Ewing's Sarcoma: Survival Rate, Symptoms, Pictures, and More

 Ewing’s sarcoma is a rare cancerous tumor of bone or soft tissue. It occurs mostly in young people.

Overall, it affects 1 out of every 1 millionTrusted Source Americans. For adolescents ages 10 to 19 years, this jumps to about 10 cases per 1 million Americans.

The name comes from the American doctor James Ewing, who first described the tumorTrusted Source in 1921. It is not clear what causes Ewing’s sarcoma, so there are no known ways to prevent it. The condition is treatable, and full recovery is possible if it’s caught early.

Keep reading to learn more about Ewing’s sarcoma and its survival rate, symptoms, and treatments.

Ewing’s sarcoma survival rate

The 5-year survival rate for people who have localized tumors is about 80 percentTrusted Source. However, when the cancer has spread to other organs, the 5-year survival rate is about 38 percentTrusted Source.

Factors that can affect the survival rate include:

• the size of the initial tumor
• location of the tumor
• the age of the patient

On average, 1 in 5Trusted Source people with recurrent Ewing’s sarcoma survive long term. This outlook can vary based on the time between recurrences and the location of new tumors.

What are the signs or symptoms of Ewing’s sarcoma?

There are three types of Ewing’s sarcoma. These types depend on whether the cancer has spread from the bone or soft tissue where it started.

• Localized Ewing’s sarcoma. The cancer has not spread to other areas of the body.
• Metastatic Ewing’s sarcoma. The cancer has spread to the lungs or other places in the body.
• Recurrent Ewing’s sarcoma. The cancer does not respond to treatment or returns after a successful course of treatment. It most often recurs in the lungs.

The most common symptom of Ewing’s sarcoma is pain or swelling in the area of the tumor.

Some people may develop a visible lump on the surface of their skin. The affected area may also feel warm to the touch.

Other symptoms include:

• loss of appetite
• fever
• weight loss
• fatigue
• general unwell feeling (malaise)
• a bone that breaks without a known reason
• anemia

Tumors typically form in your:

• arms
• legs
• pelvis
• chest

There may be symptoms specific to the location of the tumor. For example, you may experience shortness of breath if the tumor is in your chest.

Pictures of Ewing’s sarcoma

The below image shows an Ewing’s sarcoma on the left knee of a patient.

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vanzittoo/Shutterstick

How is Ewing’s sarcoma diagnosed?

If you or your child experience symptoms, reach out to a doctor. In about 25 percentTrusted Source of cases, the disease has already spread by the time of diagnosis. The sooner a diagnosis is made, the more effective treatment may be.

To diagnose Ewing’s sarcoma, a doctor will use a combination of the following diagnostic tests.

Imaging tests

Imaging tests may include one or more of the following:

• X-rays. X-rays provide an image of your bones and can identify the presence of a tumor.
• MRI scan. MRI scans take images of soft tissue, organs, muscles, and other structures. They show details of a tumor or other abnormalities.
• CT scan. Doctors use CT scans to image cross-sections of bones and tissues.
• EOS imaging. This procedure shows the interaction of joints and muscles while you’re standing.
• Bone scan. A doctor may order a bone scan of your whole body to show if a tumor has metastasized, or spread.
• PET scan. A PET scan shows whether any abnormal areas that were seen in other scans are tumors.

Biopsies

After imaging, your doctor can order a biopsy to look at a piece of the tumor under a microscope to identify it.

If the tumor is small, your surgeon may perform an excisional biopsy. In this procedure, surgeons will remove the whole tumor while the patient is under general anesthesia. If the tumor is larger, they may cut away a piece of it.

Your surgeon may also insert a needle into the bone to take out a sample of fluid and cells to see if the cancer has spread into your bone marrow.

After the removal of tumor tissue, there are several testsTrusted Source that help identify Ewing’s sarcoma. Blood tests may also provide helpful information for treatment.

What causes Ewing’s sarcoma?

