Symptoms, Diagnosis, and Staging of Ewing sarcoma

Learn about the signs and symptoms of Ewing sarcoma, the tests that may be done for it, and the outlook for those with a diagnosis.

Can Ewing sarcoma be found early?

At this time, there is no widely recommended screening test for Ewing sarcoma. Screening is testing for cancer in people without any symptoms.

Ewing sarcoma is often found because a person has signs or symptoms that prompt a visit to the doctor, such as bone pain, a lump, or swelling. The doctor may then order tests, such as an x-ray, which might suggest a bone tumor as the cause.

Signs and symptoms of Ewing sarcoma

Ewing sarcomas are most common in teens  and young adults, though they can develop in other age groups as well. These tumors are often found because of the symptoms they cause. The most common symptoms of Ewing sarcoma tumors are:

Pain: Most people with Ewing tumors will have pain in the area of the tumor. Ewing sarcoma tumors develop most often in the pelvis (hip bones), the chest wall (such as the ribs or shoulder blades), or the legs (mainly in the middle of the leg bones), but they can also start in other parts of the body. Early on, pain might come and go or be worse at night or with activity. Over time, the pain may become more intense and constant.

Numbness or weakness: Ewing sarcoma that develops near the spine can affect the nearby nerves. This can cause numbness, weakness, or even paralysis. These tumors may need to be treated right away to avoid permanent damage to the nerves.

Lump or swelling: Over time, most Ewing bone tumors and almost all non-bone (soft tissue) Ewing tumors cause a lump or swelling, which is more likely to be noticed in tumors in the arms or legs. Tumors in the chest wall or pelvis might not be noticed until they have grown quite large.

Fracture or broken bone: In some cases, Ewing sarcoma can weaken the bone so much that it breaks. This can cause sudden, intense pain and difficulty moving depending on the location of the tumor.

Pain or swelling, especially in the arms or legs, is common in normal, active children and adolescents. These symptoms are much more likely to be caused by normal bumps and bruises from sports or other activities, so they might not prompt a doctor visit right away. If you or your child have these symptoms and they do not go away within a few weeks or they get worse, see a doctor.

These symptoms are less common in adults, so they should be a sign to see a doctor even sooner.

Other signs or symptoms of Ewing sarcoma that may have spread

Ewing sarcoma can cause other symptoms, especially if it has spread to other areas of the body. Symptoms can include fever, fatigue, and weight loss. Other symptoms may depend on where the tumor has spread.

• Bone marrow: Spread to the bone marrow, where blood cells are made, can cause low blood counts which can result in low energy, easy bleeding or bruising, and a risk of developing infections.
• Lungs: Tumors that have spread to the lungs may cause trouble breathing, chest pain, or a cough.

Many of the signs and symptoms of Ewing sarcoma and other bone cancers can also be caused by other things, such as infections, injury, or even cancers that start in other parts of the body.  A person with any of these symptoms, especially if they don’t go away or get worse, should see a doctor so the cause can be found and treated, if needed.

How is Ewing sarcoma diagnosed?

Physical exams, imaging and blood tests, as well as a biopsy of the tumor are used to confirm a diagnosis of Ewing sarcoma. If Ewing sarcoma is confirmed by biopsy, more detailed tests will be done to learn more about it and how best to treat it.

Imaging tests are also used during and after treatment to help track how well treatment is working.

Staging for Ewing sarcoma

After someone is diagnosed with Ewing sarcoma, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it.

The stage of Ewing sarcoma is based on the results of physical exams, imaging tests, and any biopsies that have been done. This information can be used to plan treatment and estimate prognosis (outlook).

Survival rates for Ewing sarcoma

After Ewing sarcoma is diagnosed, many people want to understand what to expect. The tests used to diagnose Ewing sarcoma and look for spread (metastasis) describe a tumor by stage. This information, combined with other factors like a person’s age, health, and any gene changes in the tumor cells can be used to understand the outlook of the cancer.

Survival rates are a way to measure how many people survive a certain type of cancer over time. Survival rates are often reported as 5-year survival rates, which refer to the percentage of people who live at least 5 years after their cancer diagnosis. Of course, many people live much longer than 5 years. Some people find this information helpful while others prefer to focus on treatment plans and next steps.