Ewing’s sarcoma is an aggressive type of bone and soft tissue cancer that primarily affects children and teenagers. The prognosis is good if the cancer is caught in the early stages before it’s spread. Fortunately, this type of cancer is rare, occurring in approximately one out of every million people in the United States. However, 10 cases per million people, include adolescents between the ages of 10 and 19, resulting in 200 cases diagnosed annually. Here is an overview of the signs and symptoms of Ewing’s Sarcoma.
Carcinoma and Sarcoma
There are two main types of cancer: carcinoma and sarcoma. The former is the most common type of cancer. Carcinomas develop in the epithelial cells, which surround internal organs and line the surfaces of the body, including the skin, urinary tract, and blood vessels.
These cells provide a protective barrier against outside forces, such as bacteria and viruses. Epithelial cells are shaped like columns when viewed under a microscope. Carcinomas typically affect the mucous membranes and skin. Basal cell, squamous cell, transitional cell carcinomas and adenocarcinoma are the most common types of epithelial cancers.
Sarcomas develop in the mesenchymal cells in the bones and soft tissues, including the tendons, muscles, and blood vessels. Mesenchymal cells are multipotent stromal cells that have the ability to differentiate into other types of cells.
These cells include osteoblasts in the bone, myocytes in the muscles, chondrocytes in cartilage, and adipocytes in fat cells. Stromal cells are connective-tissue cells within the organs, including the lymph nodes, prostate, ovary, and uterus.
Sarcoma tumors develop in the bone, cartilage, joints, tendons, ligaments, muscles, fat, nerves, and blood vessels. There are over 75 types of sarcomas, with most occurring in the legs, arms, and abdomen. 87% of Ewing’s sarcoma occurs in the bones. Approximately 90% of all types of cancer are carcinoma, with sarcoma being much more rare.
Other types of sarcomas include:
- Undifferentiated pleomorphic sarcoma – develops simultaneously in the bones and soft tissue
- Leiomyosarcoma – cancer of the smooth muscles cells in the GI tract, uterus, and blood vessels
- Lipsosarcoma – develops in fat cells
- Osteosarcoma – cancer of the bone cells
- Peripheral primitive neuroectodermal tumor (pPNET) – a type of tumor that develops in the nerves in various parts of the body.
The human body is made up of trillions of cells. These cells are constantly growing, dividing, and replacing old, damaged cells. When this process is hindered, cancer can develop. When old cells are no longer replaced by new cells, they can divide uncontrollably to form tumors.
Tumors are abnormal growths of tissue, or malignant masses, caused by the proliferation, division, and spread of cancer cells. Tumors can be deadly – as they increase in size, malignant cells can break off from the tumor, traveling to other locations in the body via the lymph system or bloodstream. New tumors can then form in new locations, which may be far removed from where the original tumor developed.
Cancer cells can adversely impact the normal cells, blood vessels, and molecules that surround a tumor, enabling tumor growth by creating new blood vessels through a process called angiogenesis. These new blood vessels feed the existing tumor by supplying it with nutrients and oxygen that allow it to grow and thrive. They also remove waste.
Metastatic cancer is cancer that has spread from its original location. Advanced cancers are referred to by the same name as the original cancer. For instance, breast cancer that has spread to the bones or lungs is not referred to as “bone or lung cancer,” but rather “metastatic breast cancer.” The reason for this classification is because metastatic malignancies resemble the original cancer cells at the time of diagnosis.
Ewing’s Sarcoma Diagnosis
Physical exams are used to diagnose Ewing’s sarcoma, along with various other diagnostic testing methods, such as biopsies, bone marrow aspirations, bone scans, X-rays, CT and PET scans, MRIs and blood tests.
The testing methods used depend on several factors, including the type of cancer that is suspected, the location and size of the tumor, if metastases is present, the age of the patient and the symptoms they’re experiencing, along with the general state of their health and the results of previous testing.
A biopsy is a definitive way to determine if cancer is present in the suspected area. Small-tissue samples are taken from the area of growth and sent to a lab for evaluation. Children are typically put under anesthesia for the procedure.
If for some reason a biopsy isn’t able to be taken, other testing methods are used. Blood tests, notably CBC or complete blood counts, analyze red and white blood cells and platelets. Cell abnormalities are red flags for tumor growth and metastases.
