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Bone Cancer

Bone cancer diagnosis
UK Markey Cancer Center orthopaedic oncologist Patrick O'Donnell, MD. 

In the UK Markey Cancer Center’s Multidisciplinary Clinic, bone cancer patients are provided care customized to fit their needs. Our clinic offers expertise in the diagnosis and treatment of bone tumors, soft tissue bones and metastatic diseases of bone. In August 2017, Markey was designated as one of the nation’s Top 50 Cancer Centers by U.S. News & World Report.

Our Team Approach

The UK Markey Cancer Center is proud to be one of only two programs treating bone cancer in the state. The Bone Oncology team treats both pediatric and adult patients suffering from bone and soft tissue tumors along with tumor-like conditions affecting the bone system.

In addition to clinical care, this unique team of physicians and researchers is currently pursuing research in cancer immunotherapy, advanced tumor imaging, biomedical engineering of sarcoma-like substances and clinical trials – all dedicated toward improved patient-centered care.

Bone Cancer Survival Rates

For all cases among adults and children, the five year survival rate for bone cancer patients is about 70 percent, according to the American Cancer Society.

Clinical Trials

Clinical trials help keep our cancer care on the leading edge by allowing researchers to apply cancer knowledge as it develops to give you the best chance of survival.

At Markey, our specialists place a high value on all areas of bone cancer treatment, from patient care designed for the unique patient to developing treatments of the future. 

Request an appointment online or call 859-257-4488 or 1-866-340-4488 (toll free).

  • Locations

    Clinics

    Multidisciplinary Clinic

    Whitney Hendrickson Building

    UK Markey Cancer Center

    Whitney-Hendrickson Building
    First Floor
    800 Rose St.
    Lexington KY 40536

    A parking lot is located near the Whitney-Hendrickson Building, accessible via Hospital Drive.

  • About Your First Visit

    • For your first visit, you will be directed to the Comprehensive Breast Cancer Care Center on the second floor of the Whitney-Hendrickson Building. Directions to the Whitney-Hendrickson Building.
    • You can register at the front desk, where a receptionist will help guide you through your appointment.
    • Free parking is available to patients in the Whitney-Hendrickson parking lot.
    • Please remember to bring your patient packet with the completed forms. These items will help your doctor learn more about your case and determine the best plan for your care.
    • Review the patient handbook to learn about your stay and everything Markey offers for patients and families.
      • UK HealthCare accepts many forms of insurance.  
    • About Bone Cancer

      Ewing Sarcoma Treatment (PDQ®)–Patient Version

      General Information About Ewing Sarcoma

      Key Points

      • Ewing sarcoma is a type of tumor that forms in bone or soft tissue.
      • Signs and symptoms of Ewing sarcoma include swelling and pain near the tumor.
      • Tests that examine the bone and soft tissue are used to diagnose and stage Ewing sarcoma.
      • A biopsy is done to diagnose Ewing sarcoma.
      • Certain factors affect prognosis (chance of recovery).

      Ewing sarcoma is a type of tumor that forms in bone or soft tissue.

      Ewing sarcoma is a type of tumor that forms from a certain kind of cell in bone or soft tissue. Ewing sarcoma may be found in the bones of the legs, arms, feet, hands, chest, pelvis, spine, or skull. Ewing sarcoma also may be found in the soft tissue of the trunk, arms, legs, head and neck, abdominal cavity, or other areas.

      Ewing sarcoma is most common in adolescents and young adults.

      Ewing sarcoma has also been called peripheral primitive neuroectodermal tumor, Askin tumor (Ewing sarcoma of the chest wall), extraosseous Ewing sarcoma (Ewing sarcoma in tissue other than bone), and Ewing sarcoma family of tumors.

      Signs and symptoms of Ewing sarcoma include swelling and pain near the tumor.

