Ewing's sarcoma is a malignant (cancerous) bone tumor that affects children.

Ewing's family of tumors; Primitive neuroectodermal tumors (PNET)

Ewing's sarcoma can occur any time during childhood and young adulthood, but usually develops during puberty, when bones are growing rapidly. It is 10 times as common in Caucasian children as in African-American, African, and Asian children.

The tumor may start anywhere in the body, usually in the long bones of the arms and legs, the pelvis, or the chest. It may also develop in the skull or the flat bones of the trunk.

The tumor often spreads (metastasis) to the lungs and other bones. Spread at the time of diagnosis is seen in about one-third of children with Ewing's sarcoma.

Rarely, Ewing's sarcoma can occur in adults.

There are few symptoms. The most common is pain and occasionally swelling at the site of the tumor.

Children may also break a bone at the site of the tumor after a seemingly minor injury (this is called a "pathologic fracture").

Fever may also be present.

If a tumor is suspected, tests to locate the primary tumor and any spread (metastasis) often include:

• Biopsy of the tumor
• Bone scan
• Chest x-ray
• CT scan of the chest
• MRI of the tumor
• X-ray of the tumor

Treatment should be done by a cancer specialist (oncologist) and often includes a combination of:

• Chemotherapy
  • Cyclophosphamide
  • Doxorubicin
  • Etoposide
  • Ifosfamide
  • Vincristine
• Radiation therapy
• Surgical to remove the primary tumor

For additional information and resources, see cancer support group.

How well a patient does depends on:

• The location of the tumor
• If the cancer has spread

The best chance for cure is with a combination of treatments that includes chemotherapy plus radiation or surgery, provided at a center that frequently treats this type of cancer.

The treatments needed to fight this disease have many complications, which should be discussed on an individual basis.

Call your health care provider if your child has any of the symptoms of Ewing's sarcoma. An early diagnosis can increase the possibility of a favorable outcome.

Baker LH. Bone tumors: primary and metastatic bone lesions. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 208.

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bone Cancer. National Comprehensive Cancer Network; 2012. Version 2.2012.