The sooner a diagnosis is made, the more effective treatment may be. 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.
Blood tests may also provide helpful information for treatment. When chromosomes 11 and 12 exchange genetic material, it activates an overgrowth of cells. The median age of those affected is Typically, treatment involves one or more approaches, including:.
Further treatment may be necessary after surgery to replace or restore limb function, depending on where the tumor was. The specialists pathologist, radiation oncologist , and surgeon who will treat the patient usually work together to decide the best site to place the needle or biopsy incision.
The selection of the biopsy site is important. A biopsy site that is not properly selected may result in more extensive surgery to remove the tumor or a larger area that is treated with radiation therapy. If there is a chance that the cancer has spread to nearby lymph nodes , one or more lymph nodes may be removed and checked for signs of cancer.
The factors that affect prognosis are different before and after treatment. The process used to find out if cancer has spread from where it began to other parts of the body is called staging. There is no standard staging system for Ewing sarcoma.
The results of the tests and procedures done to diagnose and stage Ewing sarcoma are used to describe the tumors as localized or metastatic. Ewing sarcoma is described as localized, metastatic, or recurrent. The cancer is found in the bone or soft tissue where it began and may have spread to nearby tissue , including nearby lymph nodes.
The cancer has spread from the bone or soft tissue where it began to other parts of the body. In Ewing tumor of bone, the cancer most often spreads to the lung , other bones, and bone marrow. The cancer has recurred come back after it has been treated. The cancer may come back in the bone or soft tissue where it began or in another part of the body.
Cancer can spread through tissue , the lymph system , and the blood :. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began the primary tumor and travel through the lymph system or blood. The metastatic tumor is the same type of cancer as the primary tumor. For example, if Ewing sarcoma spreads to the lung, the cancer cells in the lung are actually Ewing sarcoma cells.
The disease is metastatic Ewing sarcoma, not lung cancer. Different types of treatments are available for children with Ewing sarcoma. Some treatments are standard the currently used treatment , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because cancer in children and adolescents is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Treatment will be overseen by a pediatric oncologist , a doctor who specializes in treating children with cancer.
The pediatric oncologist works with other health care providers who are experts in treating children with Ewing sarcoma and who specialize in certain areas of medicine.
These may include the following specialists :. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells , either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy.
Combination chemotherapy is treatment using more than one anticancer drug. Systemic combination chemotherapy is part of the treatment for all patients with Ewing tumors. It is often the first treatment given and lasts for about 6 to 12 months.
Chemotherapy is often given to shrink the tumor before surgery or radiation therapy and to kill any tumor cells that may have spread to other parts of the body. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy is used when the tumor cannot be removed by surgery or when surgery to remove the tumor will affect important body functions or the way the child will look.
It may be used to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. It may also be used to treat any tumor that remains after surgery and tumors that have spread to other parts of the body. Surgery is usually done to remove cancer that is left after chemotherapy or radiation therapy. When possible, the whole tumor is removed by surgery. Tissue and bone that are removed may be replaced with a graft , which uses tissue and bone taken from another part of the patient's body or a donor.
Sometimes an implant , such as artificial bone, is used. After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left.
Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood -forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells immature blood cells are removed from the blood or bone marrow of the patient or a donor and are frozen and stored.
After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into and restore the body's blood cells. Chemotherapy with stem cell rescue is used to treat localized and recurrent Ewing sarcoma.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Types of targeted therapies used to treat Ewing sarcoma include the following:.
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
This cancer treatment is a type of biologic therapy. For information about side effects that begin during treatment for cancer, see our Side Effects page. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:. Some late effects may be treated or controlled.
It is important to talk with your child's doctors about the effects cancer treatment can have on your child. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better.
There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Clinical trials supported by other organizations can be found on the ClinicalTrials. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated.
Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred come back.
These tests are sometimes called follow-up tests or check-ups. For information about the treatments listed below, see the Treatment Option Overview section. Standard treatments for newly diagnosed localized Ewing sarcoma include:. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Standard treatments for newly diagnosed metastatic Ewing sarcoma include:. There is no standard treatment for recurrent Ewing sarcoma but treatment options may include the following:. Treatment options being studied for recurrent Ewing sarcoma include the following:. For more information from the National Cancer Institute about Ewing sarcoma, see the following:.
For more childhood cancer information and other general cancer resources, see the following:. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine.
Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Ewing tumors are typically very responsive to radiation. Another round of chemotherapy is given following surgery or radiation therapy to destroy tumor cells that may have spread to other parts of the body. Researchers are working to find new and improved ways to treat all kinds of cancers, including Ewing sarcoma.
While some progress has been made, targeted treatments such as immunotherapy are considered experimental for patients with Ewing sarcoma. Doctors may pursue potential alternatives for patients with recurrent or advanced Ewing sarcoma who have already exhausted traditional treatment options. Clinical trials may also be available.
Your doctor can provide information about open studies at your cancer center or other centers across the country. Ewing sarcoma patients will be monitored with X-rays of the original tumor every three to six months for three to five years. Similarly, patients will have regular CT scans of the lungs and periodic bone scans to detect recurrence as early as possible.
For the rest of their lives, patients will have yearly X-rays of the area of the original tumor to monitor any reconstructive devices and healing of the limb. Exercises may be suggested to increase the function of the affected limb. According to the American Cancer Society, the overall five-year survival rate for localized Ewing sarcoma is 70 percent. Patients with metastatic disease have a five-year survival rate of 15 percent to 30 percent. It is unclear whether adults with Ewing sarcoma do as well as children with the condition.
Some studies have suggested they do not. However, these studies have been criticized because they used lower doses of chemotherapy than those used in children. Other studies have suggested that when treated aggressively, adults can do just as well as children.
The challenge with aggressive treatment is that adult bodies cannot withstand the same dosages of chemotherapy drugs that children can. As with any cancer, prognosis and long-term survival can vary greatly from person to person.
Since every individual is unique, your treatment and prognosis will be based on your unique health condition and needs. The individual patient prognosis for Ewing sarcoma greatly depends on the following:. Compared with smaller tumors, larger tumors are more difficult to remove and have had more opportunity to develop into micrometastatic disease.
Micrometastasis describes cancer that has spread to other parts of the body as tumors that are too small to be detected. Prompt medical attention and aggressive therapy help ensure the best possible prognosis. Continuous follow-up care is also essential.
A person who was treated for Ewing sarcoma as a child or adolescent may develop health effects, which are called late effects, months or years after treatment ends.
The type of late effects a survivor develops depends on the location of the tumor and the treatment method. Late effects can include heart and lung problems, emotional and learning difficulties, growth issues and second malignancies associated with chemotherapy or radiation. For example, children treated for Ewing sarcoma have a higher risk than the average population of developing solid tumors or leukemia later in life.
Some treatments may later affect fertility. If this side effect is permanent, it will cause infertility the inability to have children. Both men and women can be affected by fertility issues. They'll recommend a treatment plan based on where the cancer is and its size. Talk to your care team about why they've suggested the treatment plan, and ask them to go over the benefits and any risks involved. You may also want to discuss what care you might need afterwards.
Radiotherapy is often used to treat Ewing sarcoma before and after surgery, or it may be used instead of surgery if the cancer cannot be removed safely. Most people with Ewing sarcoma have chemotherapy to shrink the cancer and then surgery to remove as much of it as possible. This is often followed by further chemotherapy to kill any leftover cancer cells. If Ewing sarcoma affects your bones, you'll need surgery at a specialist bone cancer centre.
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