      These and other signs and symptoms may be caused by Ewing sarcoma or by other conditions. Check with your child’s doctor if your child has any of the following:

      • Pain and/or swelling, usually in the arms, legs, chest, back, or pelvis.
      • A lump (which may feel soft and warm) in the arms, legs, chest, or pelvis.
      • Fever for no known reason.
      • A bone that breaks for no known reason.

      Tests that examine the bone and soft tissue are used to diagnose and stage Ewing sarcoma.

      Procedures that make pictures of the bones and soft tissues and nearby areas help diagnose Ewing sarcoma and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the bones and soft tissues is called staging.

      In order to plan treatment, it is important to know if the cancer is in the area where it first formed or if it has spread to other parts of the body. Tests and procedures to detect, diagnose, and stage Ewing sarcoma are usually done at the same time.

      The following tests and procedures may be used to diagnose or stage Ewing sarcoma:

      • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
      • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the area where the tumor formed. This procedure is also called nuclear magnetic resonance imaging (NMRI).
        Enlarge Magnetic resonance imaging (MRI) of the abdomen; drawing shows a child lying on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
        Magnetic resonance imaging (MRI) of the abdomen. The child lies on a table that slides into the MRI scanner, which takes pictures of the inside of the body. The pad on the child’s abdomen helps make the pictures clearer.
      • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the area where the tumor formed or the chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
        Enlarge Computed tomography (CT) scan of the abdomen; drawing shows a child lying on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
        Computed tomography (CT) scan of the abdomen. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the abdomen.
      • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and a CT scan are often done at the same time. If there is any cancer, this increases the chance that it will be found.
        Enlarge Positron emission tomography (PET) scan; drawing shows a child lying on table that slides through the PET scanner.
        Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.
      • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
        Enlarge Bone scan; drawing shows a child lying on a table that slides under the scanner, a technician operating the scanner, and a computer monitor that will show images made during the scan.
        Bone scan. A small amount of radioactive material is injected into the child's vein and travels through the blood. The radioactive material collects in the bones. As the child lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen.
      • Bone marrow aspiration and biopsy : The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow and bone under a microscope to see if the cancer has spread.
        Enlarge Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone.
        Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
      • X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as the chest or the area where the tumor formed.
      • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
      • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as lactate dehydrogenase (LDH), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.

      A biopsy is done to diagnose Ewing sarcoma.

      Tissue samples are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. It is helpful if the biopsy is done at the same center where treatment will be given.

      • Needle biopsy : For a needle biopsy, tissue is removed using a needle. This type of needle biopsy may be done if it’s possible to remove tissue samples large enough to be used for testing.
      • Incisional biopsy : For an incisional biopsy, a sample of tissue is removed through an incision in the skin.
      • Excisional biopsy : The removal of an entire lump or area of tissue that doesn’t look normal.

      The specialists (pathologist, radiation oncologist, and surgeon) who will treat the patient usually work together to decide where the needle should be placed or the biopsy incision should be made. This is done so that the biopsy doesn't affect later treatment such as surgery to remove the tumor or radiation therapy.

      If there is a chance that the cancer has spread to nearby lymph nodes, one or more lymph nodes may be removed and checked for signs of cancer.

      The following tests may be done on the tissue that is removed:

      • Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
      • Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
      • Flow cytometry : A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface. The cells are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the light-sensitive dye reacts to the light.

      Certain factors affect prognosis (chance of recovery).

      The factors that affect prognosis (chance of recovery) are different before and after treatment.

      Before treatment, prognosis depends on:

      • Whether the tumor has spread to lymph nodes or distant parts of the body.
      • Where in the body the tumor started.
      • Whether the tumor formed in the bone or in soft tissue.
      • How large the tumor is at when the tumor is diagnosed.
      • Whether the LDH level in the blood is higher than normal.
      • How much radioactive glucose is taken up by the tumor during a PET scan.
      • Whether the tumor has certain gene changes.
      • Whether the child is younger than 15 years.
      • The patient's sex.
      • Whether the child has had treatment for a different cancer before Ewing sarcoma.
      • Whether the tumor has just been diagnosed or has recurred (come back).

