Ewing Sarcoma: Diagnosis

If you or your child has symptoms of Ewing sarcoma, you’ll need certain exams and tests to be sure. Diagnosing Ewing sarcoma starts with your healthcare provider asking questions. They will ask you about health history, symptoms, risk factors, and family history of disease. The healthcare provider will also do a physical exam.

What tests might be needed?

You or your child may need one or more of the following tests:

  • Imaging tests

  • Biopsy

Imaging tests

Imaging tests are the first things done if the healthcare provider thinks you or your child may have a bone tumor, such as Ewing sarcoma.

X-rays of the bone

This is often the first test done. An X-ray uses very low doses of radiation to get pictures of bones and organs. It imprints an image of the inside of the body onto a piece of film. Healthcare providers can see most bone tumors on an X-ray, and may even be able to tell if it's likely a Ewing sarcoma.

MRI

This test uses magnets and radio waves to take detailed pictures of the inside of the body. An MRI is often the next test done if an X-ray shows something suspicious. It can more clearly define changed areas to see if the problem is a Ewing tumor or if it's some other bone damage or an infection. MRI can show details of the tissue around the tumor, as well as the inside of the bone with the tumor.

Biopsy

The results of imaging tests might suggest a bone tumor. But the only way to be sure is by taking out a piece of the changed bone and looking at it under a microscope. This is called a biopsy. There are different ways to get a bone biopsy. It’s important that the healthcare provider doing the biopsy is working with a healthcare provider who has experience in treating Ewing sarcoma. This is to be sure that the way the skin is cut or the piece of tumor is taken out does not affect later treatment with radiation or surgery.

Needle biopsy

For this type of bone biopsy, your healthcare provider uses a large, hollow needle. They put it through your skin and into the bone tumor to get a tiny piece of it. This type of biopsy doesn’t need surgery. In most cases, you’re awake for it, but the area is made numb. Your healthcare provider may use a CT scan to help guide the needle into the right place. 

Incisional biopsy

If the tumor is large, a healthcare provider might take out a small part of it through a cut (incision) in your skin. If the tumor is close to the skin, you or your child may be given medicines to make you sleepy. The surgeon will numb the area to do the biopsy. If the tumor is deep inside your body, you may need general anesthesia. In this case, medicines are used to put you into a deep sleep so you don't feel pain while the biopsy is done.

Excisional biopsy

If the tumor is small, a surgeon might cut through the skin and take out (excise) the whole tumor. This type of surgery often needs general anesthesia. This means you’ll be in a deep sleep.

Getting your test results

When your healthcare provider has the results of the tests, they will contact you. Your provider will talk with you about other tests that may be needed for you or your child if Ewing sarcoma is found. Make sure you understand the results and what needs to be done next.