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Bone marrow aspiration, combined with biopsy, removes cells from the bone marrow to check for cancer. The procedure is performed under a local, quick-acting anesthetic that is injected into the skin to reduce pain, with the option to use general anesthesia instead.
The liquid portion of the bone marrow is removed during aspiration, with a biopsy immediately following. A biopsy is performed, in case the bone marrow that was extracted during the aspiration, did not contain enough malignant cells to make a diagnosis.
Bone Scans and Imaging Tests
Imaging tests, CT scans, PET scans, and MRIs, take images of internal organs to look for tumors or other abnormalities, along with their size. Specifically for Ewing’s Sarcoma, CT scans of the chest are used to see if there is metastases in the lungs. X-rays use a small amount of radiation to take pictures of tissues and organs in order to detect tumors in the bone.
Bone scans are nuclear imaging tests used to diagnose metastatic bone cancer. Small amounts of a radioactive tracer is injected into a vein, with areas of repair in the body, taking up the most amount of tracer. A radiologist then evaluates the scan for abnormalities in bone metabolism. Areas of bone that contain a tumor appear dark, and are referred to as “hot spots,” whereas, healthy bone is gray.
Causes and Treatment
Ewing’s sarcoma is not an inherited cancer, how it develops is unknown. The disease, does however, correlate to changes seen in certain non-inherited genes that can occur during a person’s lifespan. Two chromosomes, specifically chromosomes 11 and 12, have the ability to exchange genetic material.
This exchange can stimulate cell overgrowth, potentially leading to Ewing’s sarcoma. It’s also surmised that Ewing’s sarcoma may be a secondary cancer in people who have been treated with radiation for a previous cancer. How bone cancer is treated depends on the location and size of the tumor and the degree of metastases.
While there is no standardized treatment for Ewing’s sarcoma, conventional options include surgery, chemotherapy, radiation, stem cell transplants, and targeted proton therapy. Some patients choose to incorporate complementary cancer therapies into their conventional protocols. Immunotherapy, stem cell transplants, and monoclonal antibody therapy are used for metastasized bone cancer.
Symptoms Of Ewing’s Sarcoma
In 1920, Dr. James Ewing, an American pathologist, discovered a type of malignant bone tumor that develops in soft tissue and bone, notably, the ribs, hip bones, shoulder blades, and long bones – including the femur, tibia, and humerus in the upper arm.
It’s common for sarcomas to initially develop in the pelvis or thighbone, potentially metastasizing to other locations in the body, namely the lungs, adrenal glands, liver, bone marrow, kidneys, heart and other soft tissues.
Although, Ewing’s sarcoma can occur at any age, it commonly develops during puberty. This is most likely due to rapid bone growth during this time. More males are affected by the disease than are females. Interestingly, this type of cancer rarely occurs in those of African or Chinese descent. Caucasians are nine times more likely to be diagnosed with Ewing’s sarcoma.
Pain and swelling in the area of tumor growth are the most common symptoms of bone cancer. The area may be warm to the touch and develop a lump on the surface. Other symptoms include:
- chronic low-grade fever
- loss of appetite
- pain that worsens with exercise
- unintentional weight loss
- unexplained fatigue
- feeling unwell
- breaking a bone for no apparent reason
Sarcomas that develop in the pelvis, chest, arms or legs, may have corresponding symptoms related to the specific area affected. For example, a person may have difficulty breathing if the tumor is in the chest area. Treatment is less successful for cancer that has spread, with five-year survival rates hovering around 70%.
Like any type of cancer, Ewing’s sarcoma can be extremely frightening, and particularly so because it occurs in young people. It’s the second most-common type of childhood cancer, and is responsible for 1% of all childhood cancers. It is rare in adults.
Ewing’s sarcoma is found in the long bones of the body, but can develop in any bone, along with the soft tissue and muscle surrounding the tumor. If you or someone you love has any of the symptoms above, please schedule an appointment with your doctor so the cancer can be detected and treated in the early stages for the most favorable prognosis.
Do you know someone who has Ewing’s Sarcoma? Let me know in the comments:)
16 thoughts on “Signs And Symptoms Of Ewing’s Sarcoma”
Thank you for this clear and thorough overview of Ewing’s sarcoma. Thankfully, cancer in children is rare but it is desperately frightening for all involved. One of my nieces had (non-Ewings) osteosarcoma of the rib bone almost ten years ago. She was fortunate firstly to have an excellent GP who immediately sent her to a specialist children’s hospital for tests, and that we have a brilliant National Health Service in the UK so she received the very best treatment and support with no cost to her parents. She is now a healthy and happy 15 year old with no ongoing problems.
