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
the ages 10 and 19. It usually 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 and pelvis, chest, and arms
- Soft tissue of the torso, arms, and legs
What causes Ewing sarcoma in a child?The exact cause of Ewing sarcoma is not known. The cancer may be caused by changes
in the DNA of the cells. These changes are not passed on from parents to children.
They happen by chance.
What are the symptoms of Ewing sarcoma in a child?
Symptoms can occur a bit differently 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
- Weight loss
- Feeling tired
The symptoms of Ewing sarcoma can be like other 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.
He or she 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.
- CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.
- MRI. This test uses large magnets, radio waves, and a computer to make detailed images
of the inside of the body.
- Bone scan. A small amount of radioactive dye is injected into a vein. The whole body is 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 injected into the bloodstream. Cancer cells
use more sugar than normal cells, so the sugar will collect in cancer cells. A special
camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes
spot cancer cells in different areas of the body, even when they can’t be seen by
other tests. This test is often used in combination with a CT scan. This is called
a PET/CT scan.
- Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small
amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone
marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from
the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
- Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut
(incision). It is checked under a microscope for cancer cells. A biopsy is needed
to diagnose sarcomas.
After a diagnosis of Ewing sarcoma, your child may have other tests. These help the
healthcare providers learn more about the cancer. They will show how much and how
far the cancer has spread (metastasized) in your child's body. A stage grouping is
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 advanced the cancer is. Letters and
numbers can be used after the Roman numeral to give more details.
The stage of a cancer is one of the most important things to know when deciding how
to treat the cancer. Be sure to ask your child's healthcare provider to explain the
stage of your child's cancer to you in a way you can understand.
How is Ewing sarcoma in children treated in a child?
Treatment will depend on the stage and other factors. The cancer can be treated with
any of the below:
- Surgery. Surgery may be done to remove the tumor. Modern surgery methods are often able to
preserve an arm or leg so that it does not need to be amputated. This is known as
limb-salvage or limb-sparing surgery. Surgery is usually followed by chemotherapy
or radiation therapy.
- Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery.
They may also be given after surgery. Your child may have a port or catheter inserted
in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles
with periods of rest.
- 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 a tumor is hard to completely
remove with surgery.
- High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This
is followed by a large amount of chemotherapy medicine. This causes damage to the
bone marrow. After the chemotherapy, the stem cells are replaced. This treatment may
be used when there is a high risk of cancer returning.
- Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for
pain, fever, infection, and nausea and vomiting.
- Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that
may work well for your child.
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 outcome and to lessen side effects.
What are possible complications of Ewing sarcoma in a child?
A child may have complications from the sarcoma or from treatment, such as:
- Infection or bleeding from surgery
- 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
- Learning problems
- Changes in sexual development
- Problems with the ability to have children (fertility) in the future
- Return of the cancer
- Growth of other cancers
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 to 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. 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 his or her treatment in many ways. For example:
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. He or she 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. Find a counselor or child support group can
- 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
- New symptoms
- Side effects from treatment
Key points about Ewing sarcoma in children
- Ewing sarcoma is a rare group of cancers that usually occur in the bone, but can also
occur in soft tissue.
- X-ray and other imaging tests may be used in diagnosing Ewing sarcoma. A biopsy is
needed to make a definite diagnosis.
- Ewing sarcoma is treated with chemotherapy followed by surgery and/or radiation therapy.
High-dose chemotherapy and stem cell transplant may be used in some children.
- Continuous follow-up care during and after treatment is necessary.
- Many complications can occur from the cancer and from the treatment. The complications
may be short- or long-term.
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:
- Levy, Adam S, MD
- Stump-Sutliff, Kim, RN, MSN, AOCNS