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Step 1: Clinical history
The diagnosis begins with a doctor taking a clinical history (information about the patient’s symptoms), to understand a patient’s symptoms, such as bone pain.
Doctors may look for more common conditions first, including soft tissue and muscle injuries, as well as bone fractures or breaks. This means the first medical test will usually be an X-ray, which will show up any breaks or fractures. It may also show an area of bone that looks abnormal and which suggests a bone cancer. If this is the case, a patient should be referred to a specialist for further tests and investigations.
If the X-ray is normal but the symptoms remain the patient should be further investigated or again referred to a specialist. There are a range of tests doctors will do if they suspect a bone tumour.
Step 2: Common tests
a. Blood tests
There is not a blood test to diagnose Ewing’s sarcoma, but blood tests may help a doctor investigate a patient’s symptoms and provide important information about how well organs, such as the liver and kidneys, are working, or how many cells are in the bloodstream to transport oxygen, fight infections and form clots.
b. Magnetic Resonance Imaging (MRI) Scans
This type of scan helps doctors visualise the bone and soft tissue around the affected area. As the image shows soft tissue as well as bone, it provides more information than an X-ray, and allows doctors to gain more accurate information about where a tumour is, its size and how close it is to nearby structures such as blood vessels and nerves.
c. Bone scans
A bone scan provides a full body scan of all of the bones in the body. It involves a small amount of radioactive dye being injected into the body. This dye is absorbed by bones with any abnormalities. After the dye is injected, a short time is allowed so the abnormal bones may absorb the dye before a scanner will take an image of the body. Any abnormalities will show up on the image produced.
A biopsy is a procedure that enables doctors to take a sample of the tumour. This is then investigated under the microscope. A pathologist (a doctor who interprets changes in fluids and tissues of the body) then conducts tests on the sample in the laboratory to diagnose the type of tissue the lump or tumour is made from. The tests can tell the pathologist whether the tissue is cancerous and what type of cancer it is.
One of these tests is called “molecular analysis” of the tumour and is an important test to make the diagnosis as it shows the specific chromosome (genetic) translocations (abnormalities in the molecules that form DNA) and gene mutations which are unique to Ewing’s sarcoma.
In order to take a biopsy, a needle is inserted into the bone or soft tissue usually whilst the patient is under a local or general anaesthetic. Sometimes a CT or ultrasound scan is used to help guide the needle into the right place.
e. Computerised Tomography (CT) Scans
CT scans are often undertaken after the diagnosis of cancer is confirmed to determine whether it is localised (contained in the bone) or is metastatic (has spread). Ewing’s sarcoma metastases often appear in the lungs of patients. Therefore, after being diagnosed, doctors look to determine whether there are any abnormalities in the lungs.
These scans involve the injection of contrast, before a camera rotates extremely fast around the body taking a number of images used to build up a three dimensional picture of the body.
f. Other tests
To ensure that treatment is carried out safely a number of other tests will be conducted to determine whether the key organs in the body are functioning correctly before any treatment can start.
Tests will continue during the treatment, including those for heart and kidney function, to ensure the treatment remains safe. After treatment further tests may be carried out to monitor the wellbeing of certain organs.
Produced: October 2015
Published: January 2016
Review: October 2018
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