Ewing's sarcoma

Last updated date: 25-Aug-2023

Originally Written in English

Ewing's sarcoma

Ewing’s sarcoma is usually considered one of the rarest types of cancer that develop and affect bones. It can also affect the soft tissues within the bones, including the nerves and cartilages. It’s more common among children aging 10 to 20 but has an increased rate of being treated and cured. Nevertheless, it can also develop at any age. 

Ewing’s sarcoma usually starts in the pelvis and the leg bones but can also develop in any bone within the body. In rare cases, it can occur in the soft tissues within the abdomen, chest, and limbs, among other areas of the body. 


Causes of Ewing’s Sarcoma 

The actual Ewing’s sarcoma causes are not clear. However, medical experts believe that it starts when the cells acquire changes or mutations in the DNA. The DNA usually has an instruction code that informs the cell how to operate. However, DNA changes notify and trigger the cells to divide rapidly and continue surviving even if the healthy cells die. 

This eventually results in a tumor or mass of abnormal cells, which invades and damages the healthy tissues with time. These cells can also break free and metastasize or spread all over the body via the bloodstream. 

In patients with Ewing sarcoma, the DNA mutation usually alters a gene known as EWSR1. Therefore, if the doctor suspects Ewing sarcoma, they can test the cells to determine the changes in the EWSR1 gene. 


Signs and Symptoms of Ewing’s Sarcoma

Ewing’s sarcoma is usually associated with pain, stiffness, or swelling within the region of the tumor for several weeks/ months. It could be the chest, legs, pelvis, or arms. This can sometimes be mistaken for bruises and bumps, while in children, it may appear like sports injuries. 

Signs and Symptoms of Ewing’s Sarcoma

Other common Ewing’s sarcoma symptoms and signs include;  

  • A lump that forms close to the skin and has a soft and warm feeling when touched 
  • Limping caused by pain in the legs 
  • Frequent low fever
  • Bone breakage or fracture without an apparent cause 
  • Unexplainable loss of weight 
  • Bone pain that worsens when exercising or at the night 
  • Fever without an actual cause
  • Unexplainable tiredness 


Risk Factors of Ewing’s Sarcoma 

Some of the factors that increase the risks of developing Ewing’s sarcoma include; 

Age: Even though Ewing’s sarcoma can develop at any age, young children and adolescents are at a higher risk. 

Origin: Ewing’s sarcoma is less common among individuals from East Asia and Africa. However, it’s more prevalent in individuals from Europe. 


Diagnosing Ewing’s Sarcoma

To determine if you are suffering from Ewing’s sarcoma, the doctor can conduct several tests and examinations. They can also perform a staging test to determine if the tumor has metastasized to other areas and the extent. 

Overall, some of the common diagnostic tests and procedures include; 

  • Physical examination 

When diagnosing Ewing’s sarcoma, the doctor always begins with a physical examination. This enables them to understand the signs and symptoms you are currently experiencing. Through this, they can also assess the painful body part for signs like redness, swelling, and lumps. 

  • Imaging tests

Imaging tests enable the medical provider to analyze the symptoms within the bone. It also makes it easy to identify cancer and check for signs that show if it has spread to other parts. 

These imaging tests can include; 

X-rays: Doctors can use x-ray technology to capture images of specific parts of the body they suspect a tumor. In case the results indicate an abnormality, they can opt for other additional imaging tests.  

Computerized tomography (CT) scan: This procedure also requires you to lie flat in the CT scanner. It will then capture images of the internal organs and display them in the computer linked to it. However, most doctors may prefer MRI over this method.

Magnetic resonance imaging (MRI): This test uses radio waves and strong magnetic fields to produce clear, detailed images of the inner body parts. When performing an MRI test, the doctor will ask you to lie flat and remain still on a special table that slithers inside the MRI machine, usually tubal-shaped.  

Magnetic resonance imaging (MRI)

Positron emission tomography (PET) scan: This method involves an injection of a small quantity of radioactive sugar through the vein as you lie in the PET scanner. The cancerous cells will be brighter in the scan. This is because they utilize more sugar as compared to the normal cells. 