The exact cause of Ewing’s sarcoma is not clear. It’s not inherited, but it can be related to noninherited changes in specific genes during a person’s lifetime. When chromosomes 11 and 12 exchange genetic material, it activates an overgrowth of cells. This may lead to the development of Ewing’s sarcoma.

Who is at risk for Ewing’s sarcoma?

Although Ewing’s sarcoma can develop at any age, more than 50 percentTrusted Source of people with the condition receive a diagnosis as adolescents. The median age of those affected is 15.

In the United States, Ewing’s sarcoma is more likely to develop in white people than Black and Asian people.

How is Ewing’s sarcoma treated?

Treatment for Ewing’s sarcoma depends on:

• where the tumor originated
• the tumor’s size
• whether the cancer has spread

Typically, treatment involvesTrusted Source one or more approaches, including:

• chemotherapy
• radiation therapy
• surgery
• targeted proton therapy
• high-dose chemotherapy combined with stem cell transplant

Treatment options for localized Ewing’s sarcoma

The common approach for cancer that has not spread is a combination of:

• surgery to remove the tumor
• radiation to the tumor area to kill any remaining cancer cells
• chemotherapy to kill possible cancer cells that have spread, or micrometastasis

Further treatment may be necessary after surgery to replace or restore limb function, depending on where the tumor was.

Treatment options for metastasized and recurrent Ewing’s sarcoma

There is currently no standard treatmentTrusted Source for recurrent Ewing’s sarcoma. Treatment options vary depending on where the cancer returned and what the previous treatment was.

Many clinical trials and research studies are ongoing to improve treatment for metastasized and recurrent Ewing’s sarcoma. These trials and studies include:

• stem cell transplants
• immunotherapy
• targeted therapy with monoclonal antibodies
• new drug combinations

What’s the outlook for people with Ewing’s sarcoma?

As new treatments develop, the outlook for people affected by Ewing’s sarcoma continues to improve. A doctor is your best resource for information about your individual outlook and life expectancy.

There are many factors that may affect your individual outlook, including:

• age at diagnosis
• tumor size
• tumor location
• how well your tumor responds to chemotherapy
• blood cholesterol levels
• previous treatment for a different cancer
• sex assigned at birth

Doctors will continue to monitor you during and after treatment. Your doctor will periodically retest to determine whether the cancer has spread. You may require checkups every 2 to 3 monthsTrusted Source in the years immediately after treatment.

Ewing’s sarcoma may return, and after treatment, you may have a slightly higher risk of developing a second kind of cancer later in life, according to Macmillan Cancer Support. These regular tests are the best way of catching any future developments early and improving your overall outlook.

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Rectal Biopsy

 What is a rectal biopsy?

A rectal biopsy is a procedure used to extract a tissue sample from the rectum for laboratory analysis. The rectum is the lowest 6 inches of the large intestine, located just above the anal canal. The rectum’s purpose is to store the body’s solid waste until it’s released.

A rectal biopsy is an important tool for determining causes of abnormalities in the rectum. It helps to diagnose problems that are identified in screening tests such as anoscopy or sigmoidoscopy.

Anoscopy and sigmoidoscopy each use a different type of scope to observe the inner lining of the colon and rectum. The tests can identify the presence of conditions such as tumors, polyps, bleeding, or inflammation.

However, these tests are limited in determining the causes of these abnormalities. Your doctor may have to order more tests before they are able to give you a diagnosis.

Diagnostic uses of a rectal biopsy

Your doctor may recommend a rectal biopsy to:

• identify the cause of blood, mucus, or pus in your stool
• determine the causes of tumors, cysts, or masses identified in a rectal screening test
• confirm a diagnosis of amyloidosis (a condition in which abnormal proteins called amyloids build up in your organs and spread through your body)
• make a definitive diagnosis of rectal cancer

Preparation for a rectal biopsy

To get the most reliable results from your rectal biopsy, it’s necessary for your doctor to see the rectum clearly. This requires that your bowels are empty. You’ll typically be given an enema or laxative to help you empty your bowels.

You should tell your doctor about any prescription or over-the-counter medications you’re taking. Discuss how they should be used before and during the test.

