Every Thing About Ewing's Sarcoma

Every Thing About
Ewing's Sarcoma

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                                                                                DIAGNOSIS
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Blood Tests - Imaging Tests - CT Scan - MRI Scan - Scintigraphy - Biopsy - EFT Cells Exam

1-) Blood tests : If a patient is displaying symptoms, the doctor may order blood tests. An abnormal complete blood count suggests that cancer has spread. The doctor will also look for elevated levels of an enzyme called lactate dehydrogenase (LDH) in the blood. LDH also indicates metastatic disease.

2-) Imaging tests : The doctor may use an X-ray to detect bone cancer. A chest X-ray may also be ordered to see if the disease has spread to the lungs.

3-) CT Scan : The doctor may perform a computed tomography (CT) scan to create pictures of the cancer and to determine if it has spread. In CT imaging, a scanner moves around the body or portion of the body taking hundreds of X-ray images, which a computer then combines to make a three-dimensional image of the inside of the body. Sometimes a special dye is injected to help provide better detail. This helps to locate the exact position of a tumor. CT scans of the chest and abdomen can help detect cancer that has spread to the lungs, lymph nodes and the liver.

4-) MRI Scan : A magnetic resonance imaging (MRI) scan, a diagnostic test that uses electromagnetic waves to create pictures of the body, may also be performed. An MRI provides detailed images of the bone marrow and soft tissue surrounding the bones.

5-) Scintigraphy : Radionuclide scanning, or scintigraphy, helps determine whether a bone tumor or soft tissue tumor has spread. The doctor gives the patient a dose of a radioactive substance, which accumulates in areas of the bone containing metastatic cancer. Special radiation-sensing cameras enable the doctor to see if cancer has spread to the bone.

6-) Biopsy : Imaging tests enable the doctor to determine the extent of cancer, but only a biopsy can identify a specific type of cancer. The doctor may perform a bone marrow biopsy using a needle to remove a small piece of the bone about a half-inch long and 1/16 inch across.

7-) EFT Cells Exam :
a- A pathologist examines the sample under a microscope to see if EFT cells are present. Another option is to perform a fine-needle aspiration, in which a thinner needle attached to a syringe is used to extract cells from the bone marrow for examination under a microscope.
b-One lab technique that helps determine the type of cancer present is immunohistochemistry. In this test, part of the biopsy sample is treated with special antibodies that bind to and thereby identify substances that are present in EFT cells but not in other types of cancer. Stains are added to the biopsy tissue to make the cancer cells more visible under the microscope.
c-To see if a patient has EFT, the doctor may use cytogenetics (examination of chromosomes under a microscope) to detect chromosomal abnormalities (specifically, the exchange of parts of chromosomes 11 and 22).
d- Reverse transcription polymerase chain reaction (RT-PCR) is another test that detects chromosomal abnormalities in the patient. RT-PCR uses RNA (the chemical "message" that stems from DNA) to identify the genetic rearrangement of chromosomes 11 and 22.
*** Note : About 27 percent of the EFT cases occur in children younger than 10. Sixty-four percent are diagnosed in children between ages 10 and 20. Ewing's tumor rarely occurs in adults. Ewing's occurs most frequently in Caucasians; it is rare in Asian-Americans and African-Americans. EFT is more common among boys than girls.

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                                                                  STAGING   AND   TREATMENTS
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1-) Localized: The cancer has not spread beyond the bone in which it originated or only to nearby tissues. Treatment may include combination chemotherapy, possibly followed by surgery with or without radiation. Clinical trials are also an option at this stage. A clinical trial of intensified chemotherapy or new combinations or doses may be alternatives.

2-) Metastatic: The cancer has spread from the bone in which it originated to other parts of the body, such as the lung, other bones and bone marrow. The disease rarely spreads to the lymph nodes or the brain and spinal cord. The doctor may use combination chemotherapy followed by radiation therapy with or without surgery. Another option is high-dose chemotherapy, possibly with radiation therapy and stem cell transplantation. Clinical trials could include intensive chemotherapy with new drug combinations. A clinical trial of stem cell transplantation and total-body radiation is another option.

