Ewing sarcoma

What Ewing sarcoma is

Ewing sarcoma is a rare cancer than can start in the bones or in soft tissue, like the muscles. It belongs to a group of tumours called ‘undifferentiated small round cell sarcomas of the bone and soft tissue’.

Ewing sarcoma can start in any bone or soft tissue of the body but is most common in the bones. The skeleton picture below shows where Ewing sarcoma can start. The most common places are the pelvis, the thigh bone (femur) and the ribs, shown in orange.

Parts of the body Ewing sarcoma affects:

Ewing sarcoma can sometimes spread to other parts of the body. This is called ‘secondary cancer’. The most common part of the body it spreads to is the lungs. This is called ‘pulmonary metastases’. In rare cases, Ewing sarcoma spreads to other bones, organs or bone marrow.

You might hear or read some medical words that do not make sense at first, when learning about Ewing sarcoma. Our glossary includes these words along with explanations about what they mean.

Ewing sarcoma is the second most common type of primary bone cancer found in young people.

Most people are under 30 years old when they are diagnosed with Ewing sarcoma.
Ewing sarcoma tends to be more common in White people than in Black and Asian people.
Each year in the UK around 90 people are diagnosed with Ewing sarcoma.
Ewing sarcoma is more common in males than females. However, in people under 15 years old, males and females are affected equally.
Around 2 in every 100 children with cancer have Ewing sarcoma.
Treatments for Ewing sarcoma have not changed much over the past 30 years, which means survival rates have not improved.
60 out of every 100 people with Ewing sarcoma are alive 5 years after their diagnosis but some may still be receiving treatment. This number is lower if the cancer is metastatic (has spread) at diagnosis.

There are different symptoms of Ewing sarcoma. Doctors may call these 'clinical signs' or talk about 'presentation'.

Symptoms

The most common symptoms of Ewing sarcoma include:

bone pain which might be worse at night, happens all the time or stops and starts, is not helped by painkillers and may get worse over time
a lump or swelling, which may be seen or felt if the tumour is near the skin’s surface (called ‘a palpable mass’)
a broken bone caused by weakening of bone due to a tumour, without having had a fall or accident (called a ‘pathological fracture’)
problems moving, may develop a limp, stiff limbs or joints, unable to move as normal
tenderness over the bone or joint

Less common symptoms include:

a high temperature (fever)
feeling tired or weary (‘lethargy’ or ‘fatigue’)
pain with tingling and numbness (‘pins and needles’)
weight loss and loss of appetite
feeling breathless

Not everyone will have the same symptoms and they can affect people in different ways. They may be mild at first and slowly progress, or they may happen suddenly. Some people have symptoms that disappear for a while and then suddenly return.

Sometimes people have symptoms for weeks or months before they are diagnosed. This can be because the symptoms of Ewing sarcoma are quite general and can be similar to those of other conditions.

Many people struggle to get a correct diagnosis when they first see a doctor. Because lots of people have pain that stops and starts, doctors can think the cause of the pain is short-term. A lot of people do not feel ill until the cancer is fairly well advanced.

You can find more information about symptoms on our Symptoms of bone cancer webpage.

A large number of Ewing sarcoma tumours share the same kind of gene damage. An example of this damage is when 2 separate genes (DNA) combine (fuse) to become a ‘fusion’ gene. Most Ewing sarcomas are caused by fusions between the same 2 genes.

Gene fusion

It is not yet known what causes fusion between certain genes, or how to stop it happening.

We do know that:

Ewing sarcoma cannot be caught from anyone else.
There do not seem to be any environmental factors that cause it, such as radiation.
It is not caused by something you have done.

A very small number of people have other small round cell sarcomas of the bone and soft tissue, which are similar to Ewing sarcoma, but have a fusion between different genes. These are sometimes called ‘Ewing-like tumours’. Symptoms and treatments for Ewing sarcoma and Ewing-like tumours are currently the same.

Getting a diagnosis

The symptoms of Ewing sarcoma are general. There is no one clear sign that doctors can easily look for to make a diagnosis. Most people go to their doctor if they are worried and some people go to their local hospital's emergency department (A&E).

