We have expertise in diagnosis and treatment protocols for childhood cancers and blood disorders. We participate in current national clinical trials through the Children’s Oncology Group (COG).
Contact Us for specific information about your child’s health.
What is Ewing sarcoma in children?
Ewing sarcoma is a rare type of cancer. It’s most common in children and teens between
ages 10 and 19. It often grows in bone, but it can also grow in soft tissue that’s
connected to the bone. This may include tendons, ligaments, cartilage, or muscles.
Ewing sarcoma most often grows in:
Bones of the legs, hips (pelvis), and chest (such as the ribs or shoulder blades)
Soft tissue of the torso, arms, and legs
What causes Ewing sarcoma in a child?
The exact cause of Ewing sarcoma isn't known. The cancer is caused by changes in the
DNA of the cells. These changes aren't passed on from parents to children. They happen
What are the symptoms of Ewing sarcoma in a child?
Symptoms can vary in each child. They can include:
Pain around the site of the tumor that may come and go, but gets worse over time and
Swelling around the site of the tumor
A lump (mass)
A bone breaks for no known reason
The symptoms of Ewing sarcoma can be like other, more common health conditions. Make
sure your child sees a healthcare provider for a diagnosis.
How is Ewing sarcoma in children diagnosed in a child?
Your child's healthcare provider will ask about your child's health history and symptoms.
They will examine your child. Your child may be referred to a specialist. This may
be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic
oncologist). Your child may have tests such as:
X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body
Blood tests. The blood may be tested to look for signs of Ewing sarcoma. They also help get an
idea of your child's overall health.
CT scan. This test uses a series of X-rays and a computer to make detailed images of the inside
of the body.
MRI. Large magnets, radio waves, and a computer are used to make detailed images of the
inside of the body.
Bone scan. A small amount of radioactive dye is put into your child's blood through a vein. The
whole body is then scanned. The dye shows up in areas of bone where there may be cancer.
Positron emission tomography (PET) scan. For this test, a radioactive sugar is put into the blood. Cancer cells use more of
the sugar than normal cells, so it collects in cancer cells. A special camera is used
to see where the radioactive sugar is in the body. A PET scan can sometimes find cancer
cells in other parts of the body, even when they can’t be seen by other tests. This
test is often combined with a CT scan. This is called a PET/CT scan.
Bone marrow aspiration or biopsy. Bone marrow is the spongy center of some bones. It’s where blood cells are made. A small
amount of bone marrow may be taken out with a needle. This is called aspiration. Or
a solid core bone marrow tissue may be taken. This is called a core biopsy. Bone marrow
is most often taken from the hip bone. This test may be done to see if cancer cells
have spread into the bone marrow.
Tumor biopsy. A biopsy is done by taking out a small piece (sample) of the tumor. It might be done
with a needle or by a surgical cut (incision). The sample is sent to a lab and tested
for cancer cells. A biopsy is needed to diagnose sarcomas.
After a diagnosis of Ewing sarcoma, your child may need other tests. These help the
healthcare providers learn more about the cancer. They can show how much and how far
the cancer has spread (metastasized) in your child's body. A stage grouping is then
Staging Ewing sarcoma
Stage groupings can have a value of 1 to 4. They are written as Roman numerals I,
II, III, and IV. The higher the number, the more cancer there is and the more it has
spread from where it first started. Letters and numbers can be used after the Roman
numeral to give more details.
More commonly, providers classify Ewing tumor as localized or metastatic.
Localized tumors are only in the bone where they started and maybe in nearby tissues
like muscles or tendons.
Metastatic Ewing sarcoma has clearly spread when looking at imaging scans. Most of
the time, it spreads to other bones, the lungs, or the bone marrow. Less often, it
can spread to the liver or lymph nodes.
The stage of a cancer is one of the most important things to know when deciding how
to treat it. Be sure to ask your child's healthcare provider to explain the stage
of your child's cancer in a way you can understand.
How is Ewing sarcoma in children treated in a child?
Treatment depends on the stage and other factors. Ewing sarcoma can be treated with
any of these. Many times, more than 1 treatment is used:
Surgery. Surgery may be done to remove the tumor. Surgery methods used are often able to save
an arm or leg so that it doesn't need to be amputated. This is called limb-salvage
or limb-sparing surgery.
Chemotherapy (chemo). This treatment uses strong drugs that kill cancer cells. Chemo is often given before
surgery. It may also be given after surgery. Chemo is given in cycles with periods
Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill
cancer cells or stop them from growing. It may be used when it's hard to take out
all of the tumor with surgery.
High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. Then
high doses of chemotherapy are given. This damages the bone marrow. After the chemo,
the stem cells are replaced. This treatment may be used when there's a high risk of
cancer coming back.
Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child. Most children with cancer are treated as part of a clinical
trial. This allows them to get the best treatment available, along with treatments
that are thought to be even better.
With any cancer, how well a child is expected to recover (prognosis) varies. Keep
Getting medical treatment right away is important for the best prognosis. Cancer that
has spread is harder to treat.
Ongoing follow-up care during and after treatment is needed.
New treatments are being tested to improve outcomes and to lessen side effects.
What are possible complications of Ewing sarcoma in a child?
A child may have complications from Ewing sarcoma or from treatment, such as:
Loose or broken grafts or rods from limb-salvage surgery
Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising
and bleeding, and feeling tired from chemotherapy
Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers
Emotional and physical challenges from dealing with the tumor, surgery, or other needed
Heart and lung problems
Problems with growth and development
Changes in sexual development
Problems having children in the future (infertility)
The cancer comes back
Growth of other cancers later in life
How can I help my child live with Ewing sarcoma?
A child with a Ewing sarcoma needs ongoing care. Your child will be seen by oncologists
and other healthcare providers to treat any late effects of treatment and watch for
signs or symptoms of the tumor returning. Your child will be checked with imaging
tests and other tests. And your child may see other healthcare providers for problems
from the tumor or from treatment. For instance, your child may need therapy to help
with movement and muscle strength. This may be done by physical and occupational therapists.
You can help your child manage treatment in many ways. For instance:
Your child may have trouble eating. A dietitian may be able to help.
Your child may be very tired. They will need to balance rest and activity. Encourage
your child to get some exercise. This is good for overall health. And it may help
to lessen tiredness.
Get emotional support for your child. A counselor, psychologist, or child support
group can help.
Make sure your child attends all follow-up appointments.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
Symptoms that get worse or don't get better with treatment
Side effects from treatment
Signs of infection, such as fever or chills
Shortness of breath
Changes in how urine looks or smells
Your child's treatment team will talk with you about what you should look for and
when to call them. Be sure you know how to get help if you have problems or questions
after office hours or on weekends or holidays.
Key points about Ewing sarcoma in children
Ewing sarcoma is a rare group of cancers that often start in the bone, but can also
start in soft tissue.
X-ray and other imaging tests may be used to diagnose Ewing sarcoma. A biopsy is needed
to make a definite diagnosis.
Ewing sarcoma is often treated with chemotherapy followed by surgery or radiation
therapy. High-dose chemotherapy and stem cell transplant may be used in some children.
Ongoing follow-up care during and after treatment is needed.
Many complications can result from the cancer and from the treatment. These may be
short-term or long-term problems.
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.
Online Medical Reviewers:
- Adam Levy MD
- Kimberly Stump-Sutliff RN MSN AOCNS
- Louise Cunningham RN BSN