Bone Cancer - Ewing's Sarcoma
Sabrina Kempe is a freelance writer for the medical team. She studied biology, specializing in molecular biology, human genetics and pharmacology. After her training as a medical editor in a renowned specialist publisher, she was responsible for specialist journals and a patient magazine. Now she writes articles on medical and scientific topics for experts and laypeople and edits scientific articles by doctors.
More about the experts All content is checked by medical journalists.Ewing's sarcomas are the third most common type of bone cancer. They make up about eight percent of all bone cancer diseases. Ewing's sarcomas develop preferentially, but not only in bone tissue. Very seldom also arise in soft tissue (connective, fat or muscle tissue or tissue of peripheral nerves) - either with or without the involvement of bone tissue. Read everything important about Ewing's sarcoma here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C41C40
Ewing's sarcoma: symptoms
Ewing's sarcomas start from the bone marrow (rarely from soft tissue). This type of bone cancer is most commonly found in the pelvis or in the long tubular bones of the legs, and sometimes in the ribs and shoulder blades.
Patients feel pain in the affected areas at irregular intervals. These usually occur when the person concerned is moving, but can also continue at night.
As with osteosarcoma and chondrosarcoma - more common forms of bone cancer - swelling often develops in the affected area once the tumor has reached an appropriate size. It is also possible that the affected area of the body is less flexible than normal.
If Ewing's sarcoma develops in the spine or in peripheral nerves, other symptoms occur. Mainly defective symptoms such as paralysis then appear.
The symptoms mentioned above can also have causes other than bone cancer. Nevertheless, you should always have inexplicable pain, swelling or paralysis checked by a doctor as soon as possible.
Ewing's sarcoma: causes
In Ewing's sarcomas there is a typical but not hereditary chromosome change: Sections of the Ewing sarcoma gene on chromosome 22 and from another gene - mostly on chromosome 11, less often on chromosome 21 or 7 - are interchanged (translocation ). These and other genetic changes ultimately lead to a normal cell degenerating and becoming an Ewing sarcoma cell.
Ewing's sarcoma: examinations and diagnosis
The doctor gains the first clues as to the possible cause of unexplained symptoms such as bone pain from the patient's medical history (anamnesis) and a general physical examination.
If this leads to the suspicion that the patient might suffer from bone cancer, further examinations should be carried out in a tumor center - such as blood tests. For example, most people with Ewing's sarcoma have an increased rate of sedimentation. This type of bone cancer can also be associated with anemia, an increased number of white blood cells (leukocytosis) or an increase in the enzyme NSE (neuron-specific enolase).
Imaging procedures (such as X-rays and computed tomography) and the analysis of tissue samples (biopsy) are also important for establishing a diagnosis.
To learn more about these examinations when a malignant bone tumor is suspected, see Bone Cancer: Examinations and Diagnosis.
In Ewing's sarcoma, the bone marrow must also be examined for cancer. Two methods are used for this:
- Bone marrow puncture: A special hollow needle is used to suck out some bone marrow cells in order to examine them more closely in the laboratory.
- Bone marrow punch biopsy: A small cylindrical piece is punched out of the bone marrow. In this way, not only individual cells but also the tissue structure can be examined.
If the doctors suspect that the central nervous system (brain and spinal cord) is also affected by the cancer, it may also be necessary to take and analyze a nerve water sample from the spinal canal (lumbar puncture).
Ewing's sarcoma: stages
Once the diagnosis of Ewing's sarcoma has been made, it remains to be determined how serious the disease is. Therapy is then planned accordingly.
The severity of malignant bone tumors such as Ewing's sarcoma depends primarily on two factors. On the one hand, there is the size and spread of the tumor (determined using the so-called TNM system). On the other hand, how much the cancerous tissue differs from “normal” (healthy) tissue (grading) plays a role.
You can read more about this at Bone Cancer: Stages.
Ewing's sarcoma: treatment
Whether Ewing's sarcoma or some other form of bone cancer, every patient should be treated in a specialized center by a team of oncologists, surgeons, radiologists and other professionals.
How the therapy looks in each individual case depends on several factors. Among other things, the type and severity of the bone cancer disease, the age and the general state of health of the patient are decisive.
The main therapeutic options for Ewing's sarcomas and other malignant bone tumors are chemotherapy, radiation therapy, and surgery.
To find out exactly how these therapies work and how patients are treated in the event of relapse and end-stage disease, see Bone Cancer: Treatment.
Ewing's sarcoma: supportive therapy
Nausea, vomiting, kidney damage - cancer treatment can have severe side effects. In addition, there are complaints that the tumor itself causes, such as pain.
Such health problems are addressed as part of supportive therapy. The aim is to help cancer patients get through the difficult times too well.
You can find out more about this under Bone Cancer: Supportive Therapy.
Ewing's sarcoma: rehabilitation
Anyone who has come through the stressful time of cancer therapy usually has to face a new challenge - returning to everyday life as well as to social, professional or school life. Rehabilitation programs help here.
They contain very different offers and support measures. For example, prosthesis wearers learn how to deal with the “new” part of the body in rehab. Swimming and other sporting activities help cancer patients to get physically fit again. And sharing your worries and experiences with other cancer patients in the rehab group can also be good.
You can find out more about this topic at Bone Cancer: Rehabilitation.
Ewing's sarcoma: follow-up care
Once the treatment for Ewing's sarcoma is over, it is important to keep an eye on the possibility of a relapse or a second cancer as a result of the cancer therapy. This is done through regular follow-up examinations.
These follow-up appointments also focus on other possible consequences of the cancer and its treatment, such as infertility or depression.
To learn more about this topic, see Bone Cancer: Follow-Up Care.
Ewing's sarcoma: life expectancy
Ewing sarcomas are extremely malignant ulcers. Patients in whom the tumor has not yet metastasized have the best chance of surviving Ewing's sarcoma in the long term. With proper treatment, around 50 to 70 percent of patients are still alive five years after diagnosis (5-year survival rate).
Unfortunately, Ewing's sarcomas metastasize quickly and frequently. Then the chances of recovery decrease, especially when it comes to bone metastases. After three to five years, despite treatment, only a maximum of 10 to 20 percent of the affected patients are still alive, according to the statistics (3 or 5-year survival rate).
Survival rates are statistical numbers and are therefore only to be understood as guidelines. The chances of survival of an individual patient cannot be derived from this.
Bone Cancer: Additional Information
German Cancer Aid: https://www.krebshilfe.de
German Cancer Information Center: https://www.krebsinformationsdienst.de
orphanet - The portal for rare diseases and orphan drugs: https://www.orpha.net
Kinderkrebsinfo.de - information portal on cancer and blood diseases in children and adolescents: https://www.kinderkrebsinfo.de
Interdisciplinary Center for Bone and Soft Tissue Tumors, LMU Clinic of the University of Munich - Großhadern Campus
ZSE Berlin: Special outpatient clinic for pediatric oncology (DKG e.V. certified), Charité - Universitätsmedizin Berlin (CVK)
Clinic for general orthopedics and tumor orthopedics at the University Hospital Münster (one of the largest centers worldwide for the treatment of patients with bone cancer): https://internationalpatients.ukmuenster.de/index.php?id=bone-and-soft-tissue-sarcomas&L=0
Late Effect Surveillance System (LESS): www.nachsorge-ist-vorsorge.de
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