Ewing’s or Ewing sarcoma (ES) is a rare cancer of the bone and soft tissue that’s usually found in children and young people between 5 and 20. Most cases of Ewing’s sarcoma occur between the ages of 10 and 20 but about 25% of cases occur in kids under 10 and a small percentage occur in people in their 20s and 30s. There are few known risk factors for ES but one is race. Caucasians are 9 times more likely to develop ES than African-Americans. The disease is also more common among males than females.
Ewing’s sarcoma was once considered bone cancer because it develops in bones but the tumor develops from a primitive nerve cell and may also occur in the soft tissues. In most cases, ES develops in the arms, legs, or pelvis but it can also occur in the spine, ribs, or other bones and soft tissues.
Historically, ES has been very difficult to treat but a number of new treatments like radiation and surgery have improved survival with ES. As with other forms of cancer, the symptoms of Ewing sarcoma can resemble common illnesses and may include swelling, decreased appetite, fatigue, and fever. There are a number of distinctive symptoms that may point to ES, however, including bone pain, and fractures with no cause.
1. Pain Or Swelling In Affected Area
One of the predominant symptoms that most people notice in the earlier stages of the disease is swelling, pain, and stiffness in the affected area. This is called local pain. The pain and swelling around the tumor can contribute to reduced function of the affected extremity.
In active children, this pain and swelling are often mistaken for a sports injury as the symptoms can be similar. When the swelling comes with a fever, ES can also be mistaken for a bone infection. Because swelling, pain, and stiffness are the most common symptoms early in the disease, it’s common for there to be a delay in diagnosis of ES. Many patients even have symptoms for a year or longer until ES is discovered. For most people, the initial symptom is non-specific pain that slowly becomes more persistent and severe. About one-quarter of people with ES will have an X-ray that either does not capture the right part of the bone with the tumor or does not detect the abnormality while it’s in the early stages.
[nextpage title=“Next” ]2. Bone Pain
One of the most common symptoms of ES is bone pain that can be very severe. About 85% of teenagers and children with Ewing sarcoma experience bone pain. This bone pain may get worse with physical activity or at night. The pain will feel very deep in the bone but it can also spread to the surrounding tissue. The bones most frequently affected by Ewing sarcoma include the pelvis, femur, ribs, fibula, and tibia. The pain can also be felt in the scapula, spine, foot, and other bones.
[nextpage title=“Next” ]3. Unexplained Tightness
ES can affect breathing if the tumor affects the ribs or the cancer spreads. When ES affects the ribs, the pain can radiate to the chest and cause an unexplained sense of tightness. Ewing’s sarcoma of the rib is also frequently misdiagnosed as pleurisy, or inflammation of the lining of the lungs that causes pain with deep breathing. Ewing sarcoma can spread to other areas of the body, particularly the lungs and other bones. When the cancer spreads to the lungs, it can cause chest pain, wheezing, tightness of the chest, and difficulty breathing.
[nextpage title=“Next” ]4. Fever With No Cause
ES can come with a persistent fever with no obvious cause. This is likely because the out-of-control growth of cancer cells use up a large share of the body’s energy supply. It may also be that cancer cells release substances that change how the body creates energy from food. A tumor will also cause the immune system to react and produce a fever, fatigue, and weight loss similar to battling a bad flu. When someone with cancer develops a fever along with pain and weakness, it may also indicate an infection that needs to be treated quickly.
[nextpage title=“Next” ]5. Unintended Weight Loss
A common but general symptom of cancer is unexplained weight loss. For almost half of all people with cancer, unintended weight loss is the first noticeable symptom. In the past, doctors believed this weight loss was the result of an energy-hungry tumor but even a small tumor can cause weight loss but now it’s believed to be a number of factors not so easily explained. Weight loss can be caused by nausea, difficulty swallowing, pain, cytokines, a substance the body produces attempting to fight the cancer that can also lead to muscle and fat loss.
[nextpage title=“Next” ]6. Broken Bone No Cause
As ES develops and grows, the tumor may interfere with movement and weaken bones in the surrounding area. This can lead to a type of fracture called an insufficiency or pathologic fracture. A bone weakened by the tumor is likely to break after a minor injury, especially in physically active children who play sports. This risk of fracture is how many cases of ES are discovered: a child with a broken bone with no apparent cause undergoes a scan and the tumor is found. A bone that has been affected by Ewing sarcoma is typically replaced with an endoprosthesis or artificial bone.