Your doctor may provide special instructions if you’re taking medications that could affect the procedure, especially if your biopsy is part of a sigmoidoscopy. These medications may include:

• anticoagulants (blood thinners)
• nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (Bufferin) or ibuprofen (Advil)
• any medications that affect blood clotting
• herbal or dietary supplements

Tell your doctor if you’re pregnant, or think you might be, to ensure that your fetus isn’t harmed.

The rectal biopsy procedure

A rectal biopsy is usually performed during an anoscopy or sigmoidoscopy. These tests are outpatient procedures, meaning you’ll be able to go home afterward. They’re typically done by a gastroenterologist or surgeon.

Anoscopy

An anoscopy is typically performed in a doctor’s office. This test uses a lighted scope called an anoscope. The scope allows the doctor to view the lowest 2 inches of the anal canal and the lower rectum. A proctoscope, which is longer than an anoscope, may also be used.

Sigmoidoscopy

A sigmoidoscopy can be performed in a hospital, an outpatient surgical center, or in a specially equipped doctor’s office.

This test uses a much longer scope. A sigmoidoscope enables the doctor to see further into the large intestine, past the rectum, and into the colon. It’s a flexible, lighted tube that is over 2 feet long. It has a camera that transmits video images to a monitor. The images help the doctor guide the sigmoidoscope through the rectum and colon.

The procedure

Preparations for both types of procedures are similar. The sigmoidoscopy, which is the more complicated procedure, takes about 20 minutes to perform. Taking a rectal biopsy can slightly extend the time the procedure will take.

Typically, general anesthesia, sedatives, and painkilling medication aren’t administered for the procedures. You’ll be positioned lying on your left side on an examining table. You’ll pull your knees toward your chest.

Your doctor will perform a digital rectal examination. A lubricant will be applied to a gloved finger, which will be inserted gently into your anus. The initial exam is to check for obstructions that may interfere with the scope.

You shouldn’t feel any pain during the digital rectal examination, but you may feel pressure. Your doctor will then insert the lubricated scope. You will feel pressure when the scope is inserted, and you may feel cramping, as though you need to pass gas or have a bowel movement.

If you’re having a sigmoidoscopy, air will be inserted into the colon through the scope. This inflates the colon to allow the doctor to see the area more clearly. If fluid or stools are in the way, your doctor may use suction to remove them. You may be asked to change position to allow the doctor to alter the position of the scope.

Your doctor will remove a sample of any abnormal tissue they find in the rectum. The biopsy will be extracted with a brush, swab, suction catheter, or forceps. You shouldn’t feel pain from the tissue removal.

Electrocauterization, or heat, may be used to stop any bleeding that results from tissue being removed. When the procedure is over, the scope is removed slowly from your body.

Recovery from a rectal biopsy

The degree to which you need to recover will depend on the type of procedure that was used to collect your rectal biopsy.

After a flexible sigmoidoscopy, you may experience bloating from the air that was introduced into the colon. This may result in abdominal discomfort or passing gas for a few hours after the procedure.

It isn’t uncommon to find a small amount of blood in your first bowel movement after your rectal biopsy. However, you should contact your doctor if you experience:

• extreme abdominal pain
• fever
• more than one bloody bowel movement, especially if bleeding is heavy or clotted
• a feeling of faintness

You can resume your normal diet and activities as soon as the procedure is over.

Risks of a rectal biopsy

A rectal biopsy can provide valuable data for diagnosing abnormal tissue in the rectum. In cases where cancer is a concern, the procedure can provide a definitive diagnosis.

However, a rectal biopsy, like any invasive procedure, carries the risk of internal damage to the targeted organ or nearby areas. Potential risks of a rectal biopsy include:

• bleeding
• bowel perforation (tearing of the bowel)
• difficulty with urination

These risks are very rare.

Understanding the results of a rectal biopsy

The tissue sample that was retrieved during your rectal biopsy will be sent to a laboratory for examination. A pathologist — a doctor who specializes in disease diagnosis — will examine the tissue. A report on the findings will be sent to your doctor.

