Clinical trials are are aiding in the fight against tumors of the bone and soft tissue
Ewing sarcoma is a cancerous tumor of the bones or soft tissue. It comes from a family of cancers all caused by the same type of stem cell. The disease usually strikes younger patients, between 5 and 30 years of age. The Ewing sarcoma family of tumors can be subdivided into two groups.
- Ewing tumors of the bone refers to the three types that grow in the bone, which are:
- classic Ewing sarcoma,
- primitive neuroectodermal tumor (PNET), and
- Askin tumor (PNET of the chest wall).
- Extraosseous Ewing sarcoma refers to the type of Ewing family tumor which grows in the soft tissues instead of the bone.
- Ewing sarcoma is more common in males than females.
- The most common sites for tumors are the pelvis, the shin bone, and the thigh bone, although any area can be affected.
- The disease is the second-most common tumor of the bone.
- Ewing sarcoma responds well to treatment by chemotherapy.
Common symptoms include:
- Pain in the arms, legs, chest, back, or pelvis.
- Swelling in the arms, legs, chest, back, or pelvis.
- A warm-feeling lump in the arms, legs, chest, or pelvis.
- Fever for no reason.
- A bone that breaks with little applied force.
If a child shows symptoms of Ewing sarcoma, doctors will perform tests to learn more about the site and extent of the cancer. Those tests may include:
- Blood test: Doctors may draw blood to perform a complete blood count (CBC), conduct blood chemistry studies, or check the blood’s sedimentation rate.
- X-ray: An image created by radiation, an X-ray gives the physician a first look at the inside the body.
- MRI: Magnetic resonance imaging uses magnetic fields and radio waves to create an image of the body’s inside with a good view of the soft tissues as well as the bones.
- CT scan: Computed tomography (CT) images are created using a computer and X-rays taken at different angles. The patient might be injected with dye to aid in the production of this three-dimensional image.
- Bone marrow aspiration and biopsy: For this procedure, hollow needles are inserted into each hipbone. Samples are taken of blood, bone marrow, and bone, and examined under a microscope for signs of cancer.
- Bone scan: The patient is injected with a small amount of radioactive material, referred to as a “tracer,” for this imaging procedure. A scanner notes the places in the body where the tracer accumulates, which may indicate the location of a cancer tumor.
- PET scan: The positron emission tomography (PET) scan also uses a radioactive tracer material injected in the patient to reveal the location of malignant tumor cells.
A child’s treatment path and chances of recovery depend on different factors, including:
- The location of the tumor.
- The size of the tumor.
- Whether or not the tumor has spread.
- The child’s health, age, and gender.
Once the diagnosis of Ewing sarcoma has been made, the physicians will “stage” the disease. The staging determination is based on whether the cancer has spread from the bone or soft tissue where it began. Different stages call for different courses of treatment. The stages of Ewing sarcoma family of tumors are:
- Localized: The cancer is found in the bone or soft tissue in which it began and may have spread to nearby tissue, including lymph nodes.
- Metastatic: The cancer has spread from the bone or soft tissue in which it began to other areas of the body
- Recurrent: After a previous treatment, the cancer has returned in either the original area or a new part of the body.
Children with Ewing sarcoma may undergo standard treatment or may choose to participate in clinical trials. There are three types of standard treatments used, including:
- Chemotherapy: This is usually the first step in treatment, and is given to all patients with Ewing tumors. Powerful anti-cancer drugs are injected or taken by mouth to kill cancer cells and stop them from dividing. Often treatment includes multiple types of anticancer drugs—this is called combination chemotherapy.
- Surgery: As much of the tumor as possible will be removed in surgery. The procedure may include replacing diseased bone with a graft or an implant.
- Radiation: In order to shrink the tumor before surgery or kill cancer cells remaining after chemotherapy or surgery, the patient may be treated with radiation therapy. A machine directs radiation toward the body during external radiation therapy. Internal radiation therapy is given using radioactive material sealed inside needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Treatment by stage
- Combination chemotherapy followed by surgery and/or radiation therapy.
- A clinical trial of new ways of giving combination chemotherapy.
- Combination chemotherapy followed by radiation therapy to the area where the tumor first formed and the places where the tumor has spread.
- A clinical trial of chemotherapy with either stem cell transplant or radiation therapy, for tumors that have spread to the lungs.
- Surgery followed by combination chemotherapy.
- Combination chemotherapy.
- High dose chemotherapy and sometimes a stem cell transplant using the patient’s stem cells.
- Radiation therapy or surgery to remove bone tumors, as palliative therapy to reduce symptoms and improve the quality of life.
- Radiation therapy followed by surgery to remove tumors that have spread to the lungs.
- A clinical trial of new combinations of drugs.
Leading the way to a cure
The University of Minnesota is a national and international leader in basic science, clinical research, and the development of advances in the treatment of bone and soft tissue tumors. The sarcoma program at the Masonic Cancer Center, University of Minnesota is a collaboration of bone and soft tissue cancer specialists and researchers. It ranks as one of the top sarcoma research and treatment programs in the nation.
Children’s Cancer Research Fund’s relationship with the University of Minnesota supports the work of a multidisciplinary team of physicians who see a high volume of patients with sarcoma. This translates into an unparalleled depth of experience and coordinated advances in laboratory work, clinical research and education. Our goal is to achieve optimal outcomes. Children’s Cancer Research Fund resources help with pilot studies and provide support for clinical trials.
For more information on the latest research carried out by our partners, visit our Sarcomas Research page.