Ewing Sarcoma is the second commonest bone cancer in children. It usually affects children and teenagers, although it can affect younger or older individuals too. The basic cause of this cancer remains unknown, and the parents or the child will often remember having some injury to which they attribute the symptom. Injury, however, only draws the attention of the patient a pre existing disease, and has no causative role. Patients with Ewing sarcoma have pain and swelling of the affected limb (pelvis and chest are also common locations affected by Ewing sarcoma), sometimes associated with fever, tiredness, and weight loss. Because of these symptoms, and indeed, because of similar findings on x ray and MRI, this disease is often mistaken to be osteomyelitis (an infection of bone) which is a much more common entity. Hence, it is recommended that we be sure of the diagnosis (with pus culture and even biopsy, if needed) before treating or contemplating surgery for osteomyelitis.
The diagnosis and treatment of Ewing sarcoma should be undertaken only at specialised centers, where a multidisciplinary - team called Musculoskeletal Disease Management Group exists, a team consisting of Orthopedic Oncology, Pediatric/ Sarcoma medical oncology, Musculoskeletal Radiation oncology, Musculoskeletal Pathology, Musculoskeletal Radiology, Nuclear Medicine, Psycho Oncology and physiotherapy teams. After initial evaluation with an X ray and an MRI, the diagnosis is confirmed with a biopsy, which is usually a core needle biopsy. This biopsy is an OPD procedure under local anesthesia (except young children where it is done under sedation). Rarely, an open surgical biopsy is required. A staging work up follows, which will include a whole body PET CT or a combination of CT scan of chest and a whole body bone scan. Patients with Ewing sarcoma who have no spread of disease have upto
70 - 80 percent chance of cure, with complete treatment.
Treatment will consist of a combination of chemotherapy, surgery and radiation therapy. The treatment is planned by the multidisciplinary team in close coordination with the parents, with the aim of maximizing the chances of cure, and minimizing the short and long term effects. Surgical management of Ewing sarcoma nowadays is done by limb salvage surgery in more than 90 percent of patients. Post treatment follow up consists of visits to the follow up clinic every 3-6 months, usually upto 5 years.