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How Does My Doctor Know I Have Ewing Sarcoma?

You should report any symptoms that might be caused by Ewing sarcoma to your doctor. Symptoms may be caused by cancer or by other, less serious problems. To find out what is causing your symptoms, your doctor will ask you about these things.

  • Your health history

  • Your family's history of cancer

  • Your lump, if you have one

  • Your pain, if you have any

  • Any other symptoms you are having

Your doctor will also perform a careful physical exam. If you have a lump, the doctor will look at its size and shape, and the effect it has had on surrounding areas. The doctor may also schedule one or more of these tests:

X-rays. This is often the first test done if your doctor suspects a bone tumor. Doctors can identify most Ewing tumors with an X-ray. An X-ray uses very low doses of radioactive rays to see through your skin. It imprints an image of the inside of your body onto a piece of film. Sometimes doctors skip the X-rays and go right to other tests such as a computed tomography scan (CT scan) or magnetic resonance imaging (MRI) scan.

Computed tomography scan (CT scan). A CT scan can help your doctor identify more clearly a Ewing tumor. A CT scanner takes X-rays of your body from different angles as you slide through it on a table. A computer combines these pictures to produce a more detailed picture of the inside of your body.

Magnetic resonance imaging (MRI).  An MRI can more clearly define abnormalities to see if they are really due to a Ewing tumor. During an MRI, large magnets and radio waves produce detailed pictures of the inside of your body. The energy from the radio waves creates patterns formed by different types of tissue and diseases. This produces cross-sectional pictures that look like slices of your body. Your doctor may order an MRI of a certain area of bone if you are having a lot of pain at a certain spot. These pictures will also help him or her see what part of a lump to take out in a biopsy.

For this test, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of radio waves at the area being examined. A computer uses data from the radio waves to create pictures of the inside of your body. You may need more than one set of images.

Bone scan. For this test, a nurse or technician injects you with radioactive dye. Then he or she takes pictures of your bones with a special camera about two hours later. The picture shows areas of bone where the radiation is concentrated, which can mean that there is an abnormality. It does not necessarily mean there is a tumor. Other things, such as arthritis or bone fractures, can also make a bone scan abnormal. Your doctor may also use this test to find out if a bone tumor has spread to other bones or if a soft tissue tumor has spread to bone.

Positron emission tomography (PET) scan. This test is similar to a bone scan, but a slightly radioactive sugar is injected into the blood. Tumors use more of this sugar than normal cells, so the radiation collects in tumors, where it can be seen with a special camera. PET scans can help determine the spread of Ewing tumors, find out if abnormal areas seen on a bone scan or CT scan are tumors, and help follow the response of the tumor to treatment.

These tests can help show where the tumor is and whether it has spread. They may give enough information for a doctor to tell the cause of the problem, or you may need further testing. 

When You May Need More Tests

In nearly all cases, the doctor will remove a sample of tissue from your tumor to confirm the diagnosis. This is called a biopsy. A doctor who specializes in identifying disease, called a pathologist, will look at the sample under a microscope to check for cancer.

Your doctor may send you to a surgeon or another doctor for a biopsy. Although a physical exam and the pictures of the growth may suggest that a tumor is cancerous, a biopsy is the only way to be certain. The biopsy tells the doctor what, if any, type of tumor you have. Your doctor might perform one of these types of biopsy. If there is a chance that a tumor is a Ewing tumor, it is very important that the biopsy be done by a doctor with experience in treating this disease.

Excisional biopsy. If your tumor is small, a surgeon can cut through your skin and take out the whole tumor. You will be given anesthesia so that you are asleep during the biopsy.

Incisional biopsy. If your tumor is large, the surgeon removes only a small part of the tumor. If the tumor is close to your skin's surface, the surgeon may numb the area. If the tumor is deep inside your body, you will be given anesthesia to put you to sleep.

Needle biopsy. The doctor inserts a thin, hollow needle through your skin to remove tiny bits of tissue from the tumor. This type of biopsy does not require surgery, and you are awake during this test. The doctor may use a CT scan to guide the needle. Sometimes, this test does not remove enough tissue to know whether the lump is a sarcoma, but it can tell whether it is something else, such as an infection.

Bone marrow biopsy. This test is not usually done to diagnose Ewing tumors, but it may be done once the diagnosis is made to help determine if the cancer has spread to the bone marrow. For this test, hollow needles are used to remove samples of bone marrow, usually from the back of the hip bones. Teens and adults may be awake when this is done (with the area numbed), but children are usually sedated or asleep for this procedure.