Symptoms and what to look for

Common symptoms of Ewing’s sarcoma

The earliest and most common symptom of Ewing’s sarcoma is pain at the tumour site. Patients often describe a “dull” and “aching” pain. Although patients (and their GPs) sometimes believe the pain relates to an injury, perhaps caused by an accident or playing sport, the pain is often different to that which may be expected of an injury.

The pain:

  • may be mild to start with and may be intermittent (comes and goes).
  • tends to become more frequent when the patient is at rest and may increase in intensity as the tumour progresses.
  • is usually worse at night and can make it difficult to sleep. Difficulty in sleeping due to the pain is a key symptom of bone cancer that is not common with other causes of pain, so it should be urgently investigated by a GP.

Another common symptom is a noticeable swelling around the tumour site. Sometimes the swelling can be large and mistaken for other causes such as a blood clot. However, where the tumour is “deep seated”, such as tumours in the pelvis or spine, the tumour may not be noticeable at all.

If the tumour puts pressure on a nerve (compression), patients can get nerve pain, numbness, tingling or weakness of muscles supplied by that nerve. An example of this is “sciatica” caused by tumours in the pelvis that compress the sciatic nerve.

When Ewing’s sarcoma affects the spine, it is possible to present with symptoms of “spinal cord compression”, these can include:

  • Lower back pain and a noticeable swelling.
  • “Pins and needles” or numbness and tingling of arms or legs.
  • Incontinence, difficulty passing urine or constipation (i.e. going to the toilet).
  • Weakness of muscles in the arms or legs.

Less common symptoms may include fever (temperatures or feeling hot and cold), tiredness, loss of appetite and weight loss. Although somewhat rarer, symptoms due to spread of the cancer can also occur, such as breathlessness and coughing caused by the spread of the cancer to the lungs.

Importance of recognising symptoms

Early diagnosis is key to surviving Ewing’s sarcoma, but it can take many patients a long time to reach a correct diagnosis. Late diagnosis is problematic because it gives the cancer time to grow and spread.

Many symptoms of Ewing’s sarcoma mimic more common conditions that occur in children and adolescents such as sporting injuries, injuries picked up at school or accidents around the house. Therefore, it is not uncommon for misdiagnoses to occur which can lead to a 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. Patients can be told their symptoms are due to “growing pains”. It is important to note growing pains, especially in the legs, affect both limbs at the same time whereas pain caused by Ewing’s sarcoma is localised to the tumour site.

Not every GP will examine a patient with bone cancer during their career. So charities and sarcoma specialists have promoted awareness of the symptoms of Ewing’s sarcoma to the general medical practitioners through training and awareness campaigns.