Ewing's Sarcoma Cancer occurs mostly in people aged 10-20 years. Adults can also develop Ewing's sarcoma cancer, but it is rare. Generally Ewing's sarcoma cancer occurs in white people ( Caucasian ) and rarely occurs in other races. Ewing's sarcoma cancer currently has a high cure rate.
Based on the location of the cancer, Ewing's sarcoma can be divided as follows:
- Ewing's bone cancer. About 87 percent of Ewing's sarcoma cancers appear in bone, such as pelvic or thigh bones. Ewing's sarcoma can also occur in the ribs and collarbone.
- Soft tissue cancer (extraosseous) . This type of Ewing sarcoma occurs in the soft tissues around the bone such as muscles or cartilage. An extraosseous Ewing sarcoma can be found in the soft tissues around the hands, feet, head, neck, and stomach.
- Peripheral Primitive Neuroectodermal Tumor (pPNET). This type of Ewing sarcoma occurs in nerve tissue and can be found in various organs of the body.
- Askin Tumor. This is a pepper type tumor that occurs in the chest.
Causes and Risk Factors The Emergence of Ewing's Sarcoma
Until now, the cause of Ewing's sarcoma in a person is not known with certainty. However, it is thought that the main cause of Ewing's sarcoma is a DNA mutation in connective tissue, especially bone tissue, after birth.
Based on some studies, it is not certain that Ewing's sarcoma is caused by heredity. But so far it is known that Ewing's sarcoma is not associated with exposure to radiation, chemical compounds, or other environmental factors. Ewing's sarcoma generally occurs in fast-growing bones. This theory is associated with cancer patients who are generally children or adolescents in puberty. It is thought that infants with umbilical hernia also have a risk of developing Ewing's sarcoma as they grow in puberty. In adults, risk factors from Ewing's sarcoma are influenced by lifestyle, especially weight, physical activity, diet, and smoking habits. However, these factors generally accumulate for years before they can significantly increase the risk of Ewing's sarcoma.
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Symptoms of Ewing's sarcoma
If a person is exposed to Ewing's sarcoma, especially in children, the symptoms that can appear generally are:
- Pain, swelling, and stiffness in the area of tumor appearance for weeks or months. In children, these symptoms are often misinterpreted as injuries due to exercise or other physical activity.
- The appearance of a lump on the skin that feels warm and soft to the touch.
- Body temperature is low for days. In some cases, the patient will have a high fever.
- Difficult to walk due to foot pain.
- Bone pain that gets worse during exercise or at night.
- Broken bone for no apparent reason.
- Losing weight.
- Easily tired.
- Paralysis or loss of control over the bladder if Ewing's sarcoma occurs in the spine.
Diagnosis of Ewing's sarcoma
To determine whether a person is exposed to Ewing's sarcoma or not, the following checks are required:
- Physical examination. Physical examination is the first diagnostic step that a doctor will perform to check for the presence of Ewing's sarcoma in a patient. The doctor will check the body parts that experience pain, swelling, bumps, or redness.
- Scanning. Scan examination is used to estimate the presence of malignant tissues in the limbs. The methods that can be used to scan for the existence of Ewing's sarcoma are:
- Photo Rontgen. X-rays are used to get an overview of organs and tissues, so we can predict the location and type of malignancy. If the results of this examination is suspected of patients suffering from Ewing's sarcoma, then another scanning method can be used for further examination.
- Scan Bone. This examination aims to find cancer cells in the patient's bone. The radioactive contrast fluid will be injected into the bone through a vein that will then converge in the cancerous tissue of the bone. The radioactive contrasts that converge on the cancer tissue will be detected by the scanner, resulting in a more detailed picture.
- MRI. The MRI examination is used to get a detailed picture of the organs in the body, as well as to detect the presence and location of tumor tissue.
- CAT / CT scan . The scanning method using CT scan is almost similar to the X-ray method, but with more detailed and accurate picture results.
- PET scan . The PET scan method is by injecting radioactive glucose in organs suspected of having cancer. The organ is then scanned using a PET scanner to detect radioactive sugar absorption. Cancer cells will appear brighter on scanning, as they pick up and use more sugar than normal cells.
- Biopsy. A biopsy is performed by taking tissue samples from an organ suspected of having cancer. The tissue samples were then viewed under a microscope to evaluate the presence of cancer. Biopsy can also be performed on the bone marrow using a needle ( bone marrow aspiration ). Biopsy can be performed on patients using general and local anesthesia.
Stadium of Ewing's sarcoma
Cancer will develop and enlarge over time. To differentiate cancer tissue conditions from those that have not spread to already spread, a 1-4 stage system is used with the following details:
- Stage 1. Indicates that the cancer is small and remains in the organ where the cancer originated.
- Stage 2. Indicates that the cancer has not spread to the surrounding tissue, but the size of the cancer has been greater than stage 1. Sometimes in stage 2, cancer cells have spread to the lymph nodes closest to the organ of the cancer.
- Stage 3. Indicates that the cancer has enlarged from stage 2 and has spread to other tissues or lymph nodes around the cancer.
- Stage 4. Indicates that the cancer has spread from the organ where the cancer originated. This condition is called metastasis.
The goals of Ewing's sarcoma cancer treatment are:
- To cure patients from cancer.
- To maintain the function of organs as possible post-treatment.
- To avoid the smallest complications possible due to cancer and cancer treatment.
- Size and stage of cancer.
- Area of cancer spread.
- Patient health in general.
- Preferred treatment preferences of the patient.
- Chemotherapy. Chemotherapy is the most commonly used treatment of Ewing's sarcoma. Chemotherapy is done by injecting chemical drugs to kill and shrink cancer periodically. The doctor will recommend to patients to combine chemotherapy treatment with other treatment methods.
- Radiotherapy Radiotherapy is a treatment aimed at killing cancer cells by using high-energy rays. Generally the rays used to kill cancer cells are X-rays. Radiation can be administered through external radiation devices or through radiation devices installed inside the body (internal radiotherapy).
- Surgical treatment of cancer through surgery is aimed at elevating the tumor cells physically. If the cancer has spread to other body parts, there is a chance the doctor will amputate the affected body part of the cancer.
- Stem cell transplantation. Stem cell treatment is commonly used in patients with advanced stage Ewing's sarcoma (stage 3). In patients with advanced cancer, a given dose of chemotherapy is a high dose to suppress and kill cancer cells as much as possible. But the side effect of high dose chemotherapy is the breakdown of bone marrow cells that have various regeneration functions. To overcome the side effects of chemotherapy, stem cell transplantation can be done instead of damaged bone marrow cells. Transplanted stem cells may come from other parts of the patient's body or from the donor.
To estimate the prognosis of cancer, doctors will generally predict the patient's life expectancy within 5 years, after being detected. Early Ewing sarcoma patients with cancer that has not spread (stage 1-2) have a life expectancy in 5 years of 70 percent. The prognosis of Ewing's sarcoma is worse if the cancer has spread to other body parts (stage 3-4). The life expectancy in 5 years for Ewing's stroke 3-4 patients for 5 years is about 15-30 percent.