Bone Tumors

Children’s National Health System has a team of individuals who are highly skilled and experienced in the treatment of bone tumors, including osteosarcoma and Ewing sarcoma. Children’s patients have access to the most current therapies in treating pediatric cancer through Children’s Oncology Group’s protocols and other clinical trials. 

In addition, the Patient and Family Support Program Cancer and Blood Disorders provides comprehensive mental health and psychosocial services and helpful resources for all patients treated in the Center for Cancer Blood Disorders, as well as patients’ parents and siblings.

Ewing Sarcoma

What is Ewing sarcoma?

Ewing sarcoma is a cancer that occurs primarily in the bone or soft tissue. Ewing sarcoma can occur in any bone, but is most often found in the extremities and can involve muscle and the soft tissues around the tumor site. Ewing sarcoma cells can also spread (metastasize) to other areas of the body including the bone marrow, lungs, kidneys, heart, adrenal gland, and other soft tissues. Ewing sarcoma accounts for about 1.8 percent of childhood cancers. About 150 children and adolescents are diagnosed with Ewing sarcoma each year in the US. It is the second most common malignant bone tumor in children and adolescents. Ewing sarcoma most often occurs in children between the ages of 5 and 20. The number of males affected is slightly higher than the number of females.

What causes Ewing sarcoma?

The majority of Ewing sarcomas result from a chromosome rearrangement between chromosomes #11 and #22. This rearrangement changes the position and function of genes, causing a fusion of genes referred to as a fusion transcript. Over 90 percent of individuals have an abnormal fusion transcript, involving two genes known as EWS and FLI1. This important discovery has led to improvements in diagnosing Ewing sarcoma. Similar to osteogenic sarcoma, trauma or injury is sometimes involved with the site at the time of diagnosis. However, this trauma is thought to bring the condition to attention rather than to have any causal relationship. Some physicians classify Ewing sarcoma as a primitive neuroectodermal tumor (PNET). This means the tumor may have started in fetal, or embryonic, tissue that has developed into nerve tissue.

What are the symptoms of Ewing sarcoma?

The following are the most common symptoms of Ewing sarcoma. However, each child may experience symptoms differently. Symptoms may include, but are not limited, to the following:

  • Pain around the site of the tumor
  • Swelling and/or redness around the site of the tumor
  • Fever
  • Weight loss, decreased appetite
  • Fatigue
  • Paralysis and/or incontinence if the tumor is in the spinal region
  • Numbness, tingling, paralysis, and other symptoms related to nerve compression from the tumor

The symptoms of Ewing sarcoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is Ewing sarcoma diagnosed?

In addition to a complete medical history and physical examination of your child, diagnostic procedures for Ewing sarcoma may include:

  • X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve.
  • Bone scans are a nuclear imaging method that evaluates any degenerative and/or arthritic changes in the joints. Bone scans detect bone diseases and tumors, determine the cause of bone pain or inflammation and rule out any infection or fractures.
  • Magnetic resonance imaging (MRI) – is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
  • Computer-assisted tomography scan (CT or CAT scan) is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • Blood tests, including blood chemistries.
  • Biopsy of the tumor, which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Bone marrow aspiration and/or biopsy. This procedure involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

Ewing sarcoma is difficult to distinguish from other similar tumors. Diagnosis is often made by excluding all other common solid tumors, and by the use of genetic studies.

Osteogenic Sarcoma

What is osteogenic sarcoma?

Also called osteosarcoma, osteogenic sarcoma is one of the most common types of bone cancer in children and accounts for nearly 3 percent of all childhood cancers. About 400 children are diagnosed with osteosarcoma each year. The disease usually occurs in the long bones, such as the arms (humerus), legs (femur/tibia), and pelvis. It rarely occurs in the jaw and fingers, but often occurs at the ends of these bones near growth plates. Osteosarcoma affects children most often between 10 and 25 years of age. This cancer is also more prevalent in males than in females, possibly because of the rapid growth rate at this age. Prior to adolescence, the percentage of affected males and females is equal. Osteogenic sarcoma cancer cells can also spread (metastasize) to other areas of the body. Most commonly, these cells spread to the lungs. However, bones, kidneys, the adrenal gland, the brain, and the heart can also be sites of metastasis.

What causes osteogenic sarcoma?

