7 Key Symptoms of Ewing Sarcoma You Should Know

Ewing sarcoma is a rare type of cancer that primarily affects bones or the soft tissue around bones. It most commonly occurs in children and young adults, typically between the ages of 10 and 20 years. This aggressive cancer usually develops in the pelvis, legs, or chest wall, though it can occur in any bone in the body. Early detection is crucial for successful management, which makes recognizing the symptoms essential for patients and caregivers.

Understanding the warning signs of Ewing sarcoma can help ensure timely medical evaluation and diagnosis. While these symptoms can sometimes be mistaken for common injuries or growing pains in young people, persistent or worsening symptoms should always be evaluated by a healthcare professional. Below, we outline the most common symptoms associated with this condition.

1. Persistent Bone Pain

Pain in the affected bone is the most common and often the first symptom of Ewing sarcoma. This pain typically starts as intermittent discomfort but gradually becomes more persistent and severe over time.

The characteristics of this pain include:

• Pain that worsens at night or during physical activity
• Discomfort that doesn’t improve with rest or over-the-counter pain relievers
• Progressive intensity that interferes with daily activities
• Pain that may be initially dismissed as growing pains or sports injuries in young patients

The location of pain corresponds to where the tumor is growing. Most commonly, patients experience pain in the legs, pelvis, ribs, or arms. Unlike typical muscle soreness or injury pain, the discomfort from Ewing sarcoma tends to persist for weeks or months and gradually intensifies rather than improving with time.

2. Swelling or Lump Formation

As the tumor grows, visible swelling or a noticeable lump may develop near the affected bone. This is often one of the more obvious signs that prompts medical consultation.

Key features of this symptom include:

• A firm mass that can be felt under the skin
• Swelling that increases in size over weeks or months
• The lump may feel warm to the touch
• Swelling that doesn’t resolve on its own

The swelling occurs because the tumor expands and may break through the bone into surrounding soft tissues. In some cases, the lump may not be immediately visible, especially if the tumor is located deep within the pelvis or chest wall. When tumors develop in more superficial bones like those in the arms or legs, the swelling becomes more apparent and easier to detect.

3. Fever Without Clear Cause

Unexplained fever is a symptom that occurs in approximately one-third of patients with Ewing sarcoma. This fever typically comes and goes without an obvious source of infection.

Characteristics of fever associated with Ewing sarcoma:

• Low-grade to moderate temperature elevation
• Recurring episodes that don’t respond to antibiotics
• No accompanying signs of common infections like colds or flu
• May be accompanied by general feelings of being unwell

The fever occurs as the body’s immune system responds to the presence of cancer cells. When fever appears alongside bone pain and swelling, it can be an important clue that points toward Ewing sarcoma rather than a simple injury or infection. Parents and caregivers should take note of persistent fevers in young people, especially when combined with other symptoms.

4. Fractures with Minimal Trauma

Ewing sarcoma weakens the affected bone, making it more susceptible to breaking. Some patients experience a fracture (broken bone) with minimal impact or trauma, which is known as a pathological fracture.

Important aspects of this symptom:

• Bones break from activities that wouldn’t normally cause fractures
• The fracture may occur spontaneously or with very minor injury
• Pain at the fracture site may have existed before the break occurred
• X-rays taken for the fracture may reveal the underlying tumor

In some cases, a pathological fracture is the first sign that leads to the diagnosis of Ewing sarcoma. The tumor replaces normal bone tissue with abnormal cells, creating weak spots in the bone structure. When a young, otherwise healthy person experiences a fracture from minimal trauma, healthcare providers will investigate underlying causes, including the possibility of bone tumors.

5. Fatigue and General Weakness

Many patients with Ewing sarcoma experience significant fatigue and a general sense of weakness that affects their daily functioning and quality of life.

This fatigue presents as:

• Persistent tiredness that doesn’t improve with adequate rest
• Decreased energy levels for normal activities
• Reduced ability to participate in sports or physical activities previously enjoyed
• General malaise and feeling unwell

The fatigue associated with Ewing sarcoma differs from normal tiredness in its persistence and severity. It results from the body’s energy being diverted to fight cancer cells and from the overall systemic effects of the disease. Young patients may find themselves unable to keep up with peers in school or sports, and may need more rest than usual. This symptom, while nonspecific, becomes significant when it occurs alongside other warning signs.

6. Limited Range of Motion

When Ewing sarcoma develops near a joint, it can cause stiffness and reduced mobility in that area. This limitation in movement can significantly impact a person’s ability to perform everyday tasks.

