Ewing's sarcoma (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Ewing's sarcoma is a malignant bone tumor in children. It named after Dr. James Ewing, who described a bone tumor which was unlike the common bone tumor. Usual symptoms include pain at the site of the tumor, swelling at the site of the tumor, pathological fracture and fever. The tumor often spreads to the lungs and other bones. Treatments include surgical excision, radiation therapy, chemotherapy or a combination of them.

What are the symptoms of Ewing's sarcoma?
Usual symptoms of Ewing's sarcoma include:


 * Pain at the site of the tumor


 * Swelling at the site of the tumor


 * Pathological fracture


 * Fever

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Ewing's sarcoma?
Ewing's sarcoma can occur any time during childhood and young adulthood, but usually develops during puberty, when bones are growing rapidly. It is 10 times as common in Caucasian children as in African-American, African, and Asian children.

The tumor may arise anywhere in the body, usually in the long bones of the arms and legs, the pelvis, or the chest. It may also develop in the skull or the flat bones of the trunk.

The tumor often spreads (metastasis) to the lungs and other bones. Metastasis at the time of diagnosis is present in approximately one-third of children with Ewing's sarcoma. Rarely, Ewing's sarcoma can occur in adults.

Who is at highest risk?
It is not clear for the cause of Ewing's sarcoma.

When to seek urgent medical care?
Call your health care provider if your child has any of the symptoms of Ewing's sarcoma. An early diagnosis can increase the possibility of a favorable outcome.

Diagnosis
If a tumor is suspected, tests include:


 * Biopsy: It is the most important test to verify the disease.


 * Skeletal x-ray tset


 * Computed tomography (CT) scan: CT scans are often used to diagnose Ewing's sarcoma. It can confirm the location of the cancer and show the organs near the bone, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful in staging the cancer and in determining whether surgery is a good treatment option.


 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. MRI scan takes longer time than CT scan.


 * Chest X-ray and chest CT scan: This plain x-ray and CT scan of your chest may be done to see if the cancer has spread to your lungs.


 * Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.

Treatment options
Patients with Ewing's sarcoma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.


 * Chemotherapy: The treatment is to use drugs, such as cyclophosphamide, vincristine, dactinomycin or Ifosfamide to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.


 * Surgery: If it is available, the surgeon prefers to removing the tumor.

Diseases with similar symptoms

 * Fracture


 * Acute pyogenic osteomyelitis


 * Osteosarcoma

Where to find medical care for Ewing's sarcoma?
Directions to Hospitals Treating Ewing's sarcoma

Prevention
Because the cause of Ewing's sarcoma is not clear, the preventive measure is not known.

What to expect (Outlook/Prognosis)?
The prognosis of Ewing's sarcoma depends on:


 * The location of the tumor


 * Whether or not the cancer has spread

Possible complications
The treatments needed to fight this disease have many complications, which should be discussed on an individual basis.