      After treatment, prognosis is affected by:

      If the cancer recurs after initial treatment, prognosis depends on:

      • Whether the cancer came back more than two years after the initial treatment.
      • Where in the body the tumor came back.
      • The type of initial treatment given.

      Stages of Ewing Sarcoma

      Key Points

      • The results of diagnostic and staging tests are used to find out if cancer cells have spread.
      • Ewing sarcoma is described based on whether the cancer has spread from the bone or soft tissue in which the cancer began.
        • Localized Ewing sarcoma
        • Metastatic Ewing sarcoma
      • There are three ways that cancer spreads in the body.
      • Cancer may spread from where it began to other parts of the body.

      The results of diagnostic and staging tests are used to find out if cancer cells have spread.

      The process used to find out if cancer has spread from where it began to other parts of the body is called staging. There is no standard staging system for Ewing sarcoma. The results of the tests and procedures done to diagnose and stage Ewing sarcoma are used to group the tumors into localized or metastatic.

      Ewing sarcoma is described based on whether the cancer has spread from the bone or soft tissue in which the cancer began.

      Ewing sarcoma is described as either localized or metastatic.

      Localized Ewing sarcoma

      The cancer is found in the bone or soft tissue in which it began and may have spread to nearby tissue, including nearby lymph nodes.

      Metastatic Ewing sarcoma

      The cancer has spread from the bone or soft tissue in which it began to other parts of the body. In Ewing tumor of bone, the cancer most often spreads to the lung, other bones, and bone marrow.

      There are three ways that cancer spreads in the body.

      Cancer can spread through tissue, the lymph system, and the blood:

      • Tissue. The cancer spreads from where it began by growing into nearby areas.
      • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
      • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

      Cancer may spread from where it began to other parts of the body.

      When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

      • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor ( metastatic tumor) in another part of the body.
      • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

      The metastatic tumor is the same type of cancer as the primary tumor. For example, if Ewing sarcoma spreads to the lung, the cancer cells in the lung are actually Ewing sarcoma cells. The disease is metastatic Ewing sarcoma, not lung cancer.

      Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

      Recurrent Ewing Sarcoma

      Recurrent Ewing sarcoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the tissues where it first started or in another part of the body.

      Treatment Option Overview

      Key Points

      • There are different types of treatment for children with Ewing sarcoma.
      • Children with Ewing sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
      • Treatment for Ewing sarcoma may cause side effects.
      • Five types of standard treatment are used:
        • Chemotherapy
        • Radiation therapy
        • Surgery
        • Targeted therapy
        • High-dose chemotherapy with stem cell rescue
      • New types of treatment are being tested in clinical trials.
        • Chimeric antigen receptor (CAR) T-cell therapy
      • Patients may want to think about taking part in a clinical trial.
      • Patients can enter clinical trials before, during, or after starting their cancer treatment.
      • Follow-up tests may be needed.

      There are different types of treatment for children with Ewing sarcoma.

      Different types of treatments are available for children with Ewing sarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

      Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

      Children with Ewing sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children.

      Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with Ewing sarcoma and who specialize in certain areas of medicine. These may include the following specialists:

      Treatment for Ewing sarcoma may cause side effects.

      For information about side effects that begin during treatment for cancer, see our Side Effects page.

      Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:

      Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)

      Five types of standard treatment are used:

      Chemotherapy

      Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas ( regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

      Systemic chemotherapy is part of the treatment for all patients with Ewing tumors. It is often the first treatment given and lasts for about 6 to 12 months. Chemotherapy is often given to shrink the tumor before surgery or radiation therapy and to kill any tumor cells that may have spread to other parts of the body.

      See Drugs Approved for Soft Tissue Sarcoma for more information.

