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Ewing Sarcoma Diagnosis and Treatment - A Detailed Guide

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Ewing sarcoma diagnosis is done through several techniques. Ewing sarcoma therapy options include radiation therapy and chemotherapy. The Ewing sarcoma cancer survival rate depends upon the stage of the disease, organs affected, and response to treatment.

Procedures or Tests for Ewing Sarcoma Diagnosis

The procedure or tests for an Ewing sarcoma diagnosis are:

Medical History and Physical Examination

The patients should consult the doctors if they experience persistent pain, swelling, and joint stiffness, especially when the pain worsens at night. The doctor may perform a comprehensive medical evaluation to determine the cause of the symptoms. The patients may be asked about any recent falls or trauma that may have caused the symptoms. The patients may also be asked about the unexplained weight loss and recent fever, as these are also symptoms of Ewing sarcoma, particularly in advanced stages. The doctor may also evaluate the patient's respiratory health to detect pleural signs or asymmetric breath sounds. Purpura or petechiae due to thrombocytopenia, if present, are evaluated.

Imaging Tests

Clinicians face challenges in Ewing sarcoma diagnosis due to the presence of similar symptoms in benign bone lesions and pseudotumoral lesions. The initial staging of the disease, the biopsy, the choice of therapy, and follow-up care depend upon the results of the imaging techniques. Clinicians take extra care while choosing the suitable imaging technique for an accurate diagnosis and optimal treatment.

X-Rays

X-rays are usually the first imaging method clinicians recommend in cases of bone-related conditions. X-ray images assist clinicians in diagnosing Ewing sarcoma. The characteristics of the affected bone seen during the Ewing sarcoma radiology examination include diffuse bone destruction, periosteal reactions, and soft tissue involvement. A study reported that the mean time from the onset of symptoms to the first Ewing sarcoma X-ray examination was several months. Due to the vascular characteristics of Ewing sarcoma, the spread is greater than that indicated in the X-ray images.

Magnetic Resonance Imaging (MRI)

The visualization of Ewing sarcoma on the MRI depends upon the location, size, and stage of the tumor. MRI assists clinicians in detecting and localizing the primary tumor occurring in the bone and soft tissues. It also provides important information related to soft tissue and bone marrow involvement that affects treatment strategies. During diagnosis, MRI also helps determine the stage of diagnosis. It also helps plan the surgery and monitor the response to treatment and recurrence.

Computed Tomography (CT) Scan

A CT scan has a role in the diagnosis and management of Ewing sarcoma. Ewing sarcoma CT scans assist clinicians in detecting and staging the disease. Sometimes, the doctors may advise the patients to undergo complete body imaging for appropriate staging. Besides providing detailed information about the size and extent of tumors and soft tissue involvement, CT scans also assist in lung evaluation to detect pulmonary metastasis. Like an MRI, a CT scan also monitors the treatment response and recurrence.

Positron Emission Tomography (PET) Scan

PET scans use radioactive sugar analogs that are injected into the body and predominantly taken up by tumor cells. A special device is used to detect the presence of radioactive material. A PET scan plays an important role in diagnosing and staging the disease by scanning the body. It also assists in differentiating the residual disease from the scar tissue. It helps the oncologists plan the treatment and provides additional prognostic information. The technique is usually combined with a CT scan (PET/CT) for a comprehensive evaluation.

Bone Scan

Ewing sarcoma typically involves the bones, and a bone scan is an effective method to detect the sites of increased bone activity. This technique involves injecting a low dose of radioactive material into the blood. The radioactive material travels to the bones and is detected by a special camera. The sites with active bone changes have an accumulation of radioactive substances that appear as "hot spots" on the imaging. Although these may suggest the presence of a tumor, other skeletal conditions also give similar results to bone scans. Bone scans should accompany other tests, such as MRIs or X-rays. As there is a complete scan of the skeleton, the bone scan provides information about the spread of the tumor to other sites. As a PET scan gives similar information, the doctor may not advise a bone scan if the patient has already undergone a PET scan.



Blood Test

Although blood tests do not diagnose Ewing sarcoma, they provide valuable information about the patient's health. In some cases, blood tests also inform about the spread of Ewing sarcoma to other organs, such as the liver or kidneys, by detecting the levels of various substances in the blood.

Complete Blood Count (CBC)

Patients with Ewing sarcoma may have anemia (low red blood cells), leucopenia (low white blood cells), and thrombocytopenia (low platelets). A complete blood count detects these conditions, suggesting the involvement of bone marrow. However, these conditions are not exclusive to Ewing sarcoma and may occur due to other diseases.

