Surgical Procedures: Surgery and Staging for Ewing Sarcoma

Ewing sarcoma is a rare cancer that usually affects the cells of the bones and/or soft tissues. It most often affects children and young adults. Bones affected by Ewing Sarcoma are the legs, arms, feet, hands, chest, pelvis, spine, or skull. Soft tissues affected by Ewing Sarcoma are the trunk, arms, legs, head and neck, abdominal (belly) cavity, among others.

What is staging and how is it done?

Staging is done to find out if and how far cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may be:

Physical Exam: This is an exam to look at your body and to talk about past health issues.

Blood Testing: You may have labs drawn to check a complete blood count (CBC), blood chemistry studies, and lactate dehydrogenase (LDH) levels, among others.

Imaging: Radiology tests are used to look at the cancer inside your body and to see if it has spread. These tests can include: 

• Computed Tomography (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Procedures: These may include: 

• Bone marrow aspiration and biopsy.
• Biopsy: A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample in a laboratory. 

Ewing sarcoma spreads to other parts of the body through the tissue, lymph, and blood systems. Cancer stage tells how extensive the cancer is, how far it has spread, and what treatment course may be best. Ewing sarcoma stages are described as localized, metastatic, and recurrent.

Surgical Procedures Used to Treat Ewing Sarcoma

Surgery is often used to treat Ewing sarcoma. The surgery you have depends on many things, such as the size and location of the tumor, your age, and more.

Types of surgery are:

• Amputation: A limb is removed.
• Limb Salvage Therapy for Localized Ewing Sarcoma: The cancer and some nearby healthy tissue is removed using an incision (cut).
• Surgery for Metastatic or Recurrent Ewing Sarcoma: If Ewing sarcoma metastasizes or recurs (comes back), it often travels to the lungs. The affected areas of the lungs may need to be removed.
• Reconstructive Surgery: Skin grafts and prosthetic implants may be needed after surgery.
• Rotationplasty: This is a procedure used in patients with cancer in their femur or tibia that leads to amputation. The leg is rotated 180 degrees and reattached to the thigh, so that the ankle becomes a functioning knee joint.

At times, an internal (inside the body) prosthesis or bone graft may be needed. If there is cancer in the chest, a thoracotomy (removal of lung tumors) may be needed. Some ribs may need to be removed and replaced with a prosthesis. If the tumor is in the pelvis, the pelvis may need to be rebuilt. Your healthcare team will talk to you about the specifics of your surgery.

What are the risks of Ewing sarcoma surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Bleeding.
• Infection.
• Blood clots.
• Wound healing issues/skin breakdown.
• Loose or broken bone grafts or prostheses.
• Need for more surgeries, especially in growing children for prosthesis replacement.

What is recovery like?

Your healthcare team will talk with you about your plan of care after surgery. They will teach you about any medications you may be prescribed, such as those for blood clot, constipation and infection prevention, pain management, nausea management, and any others.

They will also talk to you about any changes to your activity level and when you can resume regular activity, physical therapy, home care, and other important information before leaving  the hospital. Your recovery depends on the type of surgery you had. Rehabilitation is a key part of your treatment plan.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is okay to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.