      Radiation therapy

      Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

      External radiation therapy is used to treat Ewing sarcoma.

      Radiation therapy is used when the tumor cannot be removed by surgery or when surgery to remove the tumor will affect important body functions or the way the child will look. It may be used to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. It may also be used to treat any tumor that remains after surgery and tumors that have spread to other parts of the body.

      Surgery

      Surgery is usually done to remove cancer that is left after chemotherapy or radiation therapy. When possible, the whole tumor is removed by surgery. Tissue and bone that are removed may be replaced with a graft, which uses tissue and bone taken from another part of the patient's body or a donor. Sometimes an implant, such as artificial bone, is used.

      Even if the doctor removes all of the cancer that can be seen at the time of the operation, chemotherapy or radiation therapy may be given after surgery to kill any cancer cells that are left. Chemotherapy or radiation therapy given after surgery to lower the risk that the cancer will come back is called adjuvant therapy.

      Targeted therapy

      Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

      Monoclonal antibody therapy is a type of targeted therapy used in the treatment of recurrent Ewing sarcoma. It is being studied for the treatment of metastatic Ewing sarcoma. Monoclonal antibodies are made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

      New types of targeted therapy are being studied.

      • Kinase inhibitor therapy is another type of targeted therapy. Kinase inhibitors are drugs that block a protein needed for cancer cells to divide. They are being studied in the treatment of recurrent Ewing sarcoma.
      • PARP inhibitor therapy is another type of targeted therapy. PARP inhibitors are drugs that block DNA repair and may cause cancer cells to die. They are being studied in the treatment of recurrent Ewing sarcoma.

      High-dose chemotherapy with stem cell rescue

      High-dose chemotherapy with stem cell rescue is a way of giving high doses of chemotherapy to treat Ewing sarcoma and then replacing blood -forming cells destroyed by cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Chemotherapy with stem cell rescue is used to treat recurrent Ewing sarcoma.

      New types of treatment are being tested in clinical trials.

      This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

      Chimeric antigen receptor (CAR) T-cell therapy

      CAR T-cell therapy is a type of immunotherapy that changes the patient's T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of Ewing sarcoma that has recurred.

      Enlarge CAR T-cell therapy; drawing of blood being removed from a vein in a patient’s arm to get T cells. Also shown is a special receptor called a chimeric antigen receptor (CAR) being made in the laboratory; the gene for CAR is inserted into the T cells and then millions of CAR T cells are grown. Drawing also shows the CAR T cells being given to the patient by infusion and binding to antigens on the cancer cells and killing them.
      CAR T-cell therapy. A type of treatment in which a patient’s T cells (a type of immune cell) are changed in the laboratory so they will bind to cancer cells and kill them. Blood from a vein in the patient’s arm flows through a tube to an apheresis machine (not shown), which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. Then, the gene for a special receptor called a chimeric antigen receptor (CAR) is inserted into the T cells in the laboratory. Millions of the CAR T cells are grown in the laboratory and then given to the patient by infusion. The CAR T cells are able to bind to an antigen on the cancer cells and kill them.

      Patients may want to think about taking part in a clinical trial.

      For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

      Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

      Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

      Patients can enter clinical trials before, during, or after starting their cancer treatment.

      Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

      Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

      Follow-up tests may be needed.

      Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

      Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

      Treatment Options for Ewing Sarcoma

      For information about the treatments listed below, see the Treatment Option Overview section.

      Localized Ewing Sarcoma

      Standard treatments for localized Ewing sarcoma include:

      These treatments and the order they are given depend on the following:

      • Where in the body the tumor started.
      • How large the tumor is when the cancer is diagnosed.
      • Whether the tumor was completely removed by surgery.
      • The child's age and general health.
      • Whether the treatment will affect important body functions or the way the child will look.

