In young people, the development of the tumour appears to be in some way related to periods in life with rapid growth, hence the average for tumour development is 14-15 years. The relationship to growth may also be part of the explanation why Ewing's sarcoma is slightly more common in boys than in girls. However, Ewing's sarcoma remains an extremely rare tumour in all groups of the population, and there is no extra cause for concern in rapidly growing teenagers.

How is Ewing's sarcoma diagnosed ? If a bone tumour is suspected the doctor will do a complete medical examination. This may include a blood test as bone tumours can be associated with increased levels of certain enzymes in the blood. The doctor may also recommend X-rays and other scans of the bone(s), if X-rays and scans suggest that a tumour might be present then a biopsy (removal of a sample of tissue) will be performed.

What is the treatment for Ewing's sarcoma ? Ewing's sarcoma is usually sensitive to chemotherapy and radiotherapy. Modern treatments are based on chemotherapy combined with local therapy (surgery and/or radiotherapy to the main tumour): Chemotherapy is given to kill malignant cells that may be circulating around the body. It is generally administered before and after the local therapy.

James Ewing, 1866-1943, first described the tumour that was to be named after him in the 1920's. It was Ewing's work which established that the disease was separate from lymphoma and other types of cancer know at that time. Ewing was originally born in Pittsburgh and embarked on his medical career in 1888. In 1899 he was appointed as the first Professor of Pathology at Cornell University where he developed a keen interest in cancer.

Are my relatives at risk ? Almost all Ewing's sarcoma tumours have a change in their genetic makeup. Normal human cells contain 23 pairs of chromosomes. In Ewing's sarcoma tumours, a piece of chromosome 11 has moved to chromosome 22. This creates a new piece of DNA. This does not mean that the disease is passed from parent to child. For genetic change to pass from parent to child, it must be present in the sperm or egg which give rise to a new human being.

What are the symptoms of Ewing's sarcoma ? Symptoms of Ewing's sarcoma vary from person to person and depending on the location and size of the cancer. The most common symptoms are pain and swelling or tenderness in the affected area. Pain may become very intense when the tumour is located near important nerves, like in the sacrum, pelvis or spine. Swelling is often seen, especially when the log bones of the arms or legs are affected.

There is no rationale for treating children and adults differently; chemotherapy is usually the same. However, children are thought to tolerate chemotherapy better than adults. Also children can develop more severe delayed side effects from radiation therapy, such as bone growth retardation. This is one of the factors taken into account before deciding on the type of local therapy given. Studies have shown similar results in adults and children when they are treated with the same protocol.

Ewing's sarcoma is a cancer. The cancer can start in bone or in soft tissues. The most common sites for Ewing's sarcoma are the pelvis, the thigh, and the trunk of the body. The peak ages are between 10 and 20, but younger children and older adults can also get Ewing's sarcoma. We do not know exactly what kind of cell gives rise to Ewing's sarcoma. It has some features that resemble the early cells that would normally develop into part of the nervous system.

The most frequent locations for the primary tumour are the pelvis, femur (thigh bone), tibia / fibula (bones of the lower leg), bones of the spine, ribs and humerus (upper arm). Other sites are less common, however, Ewing's sarcoma can potentially arise in any of the 206 bones in the body. It can also develop in the soft tissues without bone involvement. The figure below gives a summary of primary tumour site in a series of over 900 people diagnosed with Ewing's sarcoma of bone.

In young people, the development of the tumour appears to be in some way related to periods in life with rapid growth, hence the average for tumour development is 14-15 years. The relationship to growth may also be part of the explanation why Ewing's sarcoma is slightly more common in boys than in girls. However, Ewing's sarcoma remains an extremely rare tumour in all groups of the population, and there is no extra cause for concern in rapidly growing teenagers.

Ewing's sarcoma spreads when tumour cells enter the blood supply and are circulated to other parts of the body where they may form secondary tumours ("metastases"). Chemotherapy is given to kill these circulating tumour cells. The most common sites for secondary tumours are the lungs and other bones. Tumour cells may also spread via the lymphatic system (this is a network of lymph glands around the body).