Thanks to Nadia and Megan for sharing two interesting oncology cases with us: the first about metastatic pancreatic cancer complicated by bowel ischemia, and the second about Ewing sarcoma with spinal cord compression! Pearls on Ewing sarcoma below.


Top Pearls:

  1. 30% of Ewing sarcoma cases occur in patients over age 30.
  2. The most common locations are pelvis > femur > ribs.
  3. Fever and elevated LDH are signs of metastatic disease.
  4. Systemic chemotherapy is used even for treatment of localized Ewing sarcoma.


For those who want more info:


  • Peak incidence 10-15 years of age, but 30% occur in patients over age 30
  • Almost exclusively a disease of Caucasian patients! (unknown reason for this)
  • No specific environmental exposures have been associated


  • Most tumors in flat or long bones (pelvis > femur > ribs)
  • Can also arise from other bones or soft tissue
  • Localized pain/swelling is the most common presentation
  • Only 10-20% have constitutional sx at presentation (associated with advanced dz)


  • Assumed to be present in nearly all patients due to high relapse rate with local therapy alone
  • Overt metastasis present in 25% of patients at initial diagnosis
  • Most common site is lung (70-80%), which is leading cause of death
  • Lymph node, liver, and brain mets are uncommon


  • *Pearl: LDH elevation is associated with metastatic disease
  • MRI of entire involved bone is imaging modality of choice (can have skip lesions)
  • CT-guided core needle biopsy is most common method to obtain tissue (FNA insufficient)
  • CT chest and PET/bone scan needed for metastatic workup


  • Systemic chemotherapy even for localized disease!


  • VDC/IE is standard regimen (vincristine, doxorubicin, cyclophosphamide with alternating cycles of ifosfomide and etoposide)
  • Ewing sarcoma is radiosensitive, but surgery has better local control than RT


  • CT imaging of primary site and chest for unspecified duration
  • Most recurrences occur within 10 years


  • 5-year survival rates are 70% for localized disease and 33% for overtly metastatic disease.




Have a great day everyone!





Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s