This page explains the symptoms, diagnosis and treatment of Ewing sarcoma in teenagers and young adults. It has specific information about symptoms, diagnosis and treatment for people in this age group.
What is Ewing sarcoma?
Ewing sarcoma is a type of cancer that starts in bones (primary bone cancer). It is more common in teenagers and young adults than in older adults.
It most often affects the:
- pelvis
- thigh bone (femur)
- shin bone (tibia)
- ribs
- shoulder blades.
Sometimes Ewing sarcoma starts in the soft tissue near a bone. This is called extraosseous Ewing sarcoma (EES). You may also hear it called soft tissue Ewing sarcoma. Sometimes these cancers are called primitive neuroectodermal tumours (PNETs).
These are usually treated in the same way as Ewing sarcoma that starts in the bone.
Symptoms of Ewing sarcoma
Symptoms of Ewing sarcoma in teenagers and young adults depend on which part of the body the tumour starts in.
People often notice:
- bone pain that does not go away and may be worse at night
- swelling or a lump
- stiffness or problems moving a joint.
Many people mistake symptoms for other things, such as strains, sports injuries or growing pains. If you have any of these symptoms or you are worried, you should see your doctor for a check-up.
Diagnosing Ewing sarcoma
If you have symptoms that could be bone cancer, your GP will examine you and may refer you to a specialist bone team. The specialist team will use different scans and tests to see if you have Ewing sarcoma.
You might have one or more of these tests:
- X-ray: uses X-radiation to take images of dense tissues inside the body, such as bones or tumours.
- MRI scan: uses magnets to create an image of the tissues of the body.
- core needle biopsy: a small sample of bone taken with a needle.
- PET-CT scan: combines a CT scan with a positron emission tomography (PET) scan. A small amount of radioactive material is injected into a vein before the scan. It can help show where the cancer is in the body and whether it has spread.
This may feel like a lot of tests, but they help doctors plan the best treatment for you. We have more information about the different types of scans and tests you might have.
Treating Ewing sarcoma
Most people with Ewing sarcoma have a combination of chemotherapy, surgery, and radiotherapy. You and your team of specialists will discuss these options before starting any treatment. If you have any questions about your treatment, ask your doctor or nurse.
Chemotherapy
Chemotherapy is a medicine that kills cancer cells.
Most people have chemotherapy before surgery to shrink the tumour, and after surgery to reduce the risk of it coming back.
Your team will explain possible side effects and how they can help manage them.
Surgery in the arms or legs
If you have Ewing sarcoma in one of your arms or legs, the surgeon will try to remove the tumour without removing your arm or leg. This is called limb-sparing surgery.
The surgeon removes the affected part of bone and may replace it with either:
- a metal implant (prosthesis)
- bone from another part of your body, or from someone else (bone graft).
If the cancer affects a bone in or near to a joint, the surgeon can often replace the joint with an artificial one.
In rare cases, the surgeon may recommend removing your arm or leg (amputation). This is to make sure all the cancer has been removed. It may also be done if the surgeon thinks that limb-sparing surgery may affect how well the limb can move or be used.
Surgery in the pelvis
If you have Ewing sarcoma in your pelvis, your specialist team will plan treatment for the area where the cancer is. They may use radiotherapy, surgery, or a combination of both. Your team will talk with you about the best option for you.
If you have surgery, the surgeon will remove the cancer from the bone. They will also remove a small area of healthy tissue around it. This helps reduce the risk of the cancer coming back. This is called taking a margin.
After surgery, the pelvis may be rebuilt. This is called reconstruction. The surgeon may use bone from another part of your body. This is called a bone graft.
Radiotherapy
Radiotherapy uses high-energy radiation to destroy cancer cells. Ewing sarcoma can respond well to radiotherapy.
You may have radiotherapy:
- before surgery
- after surgery
- instead of surgery, if surgery is not possible
- to treat cancer that has spread to other parts of the body.
Some people may have proton beam therapy (PBT). This is a specialist type of radiotherapy available in certain centres. Your specialist team will tell you if PBT is suitable for you. We have more information about PBT.
