- Signs & Symptoms
Ewing family of tumors is a group of tumors that form from a certain kind of cell in bone or soft tissue. This family of tumors includes the following:
tumor of the bone. This type of tumor is found in the bones of the
legs, arms, chest, trunk, back, or head. There are three types of Ewing
tumor of bone:
- Classic Ewing sarcoma.
- Primitive neuroectodermal tumor (PNET).
- Askin tumor (PNET of the chest wall).
- Extraosseous Ewing sarcoma (tumor growing in tissue other than bone). This type of soft tissue tumor is found in the trunk, arms, legs, head, and neck.
Ewing tumors usually occur in teenagers and are more common in boys and Caucasians.
These and other symptoms may be caused by Ewing family of tumors. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Pain and/or swelling, most commonly in the arms, legs, chest, back, or pelvis (area between the hips).
- A lump (which may feel warm) in the arms, legs, chest, or pelvis.
- Fever for no known reason.
- A bone that breaks for no known reason.
The following tests and procedures may be used to diagnose or stage Ewing family of tumors:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as lactate dehydrogenase (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
- X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
- Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. The specialists (pathologist, radiation oncologist, and surgeon) who will treat the patient usually work together to plan the biopsy. This is done so that the biopsy incision doesn't affect later treatment with surgery to remove the tumor and radiation therapy. It is helpful if the biopsy is done at the same center where treatment will be given.
The following tests may be done on the tissue that is removed:
- Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
- Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
- Reverse-transcription polymerase chain reaction test (RT-PCR): A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the genes.
- Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
The prognosis (chance of recovery) depends on certain factors before and after treatment.
Before treatment, prognosis depends on:
- Where in the body the tumor started.
- How large the tumor is at diagnosis.
- Whether the tumor has spread to distant parts of the body.
- Whether the tumor has certain genetic changes.
- The patient's age, gender, and general health.
- Whether the tumor has just been diagnosed or has recurred (come back).
After treatment, prognosis is affected by:
- Whether the tumor was completely removed by surgery.
- Whether the cancer came back more than two years after the initial treatment.
Treatment options depend on the following:
- Where the tumor is found in the body and how large the tumor is.
- The patient's age and general health.
- The effect the treatment will have on the patient's appearance and important body functions.
- Whether the cancer has just been diagnosed or has recurred (come back).
Decisions about surgery may depend on how well the initial treatment with chemotherapy or radiation therapy works.
The process used to find out if cancer has spread from where it began to other parts of the body is called staging. There is no standard staging system for Ewing family of tumors. The results of the tests and procedures done to diagnose Ewing family of tumors are used to group the tumors into localized or metastatic.Ewing family of tumors are grouped based on whether the cancer has spread from the bone or soft tissue in which the cancer began.
Ewing family of tumors are described as either localized or metastatic.Localized Ewing family of tumors
The cancer is found in the bone or soft tissue in which the cancer began and may have spread to nearby tissue, including lymph nodes.Metastatic Ewing family of tumors
The cancer has spread from the bone or soft tissue in which the cancer began to other parts of the body. In Ewing tumor of bone, the cancer most often spreads to the lung, other bones, and bone marrow.There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Recurrent Ewing Family of Tumors
Recurrent Ewing family of tumors is cancer that has recurred (come back) after it has been treated. The cancer may come back in the tissues where it first started or in another part of the body.