      Treatments being studied for localized Ewing sarcoma include:

      Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

      Metastatic Ewing Sarcoma

      Standard treatments for metastatic Ewing sarcoma include:

      These treatments and the order they are given depend on the following:

      • Where in the body the tumor started.
      • Where the tumor has spread.
      • How large the tumor is.
      • Whether the treatment will affect important body functions or the way the child will look.
      • The child's age and general health.

      Treatments being studied for metastatic Ewing sarcoma include the following:

      Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

      Recurrent Ewing Sarcoma

      There is no standard treatment for recurrent Ewing sarcoma but treatment options may include the following:

      These treatments and the order they are given depend on the following:

      • Where in the body the tumor came back.
      • The initial treatment given.

      Treatment options being studied for recurrent Ewing sarcoma include the following:

      Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

      To Learn More About Ewing Sarcoma

      About This PDQ Summary

      About PDQ

      Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

      PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

      Purpose of This Summary

      This PDQ cancer information summary has current information about the treatment of childhood Ewing sarcoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

      Reviewers and Updates

      Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

      The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

      Clinical Trial Information

      A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

      Clinical trials are listed in PDQ and can be found online at NCI's website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

      Permission to Use This Summary

      PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

      The best way to cite this PDQ summary is:

      PDQ® Pediatric Treatment Editorial Board. PDQ Ewing Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/bone/patient/ewing-treatment-pdq. Accessed . [PMID: 26389350]

      Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

      Disclaimer

      The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

      Contact Us

      More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

      Updated: October 26, 2017

      This content is provided by the National Cancer Institute (www.cancer.gov)
      Syndicated Content Details:
      Source URL: https://www.cancer.gov/publishedcontent/syndication/5824.htm
      Source Agency: National Cancer Institute (NCI)
      Captured Date: 2013-09-14 09:03:06.0
    • Cancer Prevention

      You can lower your risk of cancer by committing to practices that build a healthy lifestyle. These recommendations can lower your risk for this disease, as well as improve your overall basic health.

      Avoid using tobacco products. Tobacco has been tied to multiple cancers, and it is responsible for 90 percent of lung cancer deaths.

      Stay physically active. Your physical activity is related to risk for colon and breast cancer. Excess weight gained from inactivity increases the risk of multiple cancers.

      Limit alcohol consumption. It is important to be mindful of your alcohol consumption. Alcohol intake, even in moderate amounts, can increase the risk for colon, breast, esophageal, and oropharyngeal cancer.

      It is always beneficial to be proactive in understanding your health. Make plans to be regularly screened for breast, cervical, and colorectal cancer. Learn more about our Cancer Screening Program and events.

    • Diagnosis

      Bone cancer rarely begins in the bone. A tumor that does originate in the bone is referred to as a sarcoma. More commonly, bone cancer forms when cancer from another part of the body metastasizes to the bone.

      If your healthcare provider believes you may have bone cancer, you will need certain exams and tests to be sure.

      You should expect to be asked questions about your health history, your symptoms, risk factors, and family history of disease. Your doctor will discuss the specifics of your condition during your meeting. Understanding your background will help your provider make a diagnosis.

      Your doctor may have you take one or more of the following tests:

      • Imaging Test. An X-ray image of your bone at the site of the cancer may reveal abnormalities that your healthcare providers are searching for.
      • Computer Tomography (CT) Scan. CT scans are most useful for detecting the stage of the cancer being diagnosed. The scan’s results tell your doctor if the cancer has spread to your lungs, liver, or other organs.
      • Magnetic Resonance Imaging (MRI) Scan. Typically, MRI scans are the best test for outlining a bone tumor, and are also helpful for looking at the brain and spinal cord. MRI scans take longer than CT scans – usually around an hour.
      • Positron Emission Tomography (PET) Scan. PET scans are useful for examining cancer throughout your body, and can help determine the current stage of the cancer. It is sometimes used in partnership with a CT scan to better pinpoint the cancer in question.
      • Biopsy Tissue Sample. A biopsy removes tissue or cells to be checked by a pathologist under a microscope. Results from a biopsy help determine if abnormal cells are cancer. Your doctor may perform this procedure in a variety of ways including bronchoscopy, mediastinoscopy, and needle biopsy. Ask your provider about your specific type of biopsy to learn more.