Where you may be treated
Different specialist teams treat teenagers and young adults with Ewing sarcoma.
In some centres, children and young people are treated at a children’s cancer centre. In other centres, they are treated in a Teenage and Young Adult (TYA) cancer unit.
Your age, the type of treatment you need, and where you live can all affect where you are treated. Your specialist team will talk to you about the best place for your care.
TYA units have staff who understand the needs of teenagers and young adults.
Fertility and future family planning
Some treatments for Ewing sarcoma can affect fertility. This includes chemotherapy and some types of radiotherapy. This means treatment may affect your ability to have children in the future.
Before treatment starts, your team will talk to you about this. They will explain if there is any risk to fertility.
They may also talk to you about fertility preservation. This is when eggs, sperm, embryos, or ovarian tissue may be stored for the future.
If you are worried about fertility or having children later in life, tell your doctor or specialist nurse. They can give you more information and support.
After treatment
After your treatment for Ewing sarcoma is finished, you will have follow-up appointments for several years. This is where your doctor can look for signs of sarcoma coming back.
During follow-up, you will have:
- a chance to discuss symptoms
- examinations to look for any signs of sarcoma returning
- imaging scans such as a CT or MRI
- chest X-rays to check whether the cancer has spread to the lungs
- a chance to talk about how you’re feeling and any worries you have.
We know that some people can feel uncertain or overwhelmed when treatment finishes, and that is completely normal. We have more information about living with and beyond sarcoma.
Recurrence
Ewing sarcoma can sometimes come back in the same area after treatment. This is called a local recurrence.
Sometimes Ewing sarcoma can spread to other parts of the body. This is called metastasis or secondary cancer. The most common areas where it can spread are the lungs, other bones, or soft tissue. Because of this, you may have chest X-rays or other scans during your follow-up appointments. These help your team check for any signs of the cancer returning or spreading.
If the cancer does come back or spread, your specialist team may offer more treatment. This may include chemotherapy, surgery, or radiotherapy. Your team will plan your treatment based on your individual situation.
It is useful to check for recurrences yourself through self-examination. Your doctor or sarcoma clinical nurse specialist can tell you what to look for.
It’s normal to feel worried that sarcoma might come back after treatment. Many people feel this way. If you’re feeling anxious, speak to your healthcare team. They can reassure you, answer your questions, and help you find support.
We have more information about if sarcoma comes back.
Living with Ewing sarcoma
Living with Ewing sarcoma as a teenager and young adult can be hard. We have more information about support for children, teenagers and young people. Whatever you’re worried about, we’re here to support you.
If you have any more questions about sarcoma, or if you need to talk to someone, our Support Line team are here for you.
More support
Call the Sarcoma UK Support Line
The Sarcoma UK Support Line is here for every person affected by sarcoma. Contact us for friendly, expert, confidential and free advice on anything to do with sarcoma.
Support groups
There are a number of sarcoma support groups across the UK. We have more information about support groups available online and in your local area.
Order our bone sarcoma booklet
Our booklet includes more information about bone sarcoma. Order our bone sarcoma information booklet on our shop, for free.
Other organisations
- Bone Cancer Research Trust: The BCRT offers support for people with primary bone cancer. They have health information and support available.
- Maggie’s: Maggie’s is a charity that offers advice and support for adults and young people living with cancer.
- Teenage Cancer Trust: Teenage Cancer Trust supports people aged 13 to 24. It has information about cancer and a range of support, events, and tools.
- The Children and Young People’s Cancer Association (CCLG): CCLG has information for children and young people with cancer.
- Trekstock: Trekstock provides support and services for people affected by cancer in their 20s and 30s.
- Young Lives vs Cancer: Young Lives vs Cancer provides clinical, practical and emotional support for children, teenagers, and young people with cancer. They have a Live Chat, phone, or email support service.
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Last reviewed July 2026 | Next review due July 2029
All references are available upon request. Please email info@sarcoma.org.uk