Characteristics of this symptom include:

• Difficulty moving the affected limb or joint through its full range of motion
• Stiffness that worsens over time
• Pain when attempting to move the affected area
• Gradual decrease in flexibility and function

The reduced range of motion occurs because the growing tumor causes pain, swelling, and structural changes that interfere with normal joint mechanics. For example, a tumor in the pelvis might limit hip movement, while one near the knee could affect the ability to fully bend or straighten the leg. This symptom often prompts young athletes to seek medical attention when they notice declining performance or difficulty with movements that were previously easy.

7. Weight Loss and Decreased Appetite

Unintentional weight loss and reduced appetite are systemic symptoms that can occur with Ewing sarcoma, particularly as the disease progresses.

This symptom manifests as:

• Loss of interest in food and decreased eating
• Unintended weight loss over weeks or months
• Early satiety (feeling full quickly when eating)
• General decline in nutritional status

Cancer cells alter the body’s metabolism and can produce substances that affect appetite regulation. Additionally, the physical discomfort from pain and the emotional stress of feeling unwell can contribute to decreased food intake. In children and adolescents, failure to gain weight appropriately or losing weight without trying should always be evaluated, especially when accompanied by other concerning symptoms.

Main Causes of Ewing Sarcoma

The exact cause of Ewing sarcoma remains unknown, but research has identified several factors associated with its development:

Genetic Changes: Ewing sarcoma is characterized by specific chromosomal translocations, most commonly between chromosomes 11 and 22. This genetic change creates an abnormal fusion gene that drives cancer cell growth. However, this is an acquired mutation rather than an inherited one, meaning it occurs during a person’s lifetime rather than being passed down from parents.

Age and Demographics: The condition most commonly affects children, adolescents, and young adults between ages 10 and 20. It is more prevalent in males than females and occurs more frequently in people of European descent compared to those of African or Asian ancestry.

No Clear Environmental Triggers: Unlike some other cancers, Ewing sarcoma has not been linked to environmental exposures, radiation, or lifestyle factors. It is not caused by injury to the bone, though pain from the tumor might be mistaken for an injury.

Not Hereditary: Ewing sarcoma is not typically inherited, and having a family member with the condition does not significantly increase risk. The genetic changes occur spontaneously in individual cells.

Because the precise cause is unknown and there are no identified preventable risk factors, Ewing sarcoma cannot currently be prevented through lifestyle modifications or screening programs.

Frequently Asked Questions

What is Ewing sarcoma?

Ewing sarcoma is a rare type of cancer that develops in bones or the soft tissue surrounding bones. It primarily affects children and young adults and requires prompt medical evaluation and management.

How common is Ewing sarcoma?

Ewing sarcoma is rare, with approximately 200-250 new cases diagnosed in the United States each year. It accounts for about 1% of all childhood cancers and is the second most common bone cancer in children and adolescents.

Can Ewing sarcoma be mistaken for other conditions?

Yes, the symptoms of Ewing sarcoma, particularly bone pain and swelling, can initially be mistaken for sports injuries, growing pains, or bone infections. This is why persistent symptoms should always be evaluated by a healthcare professional.

Which bones are most commonly affected?

Ewing sarcoma most frequently develops in the pelvis, femur (thigh bone), tibia (shin bone), ribs, and humerus (upper arm bone). However, it can occur in any bone in the body.

When should I see a doctor about bone pain?

You should seek medical evaluation if bone pain persists for more than a few weeks, worsens over time, interferes with sleep or daily activities, or is accompanied by swelling, fever, or unexplained weight loss.

Is Ewing sarcoma hereditary?

No, Ewing sarcoma is not typically hereditary. The genetic changes that cause the cancer occur spontaneously and are not passed down from parents to children.

What tests diagnose Ewing sarcoma?

Diagnosis typically involves imaging tests such as X-rays, MRI, or CT scans, followed by a biopsy where a small tissue sample is examined under a microscope. Blood tests and additional scans may be performed to determine if the cancer has spread.

Can Ewing sarcoma spread to other parts of the body?

Yes, Ewing sarcoma can spread (metastasize) to other bones, lungs, bone marrow, or other organs. This is why early detection and comprehensive evaluation are important.

What is the prognosis for Ewing sarcoma?

Prognosis varies depending on several factors including the size and location of the tumor, whether it has spread, and how well it responds to treatment. Early detection generally improves outcomes, which is why recognizing symptoms promptly is crucial.

Are there any risk factors I can control?

Unfortunately, there are no known modifiable risk factors for Ewing sarcoma. It is not linked to lifestyle choices, diet, or environmental exposures, so there are no specific prevention strategies currently available.

References:

• American Cancer Society – Ewing Tumor Signs and Symptoms
• Mayo Clinic – Ewing Sarcoma
• National Cancer Institute – Ewing Sarcoma Treatment
• NHS – Ewing Sarcoma
• Johns Hopkins Medicine – Ewing Sarcoma