Ewing's+Tumor

**X-ray.** An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. Doctors can usually find bone tumors with an x-ray. **Biopsy.** A biopsy is the removal of a small amount of tissue for examination under a microscope. An orthopedic oncologist (a doctor who specializes in cancers of the musculoskeletal system) who has experience with EFT should perform the biopsy of a tumor in the arm or leg. The doctor may take a sample of the tumor itself, a sample of the bone marrow, or both. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Using the tissue sample obtained from the biopsy, the doctor can conduct other laboratory tests to learn more about the cancer. The lobular pattern involves fibrovascular septa separating multicellular aggregates of tumor. The relatively uncommon filigree pattern, in which tumor is found in roughly bicellular strands separated by a filmy fibrovascular stoma, carries a poorer prognosis than other patterns Askins tumor of the chest is probably a variant of Ewing’s sarcoma. 7 || Lymph node metastases are not common. 8 || G1 Low grade (stages 1A and 1B below) G2 High grade (stages II and III below) 9 || The Enneking staging system is often used: Stage Grade intra (T1) vs Extra-compartmental (T2) Metastases 1A G1 T1 M0 1B G1 T2 M0 IIA G2 T1 M0 IIB G2 T2 M0 III G1 or G2 T1 or T2 M1 9 || || 12 || 1. Toretsky, JA. //Ewing sarcoma and primitive neuroectodermal tumors.// Available at: [|//http://emedicine.medscape.com/article/990378-overview//]//.// Accessed February 14, 2010. 2. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:610. 3. Rosier RN, O'Keefe RJ, Sahasrabudhe DM. Bone tumors. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:632. 4. Rosier RN, O'Keefe RJ, Sahasrabudhe DM. Bone tumors. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:632. 5 . Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:611. 6. http://www.cancer.net/Cancer+Types/Ewing Sarcoma.com Accessed Febuary 13, 2010. 7. Chao KS, Perez CA., Brady LW. Radiation Oncology- Management Decisions. 2nd edition. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002. pg 610-611 8. Chao KS, Perez CA, Brady LW. //Radiation Oncology-Management Decisions//. 2nd ed. Philadelphia, PA: Lippincot, Williams & Wilkins; 2002. 9. Washington CM, Leaver D. // Principles and Practice of Radiation Therapy //. 2nd ed. St. Louis, MO: Mosby. 2004 10. Chao KS, Perez CA, Brady LW. Radiation Oncology-Management Decisions. 2nd ed. Philadelphia, PA: Lippincot, Williams & Wilkins; 2002. 11. Hand CM, Kim SJW, Waldow SM. Overview of radiobiology. In: Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby; 2004:80-81. 12. Treatment plan and treatment field views courtesy of the University of Colorado Hospital, Aurora, CO; 2010.
 * Epidemiology: || Ewing's sarcoma occurs normally in younger people from infancy to about age 20. The rate of occurrence for patients from infancy to age 20 is 2.9 cases per 1 million people. 10% of cases do occur in patients from the ages of 20 to 30. After age 30, occurrence is very rare. Whites are 9 times more likely to contract Ewing's in comparison to African-Americans. Occurrence is slightly higher in males (3.3 per 1 million) versus females (2.6 per 1 million). The highest incidence occurs in late adolescence to late teenage years. 1 Location of the tumor normally involves the diaphysis. 2 The largest incidence is in the distal femur and proximal tibia. 3 ||
 * Etiology: || The etiology of Ewing's sarcoma is unknown but seems to be related to areas of rapid growth in the skeleton. 4 ||
 * Signs & Symptoms: || At presentation: swelling, tenderness and localized pain at the site of the lesion. Most patients present with metastatic disease with metastatic disease sign & symptoms being bone pain and shortness of breath. 5 ||
 * Diagnostic Procedures: || **Blood tests.** A complete blood count (CBC) is a blood test done to count the number of each type of blood cells. Abnormal levels of white blood cells, red blood cells, and platelets can indicate that cancer has spread. The doctor may also check liver and kidney function and look for high levels of a particular blood enzyme (lactate dehydrogenase, or LDH), which sometimes helps to determine the presence of cancer in the body.
 * Imaging tests **
 * Computed tomography (CT or CAT) scan.** A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
 * Magnetic resonance imaging (MRI).** An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
 * Positron emission tomography (PET) scan.** A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. A PET scan may be performed to help determine whether the tumor has spread to other parts of the body.
 * Surgical tests **
 * Bone marrow aspiration.** For this test, a small amount of bone marrow is removed with a needle from the hip bone and examined under a microscope. The child's skin is numbed with a local anesthetic during the procedure.
 * Laboratory tests **
 * Immunohistochemistry.** A test to detect EFT cells in tissue.
 * Cytogenetics test and reverse transcription polymerase chain reaction test (RT-PCR).** Tests to determine if the genetic changes that characterize EFT cells are present in the sample. 6 ||
 * Histology: || Several microscopic patterns exist; the most common is the diffuse pattern, which corresponds to the classic description.
 * Lymph Node Drainage: || Lymph node spread is rare . 7 ||
 * Metastatic Spread: || Sites of metastases include lungs, other skeletal bone, and visceral organs.
 * Grading: || Tumors are either considered:
 * Staging: || No universally accepted staging system is in place
 * Radiation Side Effects: || Two-thirds of patients develop shortening of 2 cm or more from femur irradiation. Investigators from Stanford University reported an actuarial risk of 8% for second malignancy and 4% for a secondary bone sarcoma in 25 patients. The rate of secondary malignancies is 0% to 1% for patients who recieve a median dose of less than 60 Gy. 10 ||
 * Prognosis: || The most important variable aside from metastases is the size of the primary tumor at diagnosis. Other factors include site of tumor and presence of honeycombing. The worst prognosis comes from tumors of the pelvis followed by those involving proximal bones such as femur and humerus whereas distal long bones have a better prognosis. Female gender, diagnosis less than 1 month after onset of symptoms, and a high lymphocyte count are favorable prognostic factors. 10 ||
 * Treatments: || Surgery is the treatment of choice for lower-extremity lesions in children with infused epiphyses, impending pathological fracture, or bones that are expandable (fibula, clavicle, and certain ribs). Amputations may be reserved for local failures after amputations. The best results have been achieved with multimodality regimens involving adjuvant irradiation and chemotherapy. Radiation Therapy fields as required by the IESS-II encompass the whole bone with doses of 45 Gy followed by two boosts of 5 Gy each (including the soft tissue mass) to tumor margins of 5 cm and 1 cm, while sparing the uninvolved epiphsis if possible. A list of radiation therapy guidlines is presented in table 1. 10
 * TD5/5: || The TD5/5 of any critical organs would include any at risk organs in the area of metastatic disease. If it is a primary tumor in one of the distal long bones: bone marrow - aplasia and pancytopenia at 250 cGy for the whole organ and 3000 cGy for partial organ. Muscle (child) - atrophy 20-30 Gy for the whole organ and muscle (adult) - fibrosis 60 Gy to the whole organ. Of importance is lymphatic drainage from the extremities. Lymph system - atrophy and sclerosis at 50 Gy to the whole node. 11 ||
 * Treatment Plan and Fields ||    Treatment plan fields and treatment plan isodose distribution for metastatic Ewing's sarcoma.
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