If the results of your rectal biopsy are normal, the findings will indicate the following:

• The anus and rectum are normal in size and appearance.
• There is no bleeding.
• No polyps, hemorrhoids, cysts, or tumors were found.
• No abnormalities were noted.

If the results of your rectal biopsy are abnormal, the doctor may have found:

• amyloidosis, which involves abnormal buildup of a certain type of protein
• abscesses
• infection
• inflammation
• polyps or other abnormal growths
• tumors

Abnormal results of your rectal biopsy also may indicate a positive diagnosis for:

• cancer
• Crohn’s disease, an inflammatory bowel disease that affects the gastrointestinal tract
• Hirschsprung’s disease, an intestinal disease that can cause an obstruction
• ulcerative colitis, an inflammatory bowel disease that affects the colon and rectum

Your doctor may order more laboratory tests or physical exams before they are able to reach a diagnosis.

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Gastric Tissue Biopsy and Culture

 What is a gastric tissue biopsy and culture?

A gastric tissue biopsy and culture are laboratory tests that examine stomach tissue. These tests are typically carried out to determine the cause of a stomach ulcer or other troublesome stomach symptoms.

“Gastric tissue biopsy” is the term used for the examination of tissue removed from your stomach. For a gastric tissue culture, the tissue is placed in a special dish to see if bacteria or other organisms grow.

Read more: Stomach ulcer »

Tissue samples from your stomach are obtained during an endoscopic exam. In this procedure, a long, flexible tube with a small camera (endoscope) is inserted down your throat and esophagus and into your stomach and upper small intestine (duodenum).

With the endoscope, your doctor can view your stomach for irregularities and remove tissue samples for biopsy and culture. The samples are then analyzed for the presence of infections or cancerous cells and signs of inflammation.

Purpose of gastric tissue biopsy and culture

Your doctor may order a gastric tissue biopsy and culture if you’re experiencing any of these symptoms:

• pain in your upper stomach
• nausea or vomiting
• loss of appetite
• unexplained weight loss
• black stools

These laboratory tests can help diagnose cancer and infections, including Helicobacter pylori (H. pylori) infection, which can cause ulcers of the stomach.

peptic ulcers. About half the world’s population carries some H. pylori bacteria, but most will never have symptoms.

Symptoms of H. pylori infection include:

• nausea
• vomiting
• burping
• bloating
• weight loss
• an ache or pain in your abdomen

Complications can include ulcers, inflammation of your stomach lining and small intestine, and stomach cancer.

Learn more: Chronic gastritis »

Treatment for H. pylori infection includes antibiotics and acid suppression drugs. Follow-up testing may be recommended to see if the treatment is working.

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Why Are So Many Cancer Patients Using Marijuana?

 Cancer patients are using marijuana to relieve a variety of symptoms. But even in states where it’s legal, patients are not getting the information they need.

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About 25 percent of cancer patients use marijuana.

At least that appears to be the case in Washington, a state with legalized marijuana.

Washington legalized medical marijuana in 1998 and recreational marijuana in 2012. It’s been commercially available there since 2014.

With more than half of U.S. states now allowing medical marijuana, researchers wanted to determine how many cancer patients take advantage of the availability.

For the studyTrusted Source, Dr. Steven Pergam of the Fred Hutchinson Cancer Research Center and his colleagues surveyed patients at the Seattle Cancer Center Alliance.

Of 2,737 eligible patients, 926 completed the anonymous survey.

Study authors acknowledge there might be some sampling bias due to the small response. They noted that it’s possible that current use patterns may be overrepresented or underrepresented.

Of those who responded, the median age was 58.

About 66 percent said they had previously used marijuana. About 24 percent used it in the past year and 21 percent in the past month.

Responses were validated by random urine samples.

The full study is published in the journal Cancer.

Use of medical marijuana growing

Dr. Junella Chin is an osteopath and integrative cannabis physician.

She has practiced in California and New York, two states that have legalized medical marijuana.

“There is an absolute increase in states where it has been legalized. I have seen this in California over the last decade, and now in New York City,” she told Healthline.