      Getting your test results

      Patients will be called within five days after biopsy by a nurse navigator. Further management will be recommended at that time.

    • Surgery

      surgery

      The primary treatment for bone cancer is surgery. The main goal of this procedure is to completely remove the cancer, as even a few cancer cells left behind can grow and multiply to create a new tumor. To be sure that all cancer cells are gone, surgeons typically perform a wide-excision, a procedure to remove the tumor plus some healthy surrounding tissue. A wide-excision with no cancer detected on the remaining edges of tissues, also known as a clean margin, minimizes the risk that the cancer will return.

      Tumors in the Arms or Legs

      In some cases, it is necessary for an entire limb to be removed in order to perform a successful wide-excision. This procedure is known as an amputation.

      Surgeons can remove the cancer without amputation in most cases. It is important to note that there are both advantages and disadvantages to either type of surgery, and your doctor will explain these to you.

      Tumors in these areas will be treated with one of three surgeries:

      • Amputation. This surgery removes part or all of a limb, meaning an arm or leg. Amputation treats cancer by removing the tumor, along with some healthy tissue surrounding it to ensure the tumor has been fully removed. In the past, it was the main way to treat tumors found in an arm or leg. Now it is only the best option if there is a reason not to do a limb-salvage surgery.
      • Limb-salvage surgery. This surgery aims to remove the tumor while leaving a working limb intact. In this type of surgery, a wide-excision is done to remove the tumor, while a bone graft is used to replace the bone that is lost. Over 90 percent of bone cancer patients needing treatment in a limb are able to spare it, according to the American Cancer Society.
      • Reconstructive surgery. This surgery allows joints to remain attached following a partial amputation using a prosthesis.
    • Chemotherapy

      Chemotherapy is one of the longest used and most common treatments for cancer. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow and reproduce. For some types of cancer, chemotherapy may be used alone or in combination with other treatments such as radiation or surgery. A combination of chemotherapy medicines is typically used to fight a specific cancer.

      While chemotherapy can be quite effective in treating certain cancers, the medicines reach all parts of the body, not just the cancer cells. There can be many side effects during treatment, and being prepared for these side effects can help you and your caregivers manage them effectively.

      How is chemotherapy given?

      Chemotherapy can be given in various ways, such as:

      • A pill to swallow.
      • An injection (shot) into the muscle or fat tissue.
      • Directly into the bloodstream, or intravenously (also called IV).
      • Topically (applied to the skin).
      • Directly into a body cavity.

      Chemotherapy is usually given in cycles in order to allow healthy cells the time to recover. Treatment may be given daily, weekly, every few weeks, or monthly, depending on your situation.

      Also, this treatment is typically given in an outpatient setting. This includes a hospital, clinic, or healthcare provider's office. 

      Patients are encouraged to take along something that is comforting to occupy their time during treatment. Since it is hard to predict how a patient will feel after treatment, it is important that the patient has arrangements to have someone drive them to and from their appointment.

    • Radiation Therapy

      Radiation therapy is a treatment for cancer that uses high-energy X-rays. A machine directs the rays of energy to the area of cancer, with a goal to kill or shrink cancer cells.

      When might radiation therapy be used for bone cancer?

      Most often, bone patients will not receive radiation therapy as a major part of their treatment. Most bone cancers are not easily affected by radiation, and high doses are needed to see results. Typically, radiation is used when a tumor cannot be completely removed by surgery.