Comprehensive Metabolic Panel

A comprehensive metabolic panel involves testing several markers in the blood to detect the spread of Ewing sarcoma. A liver function test is performed to determine the level of various liver enzymes. Kidney function tests are conducted to determine the health status of the kidneys. Kidney function tests are also important during treatment, as chemotherapy may affect kidney function in many patients. Erythrocyte sedimentation rate and C-reactive protein evaluation are important for determining the inflammatory process.

Lactate Dehydrogenase (LDH)

Serum levels of lactate dehydrogenase may assist in cancer cells' diagnosis, prognosis, and treatment response. However, abnormal lactate dehydrogenase levels are not specific to Ewing sarcoma and may occur with other diseases. Elevated levels of LDH, which are generally due to tissue breakdown or damage, suggest a higher tumor burden. Patients diagnosed with Ewing sarcoma and having elevated TDH levels have a relatively unfavorable prognosis.



Biopsy

A biopsy is a technique that involves obtaining the samples suspected of Ewing sarcoma and analyzing the samples in the laboratory to confirm the presence of malignant cells. There are two methods for obtaining the samples.

Bone Marrow Aspiration

This procedure involves obtaining the fluid portion from the abnormal tissues with the help of a thin, hollow needle. The doctor cleans and numbs the needle insertion site with local anesthesia before this procedure

Bone marrow biopsy

Bone marrow aspiration is generally followed by a bone marrow biopsy. It involves obtaining the solid portion, such as bone or marrow. The needle used in the bone marrow biopsy is relatively thicker.

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What are the Effective Ewing Sarcoma Treatments?

Once the diagnosis of Ewing sarcoma is confirmed and the disease is staged, specialists chart a personalized care plan that comprises various treatment approaches. The following are the different Ewing sarcoma treatments recommended:

Surgery

The type of surgical intervention for Ewing sarcoma treatment depends upon several factors, such as the location and size of the tumor, health and age, and the effect on the function of the affected part after surgery. During surgery, the oncological surgeon removes the tumor and surrounding healthy tissues to reduce the risk of recurrence. This procedure is known as a wide excision. The goal of Ewing sarcoma surgery as a part of Ewing sarcoma treatment is to perform limb salvage surgery for Ewing sarcoma of the legs and arms. In rare cases, amputation is required. The surgery may also be performed for tumors of the chest, spine, and hipbone.

Chemotherapy

Chemotherapy is another option for Ewing sarcoma treatment. Medical oncologists use a combination of various chemotherapy drugs to treat Ewing sarcoma. Chemo for Ewing sarcoma is delivered in cycles, with a resting period between the two cycles. The drug is administered orally or directly into the tissues through injection.

Radiation therapy

Radiation therapy is also an option for Ewing sarcoma treatment. This technique is effective as the Ewing tumors are sensitive to high-energy radiation. Radiation therapy is generally used with chemotherapy or surgery. The radiotherapy techniques recommended for Ewing sarcoma treatment include conformal proton beam radiation therapy, intensity-modulated radiation therapy, and three-dimensional conformal radiation therapy.

Why Choose HCG for Ewing Sarcoma Diagnosis and Treatment?

Diagnosis and management of Ewing sarcoma are challenging and require modern techniques and state-of-the-art treatment facilities for a favorable prognosis. HCG Center has excellent diagnostic and treatment facilities that provide a one-stop solution for patients with Ewing sarcoma. The hospital is equipped with imaging facilities, including bone scans. Medical and surgical oncologists are experts in performing complex surgeries related to Ewing sarcoma with a high success rate.

Conclusion

Tests available for Ewing sarcoma diagnosis include medical history and physical evaluation, imaging tests, blood tests, and biopsy. The Ewing sarcoma treatment options include surgery, chemotherapy, and radiation therapy.

Frequently Asked Questions

What are Ewing sarcoma treatment complications?

The complications of Ewing sarcoma treatment depend on the type of treatment. For instance, surgery may cause tissue loss, while chemotherapy results in hair loss and fatigue. Radiation therapy has skin-related side effects. However, most of these side effects are temporary and can be managed with medication and post-treatment care.

Surgery may not always be required or may not be the cure for Ewing sarcoma. Other treatment options, like chemotherapy and radiation therapy, may manage Ewing sarcoma in cases where surgery is not possible.

The duration of treatment depends on the disease stage and the overall health of the patient.

Several symptoms of Ewing sarcoma, such as pain and stiffness, overlap with those of other common conditions, making its diagnosis challenging.

The cure of Stage 4 Ewing sarcoma depends on the location of metastases, the patient’s age, overall health, and response to treatment.

The length of Ewing sarcoma chemotherapy depends on the stage of the disease and the overall patient's health.

As Ewing sarcoma is highly sensitive to high-energy radiation, Ewing sarcoma radiation therapy is effective in treating the disease. Evidence suggests that radiation therapy may improve the Ewing sarcoma life expectancy.