Ewing Sarcoma

Ewing sarcoma is a rare cancer that most often affects teenagers — but children and young adults can get it, too. The tumors grow in the long bones in their arms and legs, in their pelvis, spine or ribs and sometimes in soft tissues, like their muscles, tendons and ligaments.

At your child’s first appointment, we’ll start by giving them a physical exam and talking with you about their medical history and any symptoms they’ve been having. They’ll also have some blood tests to see how well their liver, kidneys and other organs are working.

Imaging tests

Next, your provider will likely order imaging tests, like X-rays and an MRI to take a closer look at your child’s bones and soft tissues. They might also use a CT scan or PET scan to see if tumors are in any other part of their body. The combination of these scans gives us highly detailed 3D images of your child’s bones and tumor.

Biopsy and bone marrow aspiration

We’ll also take a tissue sample (biopsy) and look at the sample under a microscope. Whenever possible, your child will have a needle biopsy. These aren’t too invasive and your child won’t need general anesthesia. We might also check the liquid from the spongy material inside your child’s bones (bone marrow) to see if there are any cancer cells in there. This is called a bone marrow aspiration.

Second opinions for Ewing sarcoma

When you learn your child may have cancer, you’ll want to make sure they have a team of healthcare providers you trust completely to give them the best possible treatment. At Cleveland Clinic Children’s, we encourage second opinions. We want you to feel confident in your child’s care. We also know that you don’t want to wait to get treatment started, so we do our very best to get you in for an appointment as soon as possible after you reach out to us. Second opinions are a good way to put your mind at ease that your child is in the most capable and compassionate hands.

Meet Our Ewing Sarcoma Team

When your child comes to Cleveland Clinic Children’s for Ewing sarcoma diagnosis and treatment, they’ll have a team of healthcare providers who’ll work together to confirm what’s going on and build a personalized treatment plan. Their team could include:

• Oncologists.
• Orthopaedists.
• Surgeons.
• Radiologists.
• Pathologists.
• Physical therapists.
• Occupational therapists.
• Child life specialists.

We use a variety of treatments to attack cancer cells. These include chemotherapy, radiation and surgery. Our providers work together to find the right mix of therapies and support for your child based on their test results, age, health and other unique factors.

Chemotherapy

Ewing sarcoma treatment usually starts with chemotherapy. Chemotherapy (chemo) uses powerful medications that travel through your child’s body and kill cancer cells. Our skilled team chooses the best type of chemo medication for your child’s diagnosis.

Our providers want to make Ewing sarcoma chemotherapy as comfortable and convenient as possible. We focus on ways to prevent or minimize side effects like fatigue and nausea. Often, your child can get chemo in one of our medical offices and go home the same day.

Radiation therapy

Ewing sarcoma usually responds well to radiation therapy. Today’s treatments — like stereotactic body radiation therapy (SBRT) — are safe and target and destroy cancer cells while minimizing damage to healthy tissue nearby.

Surgery

Our orthopaedic oncology surgery teams specialize in removing bone cancers like Ewing sarcoma. This usually happens after your child has chemotherapy and/or radiation.

Removing your child’s limb is a last resort. Our pediatric surgeons will do everything they can to save your child’s limb. We are experts in alternative options, like using bone grafts, making customized prostheses and joint fusion. In certain situations, they might try to do minimally invasive cryoablation, which uses a needle to destroy tumors by freezing the cancer cells. Our specialists have been successful with even the most complicated, challenging limb-sparing surgeries.

If we aren’t able to safely save your child’s limb and need to remove it, our compassionate team will work with you and your child to choose an advanced prosthesis (artificial limb). Our team partners with vendors who make 3D printed, customized replacement limbs. Prosthetic surgery techniques include:

• Osseointegration: In the traditional procedure, we attach a socket to the remaining limb. The prosthesis then fits into this socket. Using more advanced osseointegration, we instead attach a strong metal rod to the healthy bone. The prosthesis will connect to the metal rod and move naturally as it heals.
• Rotationplasty: This surgery removes a tumor near your child’s knee and saves the lower part of their leg. We’ll then rotate the bone and reattach it. Rotationplasty preserves more of your child’s natural limb. And it allows the prosthesis to fit more securely and comfortably.

Fertility preservation

It may not be top of mind now, but cancer treatments can affect your child’s long-term fertility. Our providers will work with you and your child to understand the risks and all fertility preservation options. These include storing (banking) sperm, eggs or reproductive tissue for later use. We’re here to help you make an informed decision for your child.

Genetic counseling

Our cancer team is one of the few in the country that includes dedicated geneticists and genetic counselors. If your child’s Ewing sarcoma is inherited, our team can explain how the diagnosis affects your child, you and other family members.

Taking the Next Step

When your child is diagnosed with cancer, you likely can’t stop worrying about their future. And that future relies on getting the best treatment for them. At Cleveland Clinic, we treat childhood bone cancers like Ewing sarcoma every day — with personalized care and support. Our experienced and compassionate team of healthcare providers is here to guide you and your child through this treatment journey, from diagnosis to recovery and beyond.