Some people are sent ('referred') quickly for more tests or a second opinion, but often people have to go back to their doctor 3 or 4 times before this happens. Primary bone cancers are very rare and many GPs (general practitioners) will have no experience of them.

The Bone Cancer Research Trust (BCRT) is trying to find ways of reducing the time between a person noticing symptoms and getting a diagnosis.

Bone Cancer Centres

If initial tests show that cancer may be present, you will need to go to (be ‘referred’ to) a bone cancer centre.

These are special centres where a group of people who are experts in bone cancer will discuss and manage your diagnosis and care together. This group of experts is called a multi-disciplinary team (MDT).

In England, there are 5 bone cancer centres: Birmingham, Newcastle, Oswestry, Oxford, and Stanmore (North London).
In Wales, there are no bone cancer centres. People are usually seen at Oswestry or Birmingham.
In Scotland, there are 3 bone cancer centres: Glasgow, Edinburgh and Aberdeen.
In Northern Ireland, there is a bone cancer centre in Belfast.

These bone cancer centres are shown on the map below:

Find out more in our downloadable resource: Bone cancer centres and hospital treatment centres

Diagnostic tests

When a person is referred to a bone cancer centre, doctors will carry out several different tests before a diagnosis of Ewing sarcoma can be confirmed. These tests may include:

X-ray (this is usually carried out first)
biopsy of the tumour
blood tests
bone marrow biopsy
CT scan
MRI scan
PET scan

Imaging such as x-rays and scans also help doctors to see the size of the tumour and exactly where in the body it is. Scans also check if the cancer has spread to any other parts of the body. This is known as ‘staging’.

Taking a biopsy involves taking a small sample of the tumour or bone marrow and examining it under a microscope. Results from a biopsy can take up to 2 weeks to analyse.

Using all of the test results, doctors can confirm a diagnosis of Ewing sarcoma and decide on a treatment plan.

Visit the Macmillan Cancer Support website to find out more about the different types of diagnostic tests and scans.

You may be asked to donate a tissue sample for whole genome sequencing, to contribute to the National Genomic Research Library. By taking part, it may:

help your clinical team get answers which could lead to a diagnosis, access to a different treatment, or an opportunity to participate in clinical trials
help other sarcoma patients and more widely, other cancer patients in the future
help researchers to understand sarcomas better, to improve things for you or others now or, more likely, in the future

To find out more, visit Genomics England’s website.

Prognosis

When a person has an illness, doctors try to predict how it will affect them. For example, how likely it is that the treatment will work, and how likely it is that the person will be cured. This is called a ‘prognosis’.

Lots of different things are taken into account when doctors make a prognosis for Ewing sarcoma. The main ones are:

where in the body the tumour is (this can affect which treatments will work best)
the size of the tumour
the age and general health of the person
if the Ewing sarcoma is at the original (primary) site (is local), or has spread (is metastatic)
how the tumour responds to treatment

Because everyone is different, doctors can never be sure how Ewing sarcoma will affect each individual person.

60 out of every 100 people with Ewing sarcoma are alive 5 years after their diagnosis but some may still be having treatment. This number is lower if the cancer is metastatic (has spread) at diagnosis.

Holistic Needs Assessment

It may help to talk about any feelings of anxiety or concern once your diagnosis has been confirmed. Some hospitals offer a ‘Holistic Needs Assessment’. This is where you can chat with someone in your medical team who will ask questions about your worries and concerns. It covers all parts of life, not just how the cancer and treatments affect the body. A support plan will be made to help you manage your worries and concerns. You may be offered an assessment around the time of diagnosis, during treatment or after treatment has ended. If your hospital does not offer a Holistic Needs Assessment, you can still talk to your medical team about any worries or concerns you have. They are there to help.

Where you will be treated

Where you are treated will depend on where the cancer is, how old you are and a number of other things.

You will usually have your surgery at a bone cancer centre. You may have to travel a long way to get there. Take a look at our map of UK bone cancer centres in 'Diagnosing Ewing sarcoma' above.

Chemotherapy (also called ‘chemo’) and radiotherapy for Ewing sarcoma may take place at a bone cancer centre or a different hospital closer to you. Your medical team will talk to you about this.