Bone scan: This test enables the doctor to check for cancerous cells within the bones. It involves an injection of a small quantity of radioactive dye into the vein. The injectable dye will accumulate in the bones with tumors. Hence, it makes it easy to detect the presence of tumors or cancer cells. 

  • Biopsy 

Doctors often use this technique to obtain samples from the suspicious cells for further testing and analysis in the lab. The outcome will indicate if the cells are cancerous and the exact kind of cancer. 

Basically, there are two categories of biopsy that doctors can use to detect Ewing’s sarcoma. They include; 

Needle biopsy: This is done by inserting a small thin needle into the skin and guiding it towards the location of the tumor. Once in position, the doctor will pull out some tissues and take them to the lab for testing. 

Surgical biopsy: This involves creating an incision in the skin and surgically removing a section or the whole tumor. Removal of a small area of the tumor is referred to as an incisional biopsy. On the other hand, extraction of the entire tumor is an excisional biopsy. 

  • Bone marrow aspiration and biopsy 

This is a procedure to remove a small amount of the bone marrow tissue and fluid, particularly from a section of the hip bone. The sample is then examined under a microscope to check if cancer has metastasized to the bone marrow. 


Treatment of Ewing’s Sarcoma 

When treating Ewing’s sarcoma, there are several factors that the doctor often considers. It includes; 

  • The origin and location of the tumor
  • The size and extent or how far cancer has spread
  • The overall health, age, and medical history of the patient
  • Tolerance to certain medications, treatment procedures, and therapies 
  • The patient’s preference or choice 
  • Overall goals and expectations after the treatment 

In general, the Ewing’s sarcoma treatment can include one or more of the following approaches; 

  • Chemotherapy 

Chemotherapy is a treatment form that uses strong medications to destroy cancerous cells. It usually involves a combination of two or more medications. The doctor can administer these drugs either in the form of pills, through the vein as an infusion, or sometimes both.  

In most cases, chemotherapy is usually the first treatment option for Ewing’s sarcoma. This is because it shrinks the cells or tumor, making it easy to extract through other treatment alternatives. It can be through radiation therapy or a surgical procedure. 

At times, even after radiation therapy or surgery, the doctor can still administer chemotherapy treatment. This helps destroy any cancerous cells that might have remain during the initial treatment. 

Apart from killing the cancer cells, chemotherapy has an additional benefit to the advanced type of Ewing’s sarcoma. It includes easing associated pain and slowing down the growth or progress of cancer. 

  • Radiation therapy 

This type of treatment utilizes high-energy beams, including protons and x-rays, to destroy the cancerous cells. Radiation therapy treatment involves using a special machine that rotates around the body while lying on a table. The doctor will carefully direct the beams into the specific area with the tumor. This is to minimize the risk of damage to the nearby cells. 

Sometimes, the doctor can recommend radiation therapy treatment following surgery to destroy the cancerous cells left behind. Alternatively, it can be administered instead of a surgical procedure, especially if the tumor is located in a sensitive area. In such a case, a surgical operation is impossible since it might cause problems like loss of bladder functionality. 

In addition, radiation therapy helps slow down cancer growth, especially in advanced Ewing’s sarcoma. It can also help ease the pain caused by the condition.  

  • Surgery 

Surgical treatment is an effective treatment option for addressing Ewing’s sarcoma. This treatment aims to take out all the cancerous cells or tumors. However, before opting for the procedure, it’s essential to consider factors like its impacts on your overall life and how to go about it. 

When performing the surgery, the doctor can either remove a small section of the bone or the whole limb. However, regardless of the treatment approach, there are several factors to put into consideration. It can be the location of the tumor, the size or shape, and if it shrinks following chemotherapy treatment. 



Although rare, Ewing’s sarcoma is a chronic health condition that mostly affects children and teenagers. It mainly begins and impacts the bone and the soft tissues around the bones. Some of the symptoms associated with this condition include fever, swelling, and pain. 

CloudHospital aims at helping and caring for all the patients with Ewing’s sarcoma. It works with medical experts from renowned healthcare facilities who focus on meeting the needs and requirements of both children and adults.