Ewing sarcoma

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Ewing sarcoma is a malignant bone tumor that forms in the bone or soft tissue. It affects mostly teens and young adults.

Alternative Names

Bone cancer - Ewing sarcoma; Ewing family of tumors; Primitive neuroectodermal tumors (PNET); Bone neoplasm - Ewing sarcoma


Ewing sarcoma can occur anytime during childhood and young adulthood. But it usually develops during puberty, when bones are growing rapidly. It is more common in white children than in African-American, or Asian-American children.


may start anywhere in the body. Most often, it starts in the of the arms and legs, the pelvis, or the chest. It can also develop in the skull or the of the trunk.

The tumor often spreads (metastasizes) to the lungs and other bones. At the time of diagnosis, spread is seen in about one-third of children with Ewing sarcoma.

In rare cases, Ewing sarcoma occurs in adults.


There are few symptoms. The most common is pain and sometimes swelling at the site of the tumor.

Children may also break a bone at the site of the tumor after a minor injury.

Fever may also be present.

Exams and Tests

If a tumor is suspected, tests to locate the primary tumor and any spread (metastasis) often include:

A biopsy of the tumor will be done. Different tests are done on this tissue to help determine how aggressive the cancer is and what treatment may be best.


Treatment often includes a combination of:

Treatment depends on the following:

  • Stage of the cancer
  • Age and sex of the person
  • Results of the tests on the biopsy sample

Support Groups

The stress of illness can be eased by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Before treatment, outlook depends on:

  • Whether the tumor has spread to lymph nodes or distant parts of the body
  • Where in the body the tumor started
  • How large the tumor is when it's diagnosed.
  • Whether the LDH level in the blood is higher than normal
  • Whether the tumor has certain gene changes
  • Whether the child is younger than 15 years
  • Child's sex
  • Whether the child has had treatment for a different cancer before Ewing sarcoma
  • Whether the tumor has just been diagnosed or has come back

The best chance for cure is with a combination of treatments that includes chemotherapy plus radiation or surgery.

Possible Complications

The treatments needed to fight this disease have many complications. Discuss these with your health care provider.

When to Contact a Medical Professional

Call your provider if your child has any of the symptoms of Ewing sarcoma. An early diagnosis can increase the possibility of a favorable outcome.


Anderson ME, Randall RL, Springfield DS, Gebhardt MC. Sarcomas of bone. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 92.

National Cancer Institute. PDQ Ewing sarcoma treatment. Bethesda, MD: National Cancer Institute. Updated March 3, 2016. cancer.gov/cancertopics/pdq/treatment/ewings/HealthProfessional. Accessed March 17, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): bone cancer. Updated 2016. www.nccn.org/professionals/physician_gls/pdf/bone.pdf. Accessed March 17, 2016.

Version Info

  • Last reviewed on 2/12/2016
  • Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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