Repeated trauma

It has been suggested that repeated trauma to an area may be a risk factor for developing this type of cancer. It is uncertain whether trauma is a cause or effect of the disease. Cancer lesions in the bone can make that area of the bone weaker, thus, making injury more likely. However, repeated injuries to a certain area of the bone may lead to an increased production of osteoid tissue to repair the damaged area. The rapid production of osteoid tissue may lead to the malignancy. It is thought, most often, that injury simply brings the condition to attention and has no causal relationship.

Genetics

Genetics may play an important role in developing osteosarcoma. Children and adults with other hereditary abnormalities, including exostoses (bony growths), retinoblastoma, Ollier's disease, osteogenesis imperfecta, polyostotic fibrous dysplasia, and Paget's disease, have an increased risk for developing osteosarcoma.

Exposure to ionizing irradiation

This form of cancer has also been linked to exposure to ionizing irradiation associated with radiation therapy for other types of cancer (i.e., Hodgkin and non-Hodgkin disease).

What are the symptoms of osteogenic sarcoma?

The following are the most common symptoms of osteogenic sarcoma. However, each child may experience symptoms differently. Symptoms may include, but are not limited to, the following:

  • Pain (sharp or dull) at the site of the tumor
  • Swelling and/or redness at the site of the tumor
  • Increased pain with activity or lifting
  • Limping
  • Decreased movement of the affected limb

The symptoms may have been present over a short period of time or may have been occurring for six months or more. Often, an injury brings a child into a medical facility where an x-ray may indicate suspicious bone lesions. The symptoms of osteogenic sarcoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is osteogenic sarcoma diagnosed?

In addition to a complete medical history and physical examination of your child, diagnostic procedures for osteogenic sarcoma may include:

  • X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve.
  • Bone scans are a nuclear imaging method that evaluates any degenerative and/or arthritic changes in the joints. Bone scans detect bone diseases and tumors, determine the cause of bone pain or inflammation and rule out any infection or fractures.
  • Magnetic resonance imaging (MRI) – is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
  • Computer-assisted tomography scan (CT or CAT scan) is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • Complete blood count (CBC) is a measurement of size, number and maturity of different blood cells in a specific volume of blood.
  • Blood tests, including blood chemistries.
  • Biopsy of the tumor, which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Bone marrow aspiration and/or biopsy. This procedure involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

Treatment

The specialists at Children’s National Health System aim not only to cure the cancer, but also to minimize the side effects of treatment. Specific treatment for a bone tumor will be determined by a child's physician based on the:

  • Child's age, overall health, and medical history
  • Type, location, and size of the tumor
  • Extent of the disease

Treatment may include one, or more, of the following:

  • Surgery
  • Cyberknife therapy
  • Radiation therapy
  • Amputation
  • Resections for metastases, such as pulmonary resections of cancer cells in the lung
  • Rehabilitation including physical and occupational therapy, and psychosocial adaptation
  • Prosthesis fitting and training
  • Antibiotics to prevent and treat infections
  • Continual follow-up care to determine response to treatment, detect recurrent disease, and manage late effects of treatment

Long-term outlook for a child with Ewing sarcoma or osteosarcoma

The factors for determining the prognosis and long-term survival of children with Ewing sarcoma or osteosarcoma include the following: Prognosis greatly depends on the:

  • Child’s age
  • Extent of the disease (presence or absence of metastasis)
  • Other factors that may play role in the outcome include:
    • Size and location of the tumor
    • Tumor's response to therapy
    • Child's tolerance of specific medications, procedures, or therapies

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child's needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential. Late effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of Ewing sarcoma and osteosarcoma. New methods are continually being discovered to improve treatment and to decrease side effects.

Treatments

Treatments

Treatment Services

Cancer Surgery

Our expert surgical oncology team provides the full spectrum of surgical treatment for children with cancer.

Radiation

Radiation therapy (also called radiation oncology) uses special kinds of energy waves or particles to fight cancer.

Treatment Service Locations

main hospital

Main Hospital

111 Michigan Avenue, NW
Washington, District of Columbia 20010

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Children's Team

Children's Team

Providers

Jay Greenberg

Hematologist, Oncologist

Jay Greenberg, MD, Hematologist, Oncologist

Robert Henshaw

Orthopaedic Surgeon

Robert Henshaw, MD, Orthopaedic Surgeon

Departments

Departments

Solid Tumor Program

Our solid tumor experts provide advanced diagnosis and personalized treatment plans for children with solid tumors.

Orthopaedic Surgery and Sports Medicine

Our orthopaedic experts provide advanced care for children and teens with orthopaedic conditions and sports injuries.

Oncology

Our oncology (cancer) team provides personalized treatment plans for children with cancer, including access to clinical trials.

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