The Symptoms of Ewing's Sarcoma

Ewing's sarcoma, a rare and aggressive bone cancer that affects adolescents, often begins with vague and non-specific symptoms such as fever, weight loss, and fatigue and progresses to intense pain and swelling at the tumor site. 

Tumors from Ewing's sarcoma can grow in any bone or soft tissue in the body, but it commonly affects long bones, such as the femur, or flat bones like the pelvis or chest wall. In rare instances, it may affect the spine, in which case symptoms may include incontinence and paralysis.

It is typically diagnosed between the ages of 10 and 20. The early symptoms of Ewing's sarcoma can be easily missed as they may be attributed to growing pains, sports injuries, or a virus that is going around.

Frequent Symptoms

Symptoms of Ewing's sarcoma include bone pain, weakness, fever, and sometimes a visible lump on the bone. The cause of the symptoms can be difficult to pinpoint at first because symptoms can be easily attributed to other conditions.

Pain

The primary symptom of Ewing’s sarcoma is pain and tenderness near the tumor. When a bone in an arm or leg is affected, there may also be swelling and sometimes redness in that limb that's concentrated in the area around the tumor.

At first, the pain may be intermittent and come and go. In some cases, the pain is first noticed after minor trauma to the area that instead of healing becomes increasingly more painful. As the disease progresses the pain becomes more consistent. 

The pain may be aggravated by exercise and is often worse at night. Localized pain, swelling, or redness may last weeks or even months before an accurate diagnosis is made.

Weakness

Weakness can also occur with Ewing's sarcoma, particularly in the area of the tumor or in limbs if the tumor is in the spine. In children, weakness may show up as a regression in developmental milestones and abilities. A teenager who previously excelled at sports may start having difficulties in the game.

In younger children, weakness can look like a decreased ability to perform routine tasks and may be mistaken for willfulness or laziness. They may tire more easily and ask to be carried or complain their backpack is too heavy when they previously had no problem carrying the weight.

Numbness

Ewing's sarcoma tumors can also affect nerve pathways, causing feelings of numbness and tingling. A child might describe this as the area burning or the feeling pins and needles.

Fever

Ewing's sarcoma can also have systemic symptoms like fever, lack of energy, and low appetite. At first, these symptoms may appear to be due to the flu or whatever virus is going around school. The fever may come and go throughout the day or from day to day, but it persistently returns and lasts longer than fever from a passing illness.

Many times, a fever from Ewing's sarcoma is first misdiagnosed as infection and treated with antibiotics. It is only after the symptoms do not subside that your healthcare provider may do further testing.

Lump

As the tumor grows, a lump or swelling in the area may be noticeable to the eye. This is more common in long-bone tumors, such as the arm or leg. Tumors in flat bones, such as the pelvis or chest wall, may not be visible until they have grown large.

The lump typically feels like a distinct soft-tissue mass that is usually firmly attached to the bone. It may also be tender or warm.

Broken Bones

When cancer develops within the bone, the bone may become weak and fracture without a known reason. Also referred to as a pathological fracture, this is a break that would not normally occur in a healthy bone.

When a pathological fracture occurs, it typically presents with sudden, severe pain in a bone that had previously sore for weeks or months. Ewing's sarcoma is sometimes diagnosed as a result of this type of fracture.

Rare Symptoms

Additional symptoms of Ewing's sarcoma depend on the location of the tumor and how advanced the cancer is. Some less common symptoms include:

Incontinence

Loss of bladder or bowel control can occur when a tumor impacts the spine. In children, this may be mistaken for toileting regression, nighttime bedwetting after previously being dry at night, or stool leaking out due to constipation and encopresis.

Paralysis

When a tumor affects the spine, paralysis may occur. In a child, this can be particularly frightening. While paralysis can be caused by various ailments, this is one symptom that requires immediate medical attention.

Complications

Ewing's sarcoma is an aggressive form of cancer that can metastasize or spread to other areas of the body. Most commonly, Ewing's sarcoma spreads to other bones in the body or to the lungs.

Ewing's sarcoma can be fatal, however, newer treatments have improved survival rates over the past 30 years. The 5-year survival rate is 78% for children younger than 15 years and 60% for adolescents aged 15 to 19 years.

Other complications are related to the treatments for Ewing's sarcoma and infections can be common. Side effects of chemotherapy and radiation can include hair loss, nausea, bruising, bleeding, fatigue, poor bone growth, organ damage, and new cancers. Talk with your healthcare team about ways to help manage the side effects.

When to See a Healthcare Provider

While the initial pain and swelling are often thought to be related to an injury, the persistence of symptoms raises red flags for physicians. In children and adolescents, fractures and other injuries tend to heal faster than in adults. Recovery time is usually measured in weeks for kids, compared to months in adults.

Talk to your child's doctor if your child:

• Has lingering pain from an injury.
• Has a fever that does not subside in a reasonable amount of time.
• Regresses in physical abilities.
• Experiences numbness or tingling.
• Is easily fatigued, weak, or losing weight for no reason.