Ewing sarcoma makes up 14% of all bone sarcoma diagnoses.
It most commonly affects teenagers and young adults with the pelvis, thigh bone and shin bone being the most commonly affected areas.
In rare cases, Ewing sarcoma can develop in the soft tissue around the bone, this is called soft-tissue sarcoma.
Signs and symptoms
Symptoms of bone sarcoma can vary depending on the size and location of your tumour.
- Bone pain, particularly occurring at night
- A mass or swelling
- Restricted movement in a joint
Symptoms can sometimes be confused with more common problems such as a sports injury or in children and young people, growing pains.
Your doctor will examine you. You may have one or more of these tests:
- MRI scan – uses magnets to create an image of the tissues of the body
- PET scan – shows up changes in tissues that use glucose as their main source of energy – for example, the brain or heart muscle. It involves an injection of a very small amount of a radioactive drug into the body. The drug travels to places where glucose is used for energy and shows up cancers because they use glucose in a different way from normal tissue
- CT scan – takes a number of x-rays to make a 3D image of an affected area
- X-ray – uses x-radiation to take images of dense tissues inside the body such as bones or tumours
- Bone scan – shows up changes or abnormalities in the bones. A small amount of radioactive material is injected into your veins before having a scan
- Blood test – laboratory analysis of a blood sample
To read more about scans and tests, click here.
The first treatment method for Ewing’s sarcoma is chemotherapy, which uses anti-cancer drugs to destroy cancer cells. It is sometimes used before surgery to reduce the size of the tumour so it can be operated on and removed. Chemotherapy is also sometimes used after surgery, and aims to kill off any local cancer cells which remain in the area of the tumour.
Some patients will receive limb-sparing surgery, which involves taking out the affected bone and replacing it with a bone graft (bone taken from another part of the body).
Sometimes the cancer may spread from the bone to the nerves and blood vessels around it. If the cancer spreads, the only way to treat cancer may be to remove part of the limb known as a partial amputation.
Some people may need to have all of their limb removed. This is called a full amputation.
Tumours in the pelvis can sometimes be hard to remove with surgery. You may be given chemotherapy first, then surgery to get rid of all of the cancer. You may also receive radiotherapy after surgery to get rid of any cancer cells still in the area. Pelvic bones can sometimes be reconstructed after surgery, either by a bone graft or using a prosthesis. Unfortunately, in some cases pelvic bones and the leg they are attached to might need to be removed, this is called a hind-quarter amputation.
For a tumour in the lower jaw bone, the entire lower half of the jaw may be removed. This may be reconstructed using bones from other parts of the body. If the surgeon can’t remove all of the tumour, radiation therapy may be used as well.
If your tumour is in the spine or the skull, it may not be possible to remove all of the tumour safely. Sarcoma in these bones may require a combination of treatments such as chemotherapy, surgery, and radiation.
Radiotherapy uses high-energy radiation beams to destroy cancer cells. It is effective in treating Ewing’s sarcoma and can be used before or after surgery. It is sometimes used alongside chemotherapy, particularly if the tumour is in a site where removing it surgically is very difficult or surgery may be very disabling.
After treatment for sarcoma you may benefit from rehabilitation services, such as occupational therapy, physiotherapy, dieticians, orthotics and prosthetics.
Rehabilitation usually starts after treatment. However, with bone sarcoma you may find that it helps to start rehabilitation earlier.
You may find that you are not automatically offered a referral to rehabilitation services by your medical team, so it is important to ask at the earliest opportunity for a referral.
You can read more about rehabilitation services here.
A recurrence of cancer may appear in other parts of the body. This is called a metastasis or secondary cancer.
In people with bone sarcoma, these secondary cancers may appear in the lungs. A chest x-ray is taken at follow-up appointments to look for secondary cancers in the lung.