Source: National Cancer Institute Research, www.cancer.gov
Ewing sarcoma is a type of tumor that forms from a certain kind of cell in bone or soft tissue. Other names for Ewing sarcoma are:
All of these names may be grouped together and called Ewing sarcoma family of tumors.
Ewing sarcoma may be found in the bones of the legs, arms, feet, hands, chest, pelvis, spine, or skull. Ewing sarcoma also may be found in the soft tissue of the trunk, arms, legs, head and neck, abdominalcavity, or other areas.
Ewing tumors often occur in teenagers and young adults.
These and other signs and symptoms may be caused by Ewing sarcoma or by other conditions. Check with your child’s doctor if you see any of the following in your child:
The following tests and procedures may be used to diagnose or stage Ewing sarcoma:
Tissue samples are removed during an incisional or needle biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. It is helpful if the biopsy is done at the same center where treatment will be given.
For an incisional or excisional biopsy, the specialists (pathologist, radiation oncologist, and surgeon) who will treat the patient usually work together to decide where the incision should be made. This is done so that the biopsy incision doesn't affect later treatment such as surgery to remove the tumor or radiation therapy.
If there is a chance that the cancer has spread to nearby lymph nodes, one or more lymph nodes may be removed and checked for signs of cancer.
The following tests may be done on the tissue that is removed:
The prognosis (chance of recovery) depends on certain factors before and after treatment.
Before treatment, prognosis depends on:
After treatment, prognosis is affected by:
Treatment options depend on the following:
Decisions about surgery may depend on how well the initial treatment with chemotherapy or radiation therapy works.
The process used to find out if cancer has spread from where it began to other parts of the body is called staging. There is no standard staging system for Ewing sarcoma. The results of the tests and procedures done to diagnose Ewing sarcoma are used to group the tumors into localized or metastatic.
Ewing sarcoma is described as either localized or metastatic.
The cancer is found in the bone or soft tissue in which it began and may have spread to nearby tissue, including nearby lymph nodes.
The cancer has spread from the bone or soft tissue in which it began to other parts of the body. In Ewing tumor of bone, the cancer most often spreads to the lung, other bones, and bone marrow.
Cancer can spread through tissue, the lymph system, and the blood:
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if Ewing sarcoma spreads to the lung, the cancer cells in the lung are actually Ewing sarcoma cells. The disease is metastatic Ewing sarcoma, not lung cancer.
RecurrentEwing sarcoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the tissues where it first started or in another part of the body.
Different types of treatments are available for children with Ewing sarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with Ewing sarcoma and who specialize in certain areas of medicine. These may include the following specialists:
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
The type of chemotherapy given depends on whether the cancer is found only in the place it first formed, has spread to other parts of the body, or has come back after treatment.
Chemotherapy is part of the treatment for all patients with Ewing tumors. It is usually given to kill any tumor cells that have spread to other parts of the body. Chemotherapy may also be given to shrink the tumor before surgery or radiation therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
External radiation therapy is used to treat Ewing sarcoma.
Radiation therapy is used when the tumor cannot be removed by surgery or when surgery to remove the tumor will affect the way the child will look or important body functions. It is used to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. It may also be used to treat tumors that have spread to other parts of the body.
Surgery is usually done to remove cancer that is left after chemotherapy or radiation therapy. When possible, the whole tumor is removed by surgery. Tissue and bone that are removed may be replaced with a graft, which uses tissue and bone taken from another part of the patient's body or a donor. Sometimes an implant, such as artificial bone, is used.
Even if the doctor removes all of the cancer that can be seen at the time of the operation, chemotherapy or radiation therapy may be given after surgery to kill any cancer cells that are left. Chemotherapy or radiation therapy given after surgery to lower the risk that the cancer will come back is called adjuvant therapy.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
This treatment is a way of giving high doses of chemotherapy to kill cancer cells and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Monoclonal antibodytherapy is a type of targeted therapy being studied in the treatment of recurrent Ewing sarcoma. Monoclonal antibodies are made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Kinase inhibitor therapy is another type of targeted therapy being studied in the treatment of recurrent Ewing sarcoma. Kinase inhibitors are drugs that block a protein needed for cancer cells to divide.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
The treatment of localizedEwing sarcoma always includes chemotherapy. Surgery, radiation therapy, or both may also be used. The treatments and the order they are given in depends on the following:
See the Treatment Option Overview section of this summary for more information about surgery, chemotherapy, and radiation therapy used to treat children with Ewing sarcoma. New ways of giving combination chemotherapy are being studied for localized Ewing sarcoma.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized Ewing sarcoma/peripheral primitive neuroectodermal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
The treatment of metastaticEwing sarcoma always includes chemotherapy. Surgery, radiation therapy, or both may also be used. The treatments and the order they are given depends on the following:
See the Treatment Option Overview section of this summary for more information about surgery, chemotherapy, and radiation therapy used to treat children with Ewing sarcoma. Chemotherapy followed by radiation therapy or stem cell transplant is being studied for Ewing sarcoma that has spread to the lung only.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic Ewing sarcoma/peripheral primitive neuroectodermal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
Treatment of recurrentEwing sarcoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent Ewing sarcoma/peripheral primitive neuroectodermal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about Ewing sarcoma, see the following:
For more childhood cancer information and other general cancer resources, see the following: