Ewing's Sarcoma

Many types of cancer affect adults more frequently than children, but this is not the case with Ewing's sarcoma. This tumor occurs more often in teenagers than in people of other age groups. Nonetheless, the American Cancer Society reports that Ewing's sarcoma is rare. According to the American Cancer Society, about 225 children and adolescents in the United States each year find out they have a TEF. Of those who are diagnosed with a TEF, four-fifths are white, nearly two-thirds are between the ages of 10 and 20 years old, and more than 50 percent are male. All told, Ewing's sarcoma makes up 2 percent of all teen cancers. It is not contagious.

A typical symptom of Ewing's sarcoma is pain, sometimes accompanied by swelling, at the site of the tumor. Depending on the position of the tumor and how near it is located to nerves, the pain can be quite severe. Often, the tumor is located in the middle of the upper arm bone (the humerus) or the upper leg bone (the femur), but tumors may also be located in the area between the two hips (the pelvis), in the chest, or in the back. A lump may appear at the site of the tumor, and the patient may feel warmth at the site. Also, tumors that are located near nerves can cause patients to feel numbness or tingling and can occasionally cause paralysis * or incontinence * .

In addition to these symptoms, a patient may experience a fever, fatigue, little or no appetite, and weight loss. Occasionally individuals with Ewing's sarcoma break a bone, although they have had no accidents or other injuries that would cause a broken bone. Such a break happens because the disease weakens bone. Sometimes individuals have no other symptoms of a tumor until a bone breaks, and this broken bone is what leads a doctor to diagnose the tumor. In some cases, individuals may have a tumor for many months before it begins to cause symptoms because a tumor starts out small and grows over time. Individuals may have no symptoms when the tumor is small but may begin to experience pain or swelling when the tumor gets larger.

After hearing about the symptoms an individual is having, a doctor may order a number of tests to look more closely at the affected area, including x-rays, bone scans, magnetic resonance images * , and CT scans * . If the results point to a tumor, the doctor then conducts a biopsy (BY-op-see) to remove a tiny piece of tissue. A medical professional then looks at the sample carefully using a microscope to determine whether there is evidence of cancer. In addition, doctors may conduct tests to look at chromosomes 11 and 22 to discover whether they are translocated.

After Ewing's sarcoma is diagnosed, the doctor may order additional tests to ascertain whether cancer has spread from the site of the tumor to other areas of the body. This information helps the doctor decide how to treat the disease. If Ewing's sarcoma has spread, it usually moves into the lungs first. It may also move into other bones or into the bone marrow * .

The treatment for Ewing's sarcoma usually involves chemotherapy * , radiation therapy * , and surgery. Radiation or surgery is the typical treatment for tumors that have not spread elsewhere. Usually a doctor's first choice is to remove the tumor surgically. Sometimes, however, doing so proves difficult because the tumor is located in an area where surgical removal may harm the patient's use of an associated body part. In this case, doctors may opt for radiation therapy to kill the tumor cells, or a combination of surgery and radiation. For instance, if surgery does not remove the tumor entirely, then radiation may be prescribed to treat the leftover tumor. Also, doctors sometimes use radiation to make sure the cancer does not return.

Doctors turn to chemotherapy especially when the tumor has spread, because chemotherapy kills both tumor cells, additional cancer cells, and other cells throughout the body. Doctors monitor the tumor continuously during the patient's course of chemotherapy to determine whether the tumor is shrinking. When the tumor has shrunk sufficiently, a surgeon may remove it.

During surgery for Ewing's sarcoma, doctors remove the tumor and make repairs at the tumor site. These repairs may include reconstructing the bone or joint, and perhaps using artificial joints or bone grafts * . A bone graft is new bone or another material, such as a metal rod, that replaces the bone that was removed during surgery. These artificial joints and bone grafts, along with physical therapy after the surgery, help individuals return to many of their normal activities. Doctors tell patients to avoid athletic exercise and any other movements that may put stress on the repaired bones or joints. Occasionally patients need additional operations later in life to keep bones and joints functioning properly. Subsequent operations occur often among children, whose bones are still developing. Doctors may need to do several surgeries to lengthen the repaired bone as the child grows.

Until the late 20th century, amputation * of an arm or leg was a common treatment for Ewing's sarcoma. With the improvement in chemotherapy treatments and surgery, doctors can remove the tumors in most patients without having to amputate a limb. However, some patients with Ewing's sarcoma must have a limb amputated. After an amputation, individuals typically receive an artificial limb, called a prosthesis, and work with physical and occupational therapists to learn how to use it to its greatest advantage.

Even after individuals have had the tumor removed, they still have to return for follow-up care to ensure that the tumor is indeed gone. This care may include additional diagnostic tests, such as x-rays or bone scans. Overall, the survival rate for Ewing's sarcoma varies greatly and depends, to a great extent, on many factors, including the following:

In addition to these treatments, a doctor may recommend psychological therapy to help individuals cope with the disease and its effect on their life. Teenagers especially may benefit from psychological therapy because they are dealing with adolescent issues that are also quite challenging.

As of 2015, researchers knew of no way to prevent people from developing Ewing's sarcoma.

See also Cancer: Overview • Tumor