The clinical presentation depends on the size or extent, location, and stage.
The following symptoms and complaints may indicate Ewing sarcoma:
Main symptoms
- Bone pain independent of exertion (pressure and knocking pain) that also occurs at rest and/or at night and increases in intensity
- Swelling, deformity of joints and bones (palpable) – swelling may be reddish in color
- Skin warming over the affected area
- Restriction of mobility of the affected body part
- Fractures (bone fractures) after minor trauma, mostly femur (thigh bone) and humerus (upper arm bone) are affected – osteolytic tumors break down bone substance; generally, the bone loses strength due to the tumor
- Inhibition of bone growth in the area of the tumor (in children).
- Numbness and paresis – as signs of spinal cord compression; neurological functional deficits are described in 10-20% of patients with spinal metastases. They can manifest themselves in the form of sensory deficits, bladder or rectal dysfunction, and even paraplegia.
Associated symptoms
- Leukocytosis – increase in white blood cells in the blood; these indicate an inflammatory response.
- B-symptomatics (see below) – indicates metastasis.
B-symptomatics
- Severe night sweats (wet hair, soaked sleepwear).
- Unexplained, persistent or recurrent fever (> 38 °C).
- Unintentional weight loss (> 10% percent of body weight within 6 months).
Localization
Typical of primary bone tumors is that they can be assigned to a characteristic localization in addition to a specific age range. They arise clustered at the sites of most intense longitudinal growth (metaepiphyseal/articular area).
The following questions should be answered by diagnostic measures:
- Localization in the skeleton → Which bone is affected?
- Localization in the bone → epiphysis* (joint end of the bone (near the joint)), metaphysis* (transition from epiphysis to diaphysis), diaphysis* (long bone shaft), central, eccentric (not central), cortical (at the solid outer shell of the bone), extracortical, intraarticular (within the joint capsule).
Ewing’s sarcoma commonly occurs in the metaphysis and diaphysis of the long tubular bones of the femur (thigh bone), tibia (shin bone), and humerus (upper arm bone), as well as in the pelvis and ribs.
* Example of the structure of a long bone: epiphysis – metaphysis – diaphysis – metaphysis – epiphysis.