Who will be involved in treatment

You will be treated by a team of people who are experts in bone cancer. These people will include oncologists (a doctor who cares for people with cancer), surgeons, nurses, including a clinical nurse specialist (CNS), social workers, support workers, dieticians, physiotherapists and many other experts. This group of people is called a ‘multi-disciplinary team’ (MDT). The MDT plan and decide on what treatment and care is best for you. They should include you in the decision making.

Each patient is given a clinical nurse specialist (CNS), sometimes called a ‘key worker’. They are there throughout treatment to give support and listen to questions or worries you may have.

Each case of Ewing sarcoma may also be discussed by the National Ewing sarcoma MDT. However, treatment will be managed by the local MDT.

Types of treatment

There are different treatments for Ewing sarcoma. Everyone will have a slightly different treatment plan, depending on the stage of the cancer and where it is in the body. Your MDT will talk to you about the different treatment choices and what is involved.

In the UK, the standard of care is to give people a number of different types of treatment. The exact order of treatment will differ from person to person. Treatments for Ewing sarcoma may include:

chemotherapy (before and after surgery)
surgery
radiotherapy.

Treatment of Ewing sarcoma should involve you and your doctors working together to find the best care or treatment plan.

Doctors may call the treatments ‘local’ or ‘systemic’. Local treatment includes surgery and radiotherapy. Systemic treatment includes chemotherapy.

Remember, if you are having treatment outside the UK, you may have different tests and treatments, depending on the treatment guidelines in your country. If you have any questions about this, talk to your medical team or contact our Support and Information Team.

Chemotherapy

Chemotherapy ('chemo') is a type of medicine used to treat cancer that travels around the whole body in the bloodstream. In Ewing sarcoma, different types of chemo are given before surgery (called ‘neoadjuvant chemotherapy’) to:

shrink the tumour
destroy any cancer cells that could have spread from the original (primary) site to other parts of the body.

Chemo may also be given after surgery (called ‘adjuvant chemotherapy’), to:

destroy any remaining cancer cells
lower the chance of the cancer coming back.

After you have been told you have Ewing sarcoma, your chemo will probably start quickly. The doctors will talk to you and answer any questions you may have about your treatment plan.

The standard chemo given to treat Ewing sarcoma before and after surgery is now internationally recognised as something called the 'VDC/IE drug combination' from the Euro Ewing 2012 trial (EE2012). The medicines given are called vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide. They are given together so if the cancer does not respond or stops responding to one of the medicines, the others will still work.

Chemo is given in ‘cycles.’ A cycle is the treatment time plus resting time. The resting time helps the healthy cells to recover before the next cycle starts. Each ‘cycle’ of chemotherapy is usually 2 weeks (14 days).

You will be given a cycle of vincristine, doxorubicin and cyclophosphamide (VDC), followed by a cycle of ifosfamide and etoposide (IE). They will switch like this until the end of treatment. People usually have 9 cycles of chemo. After this, the doctor will check how well the treatment is working. You may then be given 5 more cycles.

Before chemo, doctors will do blood tests to check your level of white blood cells. They will also do tests to see how well your kidneys, heart and ears are working. This is because some chemo medicines can affect these organs. They will also do tests during treatment to check for side effects.

How chemotherapy works

Cancer cells divide and grow quickly. So, chemo medicines were developed to target cells that divide quickly. Different chemo medicines target cancer cells in different ways and that is why more than one medicine is usually given. This is called ‘combination chemo’.

How chemotherapy is given

If you have Ewing sarcoma, you will be given chemo directly into the blood by intravenous infusion (I.V.).

An infusion is a way of giving a dose of I.V. medicines, such as chemo, over a set period of hours or days. The medicine goes straight into a vein in your chest, via a long tube. This tube is called a 'central line'. It is connected to a bag that holds the chemo medicine. The medicine ‘drips’ into the blood slowly.

Central lines can be kept in for weeks or a few months. Using these lines means you do not need as many needles during treatment. It also means that more than one medicine or treatment can be given at the same time. For example, fluids and nutrition. There are different types of central line. They are all slightly different. Your medical team will talk to you about which type is best for you.

