Diagnosis
Ewing sarcoma diagnosis usually begins with a physical exam and a review of symptoms and medical history. Imaging and biopsy are used to locate the tumor, find out whether it has spread and confirm the diagnosis.
Imaging tests
Imaging tests make pictures of the body. They can help show where Ewing sarcoma is located, how large it is and whether it has spread. Imaging may include:
Removing a sample of cells for testing
A biopsy is needed to confirm the diagnosis of Ewing sarcoma. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A radiologist or surgeon may place a needle through the skin and into the cancer to get a tissue sample or get a tissue sample during surgery. In the lab, a pathologist examines the sample for cancer and looks for features of Ewing sarcoma.
Your healthcare team uses the biopsy results, along with imaging and other tests, to make a treatment plan.
Genetic testing of cancer cells
A sample of the cancer cells is tested in the lab for certain gene changes called mutations. Ewing sarcoma cells mostly have changes in the EWSR1 gene. Most often, the EWSR1 gene joins with another gene called FLI1. This creates a gene fusion called EWSR1::FLI1. But other gene changes may occur with Ewing sarcoma. Testing the cancer cells for these gene changes can help confirm your diagnosis.
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Treatment
Because Ewing sarcoma is complex, care is best provided by a team of specialists with experience treating sarcoma. Ewing sarcoma treatment usually combines chemotherapy with treatment to control the tumor at its original site. The treatment may be surgery, radiation therapy or both.
Chemotherapy
Chemotherapy is a central part of Ewing sarcoma treatment. Chemotherapy treats cancer with strong medicines. It usually begins before surgery or radiation therapy. Chemotherapy continues after local treatment to treat cancer cells that may remain elsewhere in the body.
Chemotherapy may shrink the tumor before surgery or radiation therapy. That can make it easier to remove the tumor or target it with radiation therapy.
After surgery or radiation therapy, chemotherapy may be used to treat any cancer cells that may remain.
For advanced cancer that spreads to other areas of the body, chemotherapy remains an important part of treatment. Treatment plans also may include surgery or radiation therapy for some places where the cancer has spread.
Surgery
The goal of surgery is to remove all the cancer cells. Surgery for Ewing sarcoma might mean removing a small portion of bone and some surrounding tissues. Rarely, it might mean removing the affected arm or leg.
Surgery on an arm or leg might affect how you use that limb. Surgeons carefully plan the surgery to preserve function when possible.
Whether surgeons can remove all the cancer without removing an arm or leg depends on several factors. These include the tumor's size, where it is and whether chemotherapy helps shrink it.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
Radiation therapy may be used before or after surgery. Or it might be used instead of surgery if surgery is not possible or could cause major loss of function. The choice to do radiation therapy depends on several factors. These factors include the tumor's size, where it is, its response to chemotherapy and the complexity of the surgery.
For Ewing sarcoma that has spread, radiation therapy may be used to treat selected sites or to help relieve symptoms such as pain.
Targeted therapy
Targeted therapies are designed to block specific molecules or pathways that cancer cells depend on. For Ewing sarcoma, these treatments are being studied mainly for disease that has come back or has not responded to chemotherapy. Some approaches have shown activity in early studies, but they are not commonly used as the first treatment option for Ewing sarcoma.
Long-term treatment side effects
Treatment for Ewing sarcoma can cause major short- and long-term side effects. Your healthcare team can help you manage the side effects that happen during treatment. The team also can discuss side effects to watch for in the years after treatment.
Clinical trials
Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you or your child might be able to join a clinical trial.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Prognosis
Ewing sarcoma can be treated successfully when the cancer has not spread. The outlook, also called the prognosis, depends most strongly on whether the cancer has spread at diagnosis and where it has spread. Other factors include the tumor's size and location, the person's age at diagnosis, and how well the cancer responds to treatment. Talk with your healthcare team if you want to know more about the outlook for you or your child.
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Coping and support
A diagnosis of Ewing sarcoma can feel overwhelming. With time you can find ways to cope with the distress and uncertainty of cancer. Until then, you may find these suggestions helpful.
Learn about Ewing sarcoma to make decisions about care
Ask your or your child's healthcare professional about Ewing sarcoma, including treatment options and possible side effects. If your child has Ewing sarcoma, ask the healthcare team to guide you in talking to your child about the cancer in a caring way that your child can understand.
Keep friends and family close
Keeping your close relationships strong can help you deal with Ewing sarcoma. Ask friends and family to help with daily tasks, such as helping take care of your home. They can give emotional support when you need extra help.
Ask about mental health support
Talking to a counselor, medical social worker, psychologist or other mental health professional also may help you or your child. Ask your healthcare team for options for professional mental health support for you and your child. You also can check online for a cancer organization, such as the American Cancer Society, that lists support services.
Preparing for your appointment
If there are symptoms that worry you, start by making an appointment with a healthcare professional for you or your child. If the health professional suspects Ewing sarcoma, ask for a referral to an experienced specialist.
Ewing sarcoma typically needs to be diagnosed and treated by a team of specialists, which may include:
- Orthopedic surgeons who specialize in operating on cancers that affect the bones, called orthopedic oncologists.
- Other surgeons, such as chest surgeons or pediatric surgeons. The type of surgeon depends on the cancer's location and the age of the person with Ewing sarcoma.
- Doctors who specialize in treating cancer with chemotherapy or other medicines. They might include medical oncologists. For children, they might include pediatric oncologists.
- Doctors who study tissue to diagnose the type of cancer, called pathologists.
- Doctors who use radiation to treat cancer, called radiation oncologists.
- Rehabilitation specialists who can help in recovery after surgery.
- Child life specialists who can provide support for children and teens during cancer care.
What you can do
Before the appointment, make a list of:
- Symptoms, including any that seem unrelated to the reason for the appointment, and when they began.
- Any medicines you or your child takes, including vitamins and herbal supplements, and their doses.
- Key personal information, including any major stresses or recent life changes.
Also:
- Bring scans or X-rays, both the images and the reports, and any other medical records that are linked to this condition.
- Make a list of questions to ask the health professional to make sure you get the information you need.
- Take a relative or friend to the appointment, if you can, to help you remember the information you get.
For you or your child, your questions might include, for example:
- What type of cancer is this?
- Has the cancer spread?
- Are more tests needed?
- What are the treatment options?
- What are the side effects and risks of each treatment option?
- Could treatment affect being able to have children? If so, do you offer ways to be able to preserve that ability?
- Are there brochures or other printed material I can have? What websites do you suggest?
What to expect from your doctor
Your healthcare professional will likely ask you questions, such as:
- What are the symptoms that worry you?
- When did you notice these symptoms?
- Do you always have the symptoms, or do they come and go?
- How severe are the symptoms?
- What, if anything, seems to improve the symptoms?
- What, if anything, appears to worsen the symptoms?
Sept. 30, 2026