Description

Ewing's sarcoma is a type of cancer that begins as a growth of the cells in your bones and the soft tissues around the bones. Ewing (Yoo-ing) sarcoma occurs primarily in children and young adults, although it can occur at any age.

Ewing's sarcoma is most often begins in the bones of the legs and pelvis, but it can occur in any bone. Less often, it begins in the soft tissues of the thorax, the abdomen, the arms, or in other places.

Major advances in the treatment of Ewing sarcoma have improved the prognosis of this cancer. Young people with a diagnosis of Ewing's sarcoma are living longer. You sometimes face the late effects of strong treatments. Health professionals often suggest the follow-up to long-term side effects after the treatment.

Symptoms

The Ewing's sarcoma signs and symptoms typically start in and around a bone. This type of cancer most often affects the bones in the legs and pelvis.

When symptoms do occur in and around a bone, which may include:

  • A lump in the arm, leg, chest, or pelvis.
  • Pain in the bones.
  • Break in a bone, also called a fracture.
  • Pain, swelling or tenderness near the affected area.

Sometimes, the Ewing's sarcoma causes symptoms that affect the entire body. These may include:

  • Fever.
  • Losing weight without trying.
  • Fatigue.

When to see a doctor

Make an appointment with a health professional if you or your child has been continued in the signs and symptoms that worry you.

Causes

It is not clear what causes Ewing's sarcoma.

The Ewing's sarcoma that occurs when cells develop changes in their DNA. A cell's DNA contains the instructions that tell a cell what to do. In healthy cells, the DNA contains the instructions to grow and multiply at a set rate. The instructions that tell cells to die at a set time.

In cancer cells, changes in DNA to give different instructions. The changes, to tell the cancer cells to make many more cells quickly. Cancer cells can continue living when healthy cells would die.

The cancer cells may form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. At the time, cancer cells can break off and spread to other parts of the body. When cancer spreads, it is called metastatic cancer.

In Ewing's sarcoma, the changes in the DNA most often affect a gene called EWSR1 . If your healthcare provider suspects that you or your child has Ewing's sarcoma, the cancer cells can be examined for changes in this gene.

Risk factors

The risk factors for Ewing's sarcoma include:

  • The young age. Ewing's sarcoma can occur at any age. But it is more likely to occur in children and young adults.
  • European ancestry. Ewing's sarcoma is more common in people of European ancestry. It is much less common in people of African and East Asian ancestry.

There is no way to prevent the Ewing's sarcoma.

Complications

Complications of Ewing's sarcoma and its treatment include the following.

Cancer that spreads

Ewing sarcoma can spread from where it started to other areas. Ewing sarcoma most often spreads to the lungs and other bones.

Long-term side effects of treatment

The fort of necessary treatments for the control of Ewing's sarcoma can cause major side effects, both in the short and long term. Your health care team can help you manage the side effects that occur during treatment. The team can also give you a list of side effects to watch out for in the years after treatment.

Diagnosis

The Ewing's sarcoma diagnosis usually begins with a physical exam. Based on the findings of the examination, other tests and procedures.

Imaging tests

Imaging tests create pictures of the body. You can show the location and size of a Ewing's sarcoma. Tests may include:

  • X-ray.
  • The magnetic resonance imaging .
  • CT .
  • Bone scan.
  • The positron emission tomography scan, also called a PET.

The removal of a sample of cells for testing

A biopsy is a procedure to remove a sample of tissue for testing in a lab. The tissue can be removed through a needle placed through the skin and the cancer. Sometimes surgery is necessary to obtain a tissue sample. The sample is analyzed in a laboratory to see if it is cancer. Other special tests to give more details on the cancer cells.

A biopsy is needed to confirm a diagnosis of Ewing's sarcoma. Your health care team uses this information to make a treatment plan.

The evidence of the cancer cells, changes in DNA

A sample of the cancer cells will be tested in the laboratory to determine the changes in the DNA in the cells. The Ewing's sarcoma cells of the majority of the changes in the EWSR1 gene. More often the EWSR1 gene binds with another gene called FLI1 . This creates a new gene called EWS-FLI1 .

The evidence of the cancer cells, these genetic changes may help to confirm the diagnosis.

Treatment

The Ewing's sarcoma treatment usually includes chemotherapy and surgery. Which is the treatment that you have to first will depend on your situation. Other treatment options may include radiation therapy and targeted therapy.

Chemotherapy

Chemotherapy treats the cancer with strong medications.

Chemotherapy is sometimes used as the first treatment for Ewing's sarcoma. The medications that can reduce the size of the cancer. That makes it easier to remove the cancer with surgery or destination with the radiation therapy.

After surgery or radiotherapy, chemotherapy can be used to kill cancer cells that may remain.