Thanks for your comment. Yes, thankfully it’s quite rare. I’m sorry to hear about your niece. That must have been such a frightening time for everyone involved. I’m happy to hear that she had great health care providers, and that she’s now healthy and thriving. Thank you for sharing…
Many thanks to you for sharing such an excellent article with us. Ewing’s sarcoma sounds like a very bad disease and it usually affects people under 20 years of age. I didn’t know about the two types of cancer, carcinoma and sarcoma.
After reading your article, I have learned about the symptoms of sarcoma in the USA and these are the steps I can take if my kids ever get them. How can I share your article through social media? If I share your article through my social media, all my friends will know about the symptoms.
Thank you. Yes, like all cancers, Ewing’s sarcoma is scary, and particularly sad because it affects children and teenagers. It’s important to be educated about the symptoms so they can be taken seriously.
You’ll see social media icons at the bottom of my post if you’d like to share it. I sure appreciate that…
Thank you for such an informative post. I had no idea that there were two types of cancer. Maybe because they are so rare that is why I have never heard of sarcoma before, let’s just hope that it stays that way. It is scary that we do not yet know the cause of Ewing’s sarcoma. The symptoms have some similarities with osteoporosis in my opinion so it is hard to pinpoint that you have it, but I think the loss of appetite can differentiate that. I guess we just have to be cautious with our health and go get an x-ray when all the signs are there. Scary.
Thanks for reading. Yes, carcinoma and sarcoma are two types of cancer, with sarcoma being much more rare. If you or someone you know have any of the symptoms outlined in my article, please get checked. Yes, cancer is a frightening disease.
Thank you very much for this informative article about Ewing’s Sarcoma. I did not know about it, now I have learned a lot about it by reading your article. It’s really valuable & informative. This article teaches us A-Z about Ewing’s Sarcoma.
Thanks again for this useful article…
Thank you for reading and taking the time to comment:)
Wow, Ewing’s Sarcoma sounds very bad, but nearly every form of cancer is bad. I’m really glad that you have written this article, now I know what it is and what the symptoms are so I can get to a doctor quickly or I can know if someone in my family gets it. Thanks!
Yes, cancer is a scary disease that can be life-threatening if not detected in the early stages. Cancer is so deadly because of it’s ability to spread. It’s important to know the symptoms associated with Ewing’s Sarcoma so if you or someone you know has them, you can seek treatment quickly. Thanks so much for reading!
This article is well written and extremely informative to those of us that are unware of this sickness. It is very important to catch these symptoms early so treatment can start immediately. My grandfather passed away from cancer so I have first hand experience in watching his decline. I will be sharing this article with all of my social media accounts.
Thank you. I’m very sorry to hear about your grandfather. That must have been so hard. Yes, it’s imperative to catch the disease in the early stages before it has spread. I appreciate your comment:)
I do not know someone with Ewing’s sarcoma. This is a very informative presentation. I have got to say that I did not know the difference between sarcoma and carcinoma. They both are very bad for our kids and we need to know the symptoms and causes so that we can get a diagnosis early. I am very grateful for your post, I will share it with my friends who are also mothers.
Thanks for sharing!
Many people aren’t familiar with Ewing’s sarcoma unless they know someone who has had or who does have it. And again, most people don’t know the difference between carcinoma and sarcoma unless they have experience with either one.
Cancer is particularly sad when it affects children. Knowing the symptoms is one strategy in which we can keep our kids safe. Thank you for reading and for sharing…
Thank you for this information. It is sad to know that Ewing’s sarcoma bone cancer affects children and teenagers.
It is great to learn about the symptoms of this type of cancer. Sometimes we overlooked the complaints from children about bone pain. With the many advanced diagnoses, equipment, and medications available, we are now able to detect cancer at earlier stages.
I am glad I came across this article. Thank you!
Thanks for reading my article on bone cancer. Yes, it is sad that Ewing’s Sarcoma affects people at such young ages. It’s heartbreaking for everyone involved. I feel that it’s important to be aware of the symptoms of cancer so it can be diagnosed and treated before it has spread, while the outcome is still good. I’m thankful that the medical profession has so many tools at its disposable to prolong lives. Thanks for taking the time to leave a comment:)