3-) Recurrent: The disease has come back after treatment. It may recur where it originated or in another part of the body. Treatment depends on where the cancer came back and how it was treated the first time it was diagnosed. The doctor may administer chemotherapy and radiation treatment and surgically remove growths that have spread to the lungs and other organs. Clinical trials are also an option.

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                                                                                 SYMPTOMS
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1-) Stiffness, pain and tenderness in the bone or tissue surrounding the bone.
2-) About 85 percent of patients experience pain.
3-) A lump or mass may occur near the surface of the skin, which may be warm and soft to the touch.
4-) The child will have a fever.
5-) The tumor spreading under the tissue covering the bone can cause discomfort, or the tumor may grow in        the bone and cause it to weaken or fracture.

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                                                                   TREATING THE DISEASE
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1-) Surgery :
          The doctor may perform surgery to remove the cancer and some surrounding tissue. Surgery may also be needed to remove any remaining cancer cells after chemotherapy or radiation therapy is given.
How the surgery affects the patient's body depends on the location of the tumor. If the cancer occurs in non-essential bones or soft tissue, the tumors can be removed without causing disability to the patient. If the cancer occurs in the arms or legs, the doctor may have to remove much of the bone, which can affect the usefulness of the limbs. The doctor may have to use a bone graft from another part of the body to reconstruct the limb or insert a prosthesis made of metal or plastic bones and joints. Physical therapy may follow to help the child regain use of the limb.

2-) Radiation :
          This form of treatment uses high-energy rays to damage or kill cancer cells. In ETS treatment, radiation usually comes from a machine outside the body (external beam radiation therapy). Side effects include tiredness, mild skin reactions, upset stomach and loose bowels. Radiation given inside the body during surgery (intraoperative radiation therapy) is being studied in clinical trials.

          Side effects can include interference with bone growth. Some bones will not grow well after treatment and can cause uneven growth of facial bones and some disfigurement of the face. Radiation administered to the pelvic area may damage the bladder or bowel. If high-dose radiation is used, a second cancer can occur at the site where the therapy was administered. After one or two years of treatment, radiation to the brain can cause headaches and difficulty thinking.

3-) Chemotherapy :
          The doctor may use chemotherapy drugs to kill the cancer cells. These drugs are usually injected into a vein or muscle or, rarely, given by mouth. They travel in the bloodstream and kill cancer cells throughout the body. The doctor may use surgery or radiation to remove local tumors and then give chemotherapy to kill remaining cancer cells.
          Chemotherapy for this form of cancer is usually given as alternating combinations every three to four weeks up to five times. The first round of drugs includes vincristine, doxorubicin and cyclophosphamide. The other drug combination consists of ifosfamide and etoposide. If the cancer spreads, the same drugs are given at higher doses.
          The severity of side effects depends on the type of drug given and the length of time the child must take it. Because chemotherapy attacks rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth and intestines and bone marrow, patients may experience hair loss, mouth sores, nausea and vomiting.
          Lowered resistance to infections due to low white blood cell counts or bruising and bleeding more easily due to lowered platelet counts are other side effects. Low red blood cell counts (anemia) may cause fatigue. Such conditions go away after chemotherapy is over.
          Chemotherapy can also increase the risk of the child developing acute myeloid leukemia later in life, but this consequence is rare.

4-) Peripheral blood stem cell transplantation :
          Peripheral blood stem cells are self-renewing cells found in the bone marrow (the spongy tissue at the center of the bone). Stem cells create all other types of blood cells.
          The doctor harvests stem cells from the child and freezes them until they are needed for transplantation. This protects them from the effects of high-dose chemotherapy, which is then administered to kill cancer cells. After chemotherapy, the stem cells are thawed and returned to the body through a transfusion. After four to six weeks, the stem cells start to produce new blood cells in the bone marrow.
          Growth factors are given to restore the population of various blood cells more quickly and minimize the time during which the patient is at high risk for infection and other complications.

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                                                          ESCG   -- DONE --   2002
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By Adham Affara

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