Symptoms

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Common symptoms of Ewing’s SarcomaInformation Standard

The earliest and most common symptom of Ewing’s sarcoma is pain at the tumour site. The most common primary tumour sites are the “long bones”, such as the thigh bone, the shin bone, the upper arm, and forearm bones. It can also affect other bones such as the pelvis, shoulder blade, spine, ribs and collarbone.

Pain

Patients often describe a “dull” and “aching” pain. Although patients (and their GPs) sometimes believe the pain relates to an injury, the symptoms are often different from those that would be expected of such an injury.

Pain can vary in intensity. It may be mild to start with and may be intermittent (comes and goes). It tends to become more frequent when the patient is at rest, and may increase in intensity as the cancer progresses. The time at which pain commonly occurs (e.g. at night) and the intensity of the pain is also relevant to diagnosis of Ewing’s sarcoma.

Night pain

Night pain is relatively common. Pain, which is worse during the night in comparison to the day, is typically associated with primary malignant (cancerous) bone tumours and is a very distinctive symptom of Ewing’s sarcoma. This is a worrying and serious symptom that is not common with other causes of pain and should be investigated urgently.

Lump or swelling

As the tumour increases in size, a noticeable swelling around the affected site may be noticed. However, where the tumour is “deep-seated”, such as tumours in the pelvis, or spine, the tumour may not be noticeable.

Other symptoms relating to where the tumour starts

If the tumour puts pressure on a nerve (compression) patients can get nerve pain, numbness or tingling, or weakness of muscles supplied by that nerve. An example of this is ‘sciatica’ caused by tumours in the pelvis that compress this sciatic nerve. When Ewing’s sarcoma affects the spine, it is possible to present with symptoms due to “spinal cord compression”.

Symptoms of this can include:

  • Lower back pain and a noticeable swelling
  • Pins and needles or numbness and tingling of arms or legs (paraesthesia)
  • Incontinence or difficulty passing urine or opening bowels
  • Weakness of muscles of arms or legs

General symptoms of Ewing’s sarcoma

These may include fever (temperatures or feeling hot and cold), tiredness, loss of appetite and weight loss. Symptoms due to spread of the cancer can also occur rarely such as breathlessness or coughing caused by spread of the cancer to the lungs.

Late or misdiagnoses

It takes many patients a long time to reach a correct diagnosis. Many symptoms of Ewing’s sarcoma mimic more common conditions that occur in the age group of the patient. Therefore, it is not uncommon for misdiagnoses to occur, which leads to late diagnosis of Ewing’s sarcoma. 

Pain that comes and goes can lead patients to believe the injury or problem has disappeared. Only when the pain returns do patients go back to see their GP or have further investigation. Patients can be told their symptoms are due to ‘growing pains’. It is important to note growing pains do not affect one limb only, do not get worse and do not occur at night.

 The symptoms described above, including pain, can be linked to traumatic incidents, so there are many possible diagnoses to consider.

 Consequently, Ewing’s sarcoma in young patients can be misdiagnosed as transient synovitis (a common condition involving inflammation of the hip joint) and osteomyelitis (bone infection). Tendonitis (inflammation, irritation, and swelling of a tendon) and sciatica (back pain radiating to the leg, sometimes with associated weakness or numbness) are other frequent misdiagnoses.

Produced: October 2015

Published: January 2016

Review: October 2018

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