Children's Hospital Colorado

Ewing's Sarcoma in Children

What is Ewing's sarcoma?

Ewing's sarcoma is a tumor made up of cancer cells that occurs in or around bone. It is the second most common type of bone cancer in children and adolescents and accounts for about 3% of all childhood cancers. Ewing's sarcoma most often occurs in school-age kids, adolescents and young adults. The Orthopedic Tumor Program at Children's Hospital Colorado treats all patients with Ewing's sarcoma up to age 30.

The most common tumor locations include the arm and leg bones, the pelvic bone and the chest wall (ribs). However, Ewing's sarcoma can occur in any bone of the body. The muscles and soft tissues around the tumor can also be affected to varying degrees.

Some cancerous tumors are localized, meaning the cancer cells have not spread beyond the bone and nearby tissues to other parts of the body. Other tumors are metastasized, meaning the cancer cells have spread to other parts of the body. The most common places for the cancer cells to spread are to the lungs and/or other bones.

Causes of Ewing's Sarcoma

Ewing's sarcoma most often occurs in school-age children (ages 6-12), adolescents and young adults and affects both boys and girls. There is no known cause or methods of prevention for Ewing's sarcoma at this time.

What are signs and symptoms of Ewing's sarcoma?

The most common Ewing's sarcoma symptoms include:

  • Recurring pain that occurs with activity or at rest; children often complain that the pain wakes them up at night
  • Swelling or presence of a palpable mass (bump)
  • An unexplained fever with no symptoms
  • Unexplained weight loss
  • Poor appetite
  • Fatigue

It is not uncommon for the child to experience a minor injury or have a limp that brings attention to the tumor. Symptoms can also appear to be similar to symptoms of an infection. Symptoms can be present for several weeks or months, or only for a few weeks and they do not go away over time.

If your child or young adult has these symptoms it is important to see a doctor immediately. Studies have shown that early treatment of Ewing's sarcoma is more likely to be successful.

How is Ewing's sarcoma diagnosed?

To ensure your child receives the most accurate diagnosis and the best treatment possible, it is important to choose a doctor who specializes in pediatric bone tumors. A bone tumor specialist will begin by getting a detailed medical and family history, and performing a comprehensive physical exam.

Common tests

Radiographic studies are usually performed and may include X-rays, magnetic resource imaging (MRI), bone scan and/or a CT scan of the lungs.

The ultimate diagnosis is always based on a biopsy of the tumor and examination of the biopsy specimen. Often times, a preliminary diagnosis is available on the day of biopsy; however, it may take up to a week to get a permanent diagnosis depending on what additional studies need to be done.

After the diagnosis of Ewing's sarcoma is made, your child’s bone tumor specialist will evaluate the extent of the disease by performing several different tests, such as a Ewing's Sarcoma bone scan. This is known as staging. These tests may include a bone scan, a PET scan, a CT scan or an MRI. The doctor will also order blood tests. The studies are done to look for any evidence that the tumor has spread from the original site and are necessary in order to provide the most definitive treatment for the disease.

Determining the stage of Ewing's sarcoma

Learn how our Orthopedic Tumor Program treats bone cancer in kids.

How is Ewing's sarcoma treated in kids?

At Children's Colorado, Ewing's sarcoma treatment typically includes chemotherapy, surgery and/or radiation therapy. Treatment methods are based on the location of the tumor and how safely it can be surgically removed. Treatment recommendations will include a combination of the following:


Chemotherapy refers to a type of medicine used to help shrink the size of the tumor and kill additional microscopic cancer cells throughout the body. It is administered through a special type of IV known as a port, which goes into a large vein in the upper chest. The port is placed surgically in the operating room.

Chemotherapy drugs are given to treat both the known tumor (mass in the bone) and other potential cancer cells throughout the body. When treating Ewing's sarcoma, chemotherapy is typically given before and after the surgical procedure to remove the tumor.

Radiation therapy

Radiation therapy is sometimes used in combination with chemotherapy in place of surgery to treat the tumor. The use of radiation therapy is determined by the location of the tumor and/or if there are tumors in other parts of the body. Your child's treatment team (orthopedic surgeon, oncologist and radiation oncologist) will determine if he or she will need radiation therapy.


The Ewing's sarcoma tumor may be surgically removed. The kind of surgery that your child will have depends on the size of the tumor and where the tumor is located. Surgical options may include:

  • Limb-sparing surgery: This type of surgery removes the tumor, bone and tissues surrounding it that contain cancer cells, while leaving the surrounding muscles, nerves and blood vessels. A bone graft or metal implant will replace the bone and soft tissues that have been removed, thereby preserving the patient’s extremity (arm, leg, etc).​
  • Rotationplasty: In rotationplasty, the tumor, distal femur, knee and upper end of tibia are removed. The leg below the knee is rotated 180 degrees and attached to the femur. This allows the ankle joint to be used as a knee joint improving the function of an artificial leg (also known as a prosthesis). This allows the child to participate in any running or jumping activities and sports.
  • Amputation: Sometimes the tumor has to be taken out with removal of the affected limb. This may be done because the tumor is too large to treat with limb-sparing surgery, or the tumor has a high risk of recurring. Children are typically very good at using and adapting to an artificial limb (prosthetics). With the help of the experts at our Amputee Program, many kids and young adults with artificial limbs are quite active and participate in sports.

Related departments