      Types of Radiation Therapy

      • Intense-modulated radiation therapy. This therapy is an advanced form of external beam radiation therapy. Computers are used to match the radiation beams to the shape of the tumor and adjust the strength of the radiation beams. This makes it possible to reduce radiation damage to normal tissue and pinpoint the radiation dose on the cancer.
      • Proton-beam radiation. This special form of radiation uses protons instead of regular x-rays to kill cancer cells. Protons are positively charged particles found in all atoms that cause little damage to normal tissue but are effective at killing cancer cells, allowing higher doses to be given during therapy.
    • Questions to Ask Your Doctor

      questions

      Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Consider asking each of the following questions:

      • Where is the sarcoma located?
      • Has it spread beyond where it started?
      • What’s the sarcoma’s stage, and what does that mean?
      • What type of treatment do you recommend and why?
      • What type of side-effects come along with this treatment?
      • Should I consider taking part in a clinical trial?
      • If I need surgery, where will the incision be?
      • If I need surgery, how much tissue will be removed?
      • Will I need treatment after surgery, like radiation or chemotherapy?
      • What type of follow-up care will I need?
      • When can I go back to my normal activities? 
    • Surveillance and Ongoing Care

      When their initial treatment is completed, patients in the Multidisciplinary Clinic are referred to Markey's Surveillance clinic. The surveillance clinic is designed to connect a patient's medical history with their future quality of life as a cancer survivor.

      A standard, initial meeting helps patients identify important aspects of their continuing health care, including long-term or late effects of treatment, diet, smoking cessation, and enlisting the help of Markey's American Cancer Society Patient Navigators and financial counselors. This first meeting is usually broken up to include 30 minutes with the program leader, and another 15 to 30 minutes with dietitians and the patient navigator.

      Patients also receive a personalized care plan, in accordance with national best practices for ongoing surveillance care and are referred to a primary care provider if they don't already have one.

      Expressions of Courage

      Expressions of Courage is an event designed to showcase the experiences and creativity of Markey patients who have battled cancer, timed to coincide with other nationwide celebrations in June for Cancer Survivorship Month. Along with celebrating, the event provides opportunities to connect with members of the Healthy Living Panel to further enhance their recovery process.

      Learn more about Expressions of Courage events.

    • Support

      The UK Markey Cancer Center is known for providing state-of-the-art care for cancer patients, incorporating the latest advances in surgery, chemotherapy and radiation medicine.

      However, cancer patients have needs that even these treatments cannot reach. They may have pain from their disease or secondary to treatment. They often experience anxiety or depression. They may undergo a spiritual crisis. Some are overwhelmed by decisions they have to make concerning their care. Many worry about family members who rely upon them. Palliative care is a special branch of medicine dedicated to meeting these patient needs.

      Palliative care and integrative medicine at Markey Cancer Center currently includes:

      • Jin Shin Jyutsu.
      • Nutrition information and planning.
      • Psych-Oncology services.
      • A variety of support groups and local resources.
      • Palliative care resources at UK HealthCare.
      • Art therapy.

      To learn more about the support services available at the UK Markey Cancer Center, you can visit Markey's  Support Services section. For specific support information, consider the following pages.

      Integrative Medicine & Health

      The UK Integrative Medicine and Health program uses traditional medical therapies and practices, while also recognizing the interaction between the patient’s mind, body and spirit.

      Learn more about UK's Integrative Medicine & Health program.

      Nutrition Counseling

      Good nutrition is the best way to prevent weight loss and increase quality of life during cancer treatment.

      Learn more about nutrition counseling resources.

      Palliative Care

      Markey patients benefit from access to the UK HealthCare Palliative Care Service, which works works with the Palliative Care Center of the Bluegrass to provide comfort to patients who are experiencing a life-limiting illness such as cancer.

      Learn more about the UK HealthCare Palliative Care Service.

      Oncology Social Work

      The Markey Psych-Oncology staff can offer emotional support and counseling during treatment and can help address various types of issues that patients experience during treatment.

      Learn more about Oncology Social Work.