For the advanced cancer that spreads to other areas of the body, chemotherapy may help relieve the pain and decrease the growth of cancer.

Surgery

The goal of surgery is to remove all the cancer cells. Surgery for Ewing's sarcoma can mean the removal of a small portion of bone and part of the surrounding tissue. Rarely, it could mean the removal of the affected arm or leg.

The surgery on an arm or a leg could affect the way in which you can use this member. The surgeons carefully plan the surgery to minimize this risk, when possible.

If surgeons can remove all of the cancer without removing the arm or the leg depends on several factors. These include the size of the cancer, where it is and if the chemotherapy helps to reduce it.

Radiation therapy

Radiation therapy treats cancer with powerful rays of energy. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

The radiation therapy may be suggested after surgery to destroy any cancer cells that remain. Radiation therapy may be used instead of surgery if an operation is not possible or if there is the possibility of injury to nearby organs. For example, if the surgery can cause a loss of bowel or bladder control, radiation may be used in its place.

For advanced Ewing's sarcoma, radiation therapy may decrease the growth of cancer and help to relieve the pain.

Targeted therapy

Targeted therapy for cancer is a treatment that uses drugs that attack specific ways in which cancer cells can grow. By blocking these specific things in the cells, targeted treatments can cause cancer cells to die. For the Ewing's sarcoma, researchers are looking into the use of targeted therapy when the cancer comes back or does not respond to other treatments.

Clinical trials

Clinical trials are studies of new treatments. These studies provide an opportunity to test the latest treatments. The risk of side effects may not be known. Ask your health care team if you or your child may be able to join a clinical trial.

Coping and support

A diagnosis of Ewing's sarcoma can be overwhelming. With time you are going to find ways to cope with the distress and uncertainty of cancer. Until then, you may find these suggestions useful.

Learn about the Ewing's sarcoma to make decisions about the care

Ask your son or health care professional of the Ewing's sarcoma, including treatment options. As you learn more, you can feel better about the decision making about treatment options. If your child has Ewing's sarcoma, ask the health care team to guide you in talking with your child about the cancer in a loving way that your child can understand.

Keep friends and family close

Keep your close relationships strong will help you deal with Ewing's sarcoma. Friends and family can help with daily tasks, such as helping to take care of your home if your child is in the hospital. They can serve as emotional support when you feel like you're dealing with more than you can handle.

Ask about mental health support

Speak with a counselor, medical social worker, psychologist or other mental health professional can also help you or your child. Ask your health care team for options for professional mental health support for you and your child. You also can search online for a cancer of the organization, such as the American Cancer Society, which lists the support services.

Preparing for your appointment

If there are signs and symptoms that worry you, start by making an appointment with a health professional for you or your child. If the healthcare provider suspects of Ewing's sarcoma, ask to be referred to a trained specialist.

The Ewing's sarcoma, should normally be treated by a team of specialists, which may include:

  • The orthopedic surgeons who specialize in the operation of the cancers that affect the bones, called orthopedic oncologists.
  • Other surgeons, such as chest of surgeons or pediatric surgeons. The type of board depends on the cancer's location and the age of the person with Ewing's sarcoma.
  • Doctors who specialize in the treatment of cancer with chemotherapy or other medications. May include medical oncologists, or, for children, pediatric oncologists.
  • Doctors who study tissue to diagnose the type of cancer, called pathologists.
  • The medical uses of radiation to treat the cancer, called radiation oncologists.
  • Rehabilitation specialists who can assist in the recovery after the surgery.

What you can do

Before the appointment, make a list of:

  • The signs and symptoms, including any that seem unrelated to the reason for the appointment, and when they began.
  • Any medication that you or your child are taking, including vitamins and herbal supplements, and dosage.
  • Key personal information, including any major stresses or recent life changes.

Also:

  • To bring to, or x-rays, both in the images and reports, and any other medical records that are linked to this condition.
  • Make a list of questions to ask the health care professional to ensure that you get the information you need.
  • Invite a family member or friend to the appointment, if you can, to help you remember the information that is obtained.

For you or for your child, the questions might include, for example:

  • What kind of cancer is this?
  • Has the cancer spread?
  • More proof do you need?
  • What are the treatment options?
  • What are the odds that the treatment is going to cure this type of cancer?
  • What are the side effects and risks of each treatment option?
  • It influences the treatment to be able to have children? If so, does it offer ways to be able to preserve that ability?
  • Are there brochures or other printed material I can have? What websites do you suggest?

What to expect from your doctor

Your healthcare provider is likely to ask you questions, such as:

  • What are the signs and symptoms that concern you?
  • When did you notice these symptoms?
  • Do you always have symptoms, or come and go?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Ewing sarcoma