Ewing sarcoma

What is Ewing sarcoma?
Ewing sarcoma is the second most common type of bone cancer, after osteosarcoma. This tumor usually attacks the long bones of the arms, legs, pelvis and chest wall. Ewing sarcoma can also affect soft tissue (known as extraosseous Ewing sarcoma). This type of soft tissue tumor is found in the torso, arms, legs, head, and neck. It is seen both in adolescents and in adults.

What causes Ewing sarcoma?
The exact cause of Ewing sarcoma is not known, however some specific genetic abnormalities may increase the risk of developing it.

What are the symptoms of Ewing sarcoma?
• Pain and/or swelling, in the affected location. The pain increases at night, is not related to physical activity, and does not respond to over-the-counter painkillers, like Panadol.
• A lump felt at the affected bone. Usually the lump is felt 2-3 months after the onset of pain.
• A bone that breaks for no known reason.
• If the tumor is close to a joint, limited movement may be noticed.
• Some patients experience fever and fatigue and in more advanced cases - weight loss.

How is Ewing sarcoma diagnosed?
At KHCC Ewing sarcoma is mainly diagnosed by taking an x-ray of the bone and by performing a biopsy. A biopsy removes a sample of bone and tissue to further examine in a lab for abnormalities. Biopsies for any bone tumor at KHCC are performed by an experienced orthopedic oncologist or interventional radiologist to prevent contamination of healthy tissue. An MRI scan of the affected limb is necessary to estimate the local extension of the disease, while a chest CT scan is needed to evaluate for any possible spread of the disease to the lungs. A bone scan is also needed to evaluate the spread of disease to other bones. Bone marrow biopsies are also taken to rule out the spread of cancer in the bone marrow.

How is Ewing sarcoma treated at KHCC?
The treating physician will present the case to the MDC panel who will determine the right treatment for the patient depending on how much the cancer has spread throughout the body.

Chemotherapy is the standard treatment for this type of disease. After 4 or 5 cycles of chemotherapy, surgery is usually performed to remove the tumor. At KHCC, surgeons are experienced in limb salvage surgery, which aims to remove the tumor completely without having to amputate the affected limb. What makes Ewing sarcoma unique to other bone cancers is its sensitivity to treatment with radiation. In central tumors, like those that occur in the pelvis, radiotherapy is given with good results. In cases of lung metastasis (spread of cancer to the lungs), radiotherapy to the lung may be effective.

At KHCC, Ewing sarcoma patients receive top quality care through a multidisciplinary team of specialists highly experienced in treating all types of sarcoma.
Supportive Care
The sarcoma multidisciplinary clinic works in close cooperation with other departments at KHCC so that sarcoma patients receive the most comprehensive care possible. Supportive care services at KHCC include: