Ewing sarcoma is malignant (cancerous) aggressive tumor that arises directly from the bone. It most commonly affects the femur, tibia, and humerus, frequently in children and adolescents. Treatment includes a combination of chemotherapy and surgery.
Ewing's Sarcoma is a small round blue cell sarcoma (cancerous tumor). It is a childhood sarcoma, as a high percentage of cases occur within the first two decades. It is the fourth most common primary malignancy of bone and accounts for approximately 5% of all biopsied tumors. Although Ewing's Sarcoma can occur in any bone, the most common site is long bones (e.g. humerus, radius, ulna, femur, tibia, fibula) with the femur being the most common site. Ewing's Sarcoma is cancerous and has the potential to metastasize, or spread, to other areas of the body if not treated.
Ewing's Sarcoma is an aggressive, cancerous (malignant) tumor that, if left unchecked, will grow and destroy the normal bone. Clinically, they manifest as localized pain (usually worse at night), fever, and swelling. The affected area may be tender and warm. Patients may also notice night sweats and weight loss. Early and effective treatment is essential, as Ewing's Sarcoma also has the ability to spread to other parts of the body, known as metastasis. Advanced imaging, such as whole body bone scans and CT of the chest/abdomen/pelvis, are used to check if the cancer has spread, or metastasized, throughout the body.
An example of an MRI depicting Ewing's sarcoma in the lower extremity is shown.
The treatment for Ewing's Sarcoma involves a multifocal approach, consisting of chemotherapy and surgical resection or removal of the cancer. Ewing's Sarcoma is very responsive to chemotherapy. Several cycles of chemotherapy are given before surgery (preoperatively) and again after surgery (post-operatively). Preoperatively, chemotherapy is used to reduce the size of the tumor. Post-operatively, chemotherapy is used to lower the risk of the cancer coming back (recurrence). The surgical procedure commonly used to treat Ewing's Sarcoma is a radical resection and reconstruction.
Chemotherapy is a systemic treatment option for some cancers, meaning the chemotherapy drugs travel throughout the body and can kill the cancerous cells that have metastasized, or spread throughout. Chemotherapy is used to treat cancer, control/prevent cancer from spreading, and ease the symptoms related to the cancer. There are various drugs used in chemotherapy, so the combinations of drugs administered and the number of cycles may differ between each person and tumor. Lastly, chemotherapy may be used in conjunction with other treatments, specifically local treatments such as surgery.
Surgical treatment includes wide or radical resections to remove the complete tumor and additional margins. The removal of additional, surrounding margins ensures that the tumor is completely removed and decreases the chances of the tumor coming back. Common surgical procedures are:
Once the tumor and margins have been removed, reconstruction with a prosthesis is performed. Since Ewing's Sarcoma is a childhood sarcoma, a special, customized, expandable prothesis may be used, which allows the prosthesis to "grow" with the child. The patient may return to the office, where the prosthesis can be lengthened using a magnet without any pain.
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Myself and my amazing team are dedicated to saving your life and your limb. Losing a limb because of a tumor can be a terrifying experience. But, it does not have to be the only option. I’ve spent 20+ years as a Board-Certified Orthopedic Surgeon and Orthopedic Oncologist.
I’ve devoted my career to helping children and adults afflicted with bone and soft tissue masses by performing complex limb saving surgeries. Most patients can have their limb saved, which may require innovative techniques.
Patients afflicted with musculoskeletal tumors have complex conditions that are best taken care of at large hospitals. I am the Chairman of Orthopedics and Chief of Orthopedic Oncology at Morristown Medical Center. My philosophy is a multidisciplinary team approach, working together to tailor treatment to individual patients. Education and research are essential to my practice, providing the best setting for extraordinary patient care. Because of this, we have some of the top results in the country.