Chin said there’s been a surge of patients registered in the New York State Medical Marijuana Program.

“What is not typical about my practice is that even among the limited number of doctors who are performing medical cannabis evaluations, I am one of the few who does them in the context of a full-scope general medical practice,” said Chin.

“I have worked to develop my own standards by reading the scientific literature, learning from the experience of other expert clinicians and international scientists, and thorough application of the past 15-plus years of treating patients,” she explained.

Why cancer patients turn to cannabis

Most of the study respondents said they used marijuana for physical and psychological symptoms.

Reasons included pain, nausea, upset stomach, and stress.

Some also reported using it for enjoyment.

Sometimes cancer patients simply run out of options, said Chin.

They’re given a variety of medications to combat symptoms and side effects.

“And when these don’t work, or they are too taxing on their system, they research cannabis as an option, legal or not,” she said.

According to Chin, cannabis is the only anti-nausea medicine that increases appetite, helps patients sleep, eases pain, and elevates mood.

Study authors point to the need for clinical trials to evaluate the role of cannabis in symptom management.

Marine Yanikian-Sutton, 39, was diagnosed with colon cancer in 2016.

Yanikian-Sutton, who is now in remission, told Healthline that she used marijuana while undergoing chemotherapy.

“It eased both mental and physical pain, and I could not have endured the pain without it,” she said.

Although it’s legal in her state, Yanikian-Sutton said that wasn’t a deciding factor.

“The deciding factor was the realization that the chemo meds are more poisonous and life threatening than the marijuana. I chose to ease the side effects produced by the chemo naturally, as opposed to taking more meds,” she said.

She didn’t take this step lightly.

“I researched it, discussed it with my oncologist, received sound advice as to which [strains] to use to ease which symptoms before I obtained the license necessary to purchase it,” she explained.

“In California, there are organizations that provide free marijuana to cancer patients, and I was one such patient,” added Yanikian-Sutton.

About 70 percent of study respondents who use cannabis reported inhaling or consuming it in food. About 89 percent used both methods.

Chin said patients are using tincture (sublingual), capsules, and vape.

“It depends on preference and/or the reasons why it’s being used. For example, vape is great for nausea. It takes away nausea within minutes. Patients may use sublingual [applied under the tongue] for sleep or pain, for an even longer extended relief. But the onset of action might be 30 minutes to one hour,” explained Chin.

A word of caution

All cannabis is not the same.

Chin pointed out that there’s a huge variation in cannabis medicine. And strain names can be misleading.

“With the new state regulations, there will hopefully be a system in place in which the consumer can get the biochemical compound of the plant/product,” she said.

As for cancer patients who live in states without legalized cannabis, Chin said, “I caution obtaining unregulated cannabis because it passes six hands before it gets to you. If you areimmunocompromised, you can’t risk using cannabis that is contaminated with fungus, pesticides, etc.”

Legal, but information is lacking

Study authors found that legalization was an important factor in the decision to use cannabis.

They concluded that cancer patients in a state with legalized cannabis had high rates of active use across broad subgroups.

They also noted that cancer patients would prefer to get information about cannabis from their oncologist.

But that’s not happening.

“We hope that this study helps to open up the door for more studies aimed at evaluating the risks and benefits of marijuana in this population. This is important, because if we do not educate our patients about marijuana, they will continue to get their information elsewhere,” Pergam said in a press release.

Chin agrees.

“Many doctors are not educated on the endocannabinoid system. I certainly was not, and I attended medical school and did my residency in California, a state that legalized it in 1996,” said Chin.

“Doctors may not be comfortable recommending or following up with patients on cannabis, so they refer to me,” she continued.

She’d like to see the chemical composition of cannabis medicine on detailed labels, much like food labels.

“The trouble is,” said Chin, “we are still dealing with a clandestine industry. The states that have set forth regulation and legalized medical cannabis model should also be actively educating patients about cannabis medicine.”

“More educated patients will come to understand the source and quality of medicine and work with their doctor on how cannabis can help them with their life-threatening disease,” said Chin.

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