific pain can result in x-rays being taken of the wrong part of the bone or x-rays that may not reveal early abnormalities. Many factors are involved in making a timely, correct diagnosis.

The first step in diagnosing Ewing's sarcoma is the conducting of imaging studies. Imaging tests like x-rays, MRIs, and CT scans help identify bone abnormalities. Other tests may include a bone scan, a specialized nuclear imaging test that allows doctors to see the metabolic activity of the bone. Bone scans identify areas in the bone that have new growth or have broken down -- excellent indicators of abnormal conditions.

Ultimately, it is a bone biopsy that will rule out or confirm the presence of cancer. A bone biopsy involves the removal of a small amount of bone tissue to be examined under a microscope. It usually takes less than an hour and can be done as an outpatient or inpatient surgical procedure.

The biopsy sample is then evaluated by a pathologist, who exams the sample under a microscope. Ewing's sarcoma tumor cells often look very similar to other types of bone tumor cells, so chromosomal tests may be needed to confirm what type of tumor it is.

Treatment of Ewing's Sarcoma

Ewing's sarcoma patients are treated by a pediatric oncologist, a specialist who is experienced in treating children with cancer. Treatment of Ewing's sarcoma varies based on whether the cancer is has spread (metastatic) or not spread (localized).

Chemotherapy is usually the first course of action in treating Ewing's sarcoma, but it may follow surgery or radiation in some cases. The goal of chemotherapy is to shrink the tumor and prevent the cancer from spreading. Chemotherapy is a systemic treatment, meaning it affects the whole body. It can be taxing on the body, so it is given in cycles. This allows blood cell counts to stabilize in-between chemotherapy cycles.

Once chemotherapy cycles are complete, surgery is performed to remove the remaining tumor(s). Amputation once was a common treatment for bone cancer, but this is no longer a standard treatment. Great advancements have been made in limb salvage surgery, and bone reconstruction that rarely is amputation needed. An orthopedic surgeon who specializes in bone cancer is essential for performing this type of surgery.

Radiation therapy may be an option some with Ewing's sarcoma. Radiation therapy uses specific types high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Cancer cells are highly sensitive to radiation and typically die when exposed. Healthy cells that are damaged during treatment are resilient and are usually able to fully recover.

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