Ewing's Sarcoma
What is it?
Ewing's sarcoma is the second most common form of childhood bone cancer. A sarcoma is a cancer of the bone, soft tissues, or connective tissue around the bone.
Who gets it?
Ewing's sarcoma occurs most often in children and young adults between the ages of 10 and 20. It is more common in males than females, and more than 80% of patients with Ewing's sarcoma are white. Approximately 27% of all cases of Ewing's sarcoma occur in children under the age of
10.
What causes it?
While the cause of Ewing's sarcoma is unknown, it is likely that people inherit a tendency to develop bone cancer. Ewing's sarcoma usually begins in the soft tissue, called the marrow, that is found inside leg, hip, rib, and arm bones. The cancer can spread quickly to the lungs. Cancer that spreads from one area of the body to another is said to metastasize. Ewing's sarcoma can metastasize to other bones in the body as
well.
What are the symptoms?
The most common symptoms of Ewing's sarcoma are pain and swelling around the site of the tumor. The tumors can be large, in which case you may be able to see a lump around the affected bone. Other symptoms can include fever, fatigue, and weight loss. With time, the tumor weakens the bone structure and the bone breaks for no apparent
reason.
How is it diagnosed?
To diagnose Ewing's sarcoma, your doctor will perform a thorough physical examination. He or she will order x-rays of the painful area. If the x-rays show a tumor, your doctor may also order a computed tomography (CT) scan to pinpoint the exact location of the tumor and to determine if it has spread to the muscles and fat around the bone. This will help target the location for a bone biopsy, which will help confirm a diagnosis. There a two ways to perform this biopsy. A needle biopsy is performed under local anesthesia, which means the affected area is numbed so your child will not feel pain during the procedure. Then, a long, thin needle is inserted into the tumor and a sample of tumor cells and tissues is removed for examination under a microscope. An open biopsy is performed under general anesthesia, which means your child will be given drugs to put him or her into a sleep-like state. With an open biopsy, a piece of the tumor is removed surgically. A technique called immunohistochemistry is frequently used to identify the cells found in Ewing's sarcoma, but not in other types of bone cancer. To perform this test, special stains consisting of chemicals and antibodies are added to the tissue sample taken during the biopsy. These stains reveal the Ewing's sarcoma cells.
Magnetic resonance imaging (MRI) is another diagnostic technique that may be used to determine the location and number of tumors. Your doctor will also order bone scans and CT scans of other parts of your child's body, such as the chest and abdomen, to determine whether the cancer has spread. A blood sample will be taken for a complete blood count (CBC), which may help determine how much the bone marrow is affected. Determining whether and how far the cancer has spread from its original location is called
"staging," and helps determine treatment. Localized Ewing's sarcoma means the cancer has not spread beyond the bone where it originated. Metastatic Ewing's sarcoma means the cancer cells have spread to other areas of the
body.
What is the treatment?
Ewing's sarcoma is treated by cancer specialists called oncologists, and bone specialists called orthopedic surgeons. While treatment depends upon the cancer's stage, most cases are treated with a combination of surgery and chemotherapy. Chemotherapy involves doses of very strong medicine that are often given first to control the growth of the tumor by killing the cancer cells. Then, the tumor is surgically removed and any gap in the bone is filled in with a bone graft from another part of the body or a metal rod. In the past, the affected arm or leg was surgically removed, called amputation. Today, however, many cases of Ewing's sarcoma are treated with limb-saving surgery. Amputation is performed only when the tumor has spread beyond the bone to the surrounding nerves and blood vessels. If the cancer has spread to other areas of the body, your child will need surgery to remove those tumors as well. Your child will receive additional chemotherapy treatment after the surgery. Chemotherapy can make your child feel sick and weak, and lose his or her hair. These side effects are temporary and will go away once the chemotherapy treatments are finished. Your doctor can prescribe medicine to counteract these side effects if your child cannot tolerate them.
Radiation therapy may also be recommended to kill the cancer cells. If your child has had surgery to save his or her limb, it will take some time and physical therapy to regain use of the affected limb. If he or she has had a limb amputated, a prosthetic (artificial) limb can be fitted. It may take anywhere from three to six months for your child to learn to use the prosthetic leg or arm. In addition to physical therapy, most adolescents will also need psychological therapy to help them cope with their condition during an already difficult time of life. After treatment is complete, your child will continue to have follow-up diagnostic tests such as CT scans, bone scans, and x-rays to ensure the tumor is gone. Survival rate depends upon the stage of the cancer and the success of treatment.
Self-care tips
Because many cases of Ewing's sarcoma occur for no apparent reason, or are genetically inherited, there are no known steps to take to prevent this type of cancer. It's important to have your child examined by a doctor if he or she develops any unexplained bone pain, tenderness, or swelling.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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