Health Library

Ewing Sarcoma


Ewing sarcoma is a cancerous bone tumor that may occur in any bone in the body. When it occurs in soft tissue, it is called extraosseous sarcoma. The most commonly affected areas include the pelvis, thigh, lower leg, upper arm, and chest wall.

Leg and Pelvic Bones—Common Sarcoma Sites
Leg bones
Copyright © Nucleus Medical Media, Inc.


The causes of Ewing sarcoma are not fully understood. Chromosomal rearrangement that alters the genes may be a factor.

Risk Factors

Because the causes of the cancer are unknown, risk factors are also not fully understood. Ewing sarcoma appears to be more common in Caucasians, teenagers, and males.


Symptoms include:

  • Pain, redness, and swelling surrounding the tumor
  • Fever
  • Weight loss and reduced appetite
  • Fatigue
  • Incontinence
  • Numbness, tingling, and paralysis
  • Difficulty breathing


You will be asked about your symptoms and medical history. A physical exam will be done. You will be treated by a team of doctors which may include an oncologist who specializes in cancer, an orthopaedic surgeon who operates on bones, and a radiation oncologist who works with radiation to kill cancer cells.

Your bodily structures may need to be viewed. This can be done with:

Your bodily fluids and tissues may need to be tested. This can be done with:

Bone Biopsy
Bone biopsy
Copyright © Nucleus Medical Media, Inc.


Treatment involves a combination of chemotherapy, surgery, and radiation. Typically, patients are first treated with chemotherapy for 8-12 weeks, followed by a CT or MRI scan to evaluate the tumor. Depending on the tumor size and location, either surgery or radiation therapy follows. Chemotherapy then resumes for several months after surgery or radiation therapy.


Chemotherapy drugs are used to kill tumor cells. Your doctor will prescribe a combination of drugs to be given over a set time. This usually means every 2-4 weeks for several months.


Surgery may be used to remove the tumor, as well as rebuild the affected bone. Depending on the location of the tumor, a bone graft or prosthesis may be needed. There are special types of prostheses that expand as the bone grows. Sometimes, several surgeries are needed to make sure the limb functions properly.

Radiation Therapy

Radiation therapy uses high-energy x-rays to kill tumor cells. It may be used with surgery or instead of surgery. It is usually given over several weeks and is followed by chemotherapy.

Future Therapy

A combination of high-dose chemotherapy and stem cell transplant is being evaluated at certain cancer centers. This combination therapy is typically used in cases where the tumor is resistant.


There are no current guidelines to prevent Ewing sarcoma because the cause is unknown.


American Cancer Society

National Cancer Institute

Canadian Resources

Canadian Cancer Society

Ewings Cancer Foundation of Canada


Ewing family of tumors. American Cancer Society website. Available at: Accessed September 6, 2016.

Ewing sarcoma. EBSCO DynaMed Plus website. Available at: Available at: Updated October 29, 2014. Accessed September 28, 2016.

Ewing sarcoma. St. Jude Children's Research Hospital website. Available at: Accessed September 6, 2016.

Ewing’s sarcoma. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: Updated September 2011. Accessed September 6, 2016.

Ewing's sarcoma. UCSF Benioff Children's Hospital website. Available at: Accessed September 6, 2016.

Miser ES, Goldsby RE, et al. Treatment of metastatic Ewing’s sarcoma/primitive neuroectodermal tumor of bone: evaluation of increasing the dose intensity of chemotherapy-a report from the children’s oncology group. Pediatr Blood Cancer. 2007;49(7):894-900.