High-dose chemotherapy and stem cell transplant

In rare cases, people may be recommended high-dose chemotherapy, followed by a 'stem cell transplant'. This does not often happen in the UK. Stem cell transplants help to replace blood cells that have been destroyed by high-dose chemotherapy.

Side effects of chemotherapy

Most healthy cells do not divide quickly. However, cells of the hair follicle, skin, bone marrow, and digestive tract (where food moves through the body) do divide quickly. Chemo can affect these healthy cells and this is what causes side effects.

Side effects include feeling sick (nausea), diarrhoea, hair loss, mouth sores, a nasty taste in your mouth and lack of energy (fatigue). They go away when the chemo is finished. Medicines can be given before and after chemo to help with some of these side effects, such as anti-sickness medicines.

When doctors tell you the list of side effects that you could get, remember that you might not get any of them, you might only get some of them, and they might not affect you as much as other people. If you do not have the same side effects as people having the same chemo as you, it is okay. This does not mean your treatment is not working.

It might help to talk to your medical team and other people who have had cancer treatment, about side effects and how to cope with them. BCRT has support and information videos which you may find helpful to watch. The most common side effects of chemotherapy are described below:

Feeling sick and being sick

The doctors can give you anti-sickness tablets to help stop you feeling sick (nauseous) or being sick (vomiting). Try to avoid strongly flavoured food or fried, greasy food. Eating small meals, more often will help.

Low levels of white blood cells (neutropenia)

Before and during treatment you will have regular blood tests to check levels of special blood cells called ‘neutrophils’. Neutrophils are white blood cells that help protect against bacterial or viral infections. Chemo can lower the number of neutrophils in the blood. This can cause a condition called ‘neutropenia’ which increases your risk of getting infections.

It is very important that you know what to do if you get a high temperature (fever) while having chemo. This can be a sign of infection. Your MDT will give you a contact number at the hospital to use if you get a temperature. If this happens, it is very likely that you will be asked to go to hospital for a blood test and to see an oncologist. You will be given antibiotics to fight off the infection if you have neutropenia. You may need to have small injections under the skin, called G-CSF. This is to help the neutrophils recover after chemo.

Lack of energy (fatigue)

Lack of energy, or feeling very tired all the time (‘fatigue’), is the most common side effect of chemo and other cancer treatments. Th feeling does not seem to go, even after a long sleep. Fatigue can also be caused by not having enough red blood cells. This is another side effect, called ‘anaemia’.

There is a medicine that doctors can give you to help with fatigue. You may have a blood transfusion if your fatigue is caused by anaemia. Research has shown that exercise and keeping active can help to reduce the feeling of fatigue. Resting all the time makes it worse, so plan something to do to stay active. Talk to your medical team about how to do this safely.

Sore mouth

Mouth ulcers can be a side effect of chemo. They can make it difficult or unpleasant to eat. Doctors can give you mouthwashes and gels that can help. Brushing your teeth often with a soft toothbrush will also help to keep your mouth clean.

Sucking ice cubes or eating ice cream while you are having chemo may also help.

Taste changes

You may find that you have a taste of metal in your mouth or that your favourite foods suddenly taste horrible, salty or bitter. Using plastic spoons, knives and forks may help to reduce the taste of metal. Adding herbs and spices to food and avoiding food that doesn’t have much flavour may also help. Talking to a dietician is also a good idea.

Hair loss

This is the side effect of chemo that most people know about. Hair loss can begin from a few days to a few weeks after starting chemo. You may lose some or all your hair, eyebrows, eyelashes and pubic hair. You may feel you want to wear a head scarf, cap, beanie or wig. You may just want to bare all by shaving your head before the hair loss starts.

If you feel upset or scared about losing your hair, talk to your key worker or someone in your medical team. You can also contact our Support and Information Team.

For children with Ewing sarcoma, The Little Princess Trust may be able to provide a free wig. Visit their website: littleprincess.org.uk or call them on 01432 760 060 to find out more.

Weight changes

During treatment, you may not feel like eating and start to lose weight. It’s important to keep your weight as stable as you can, calories are really important. Try and eat as much as you can, when you can.

It’s important to eat a healthy diet that includes a variety of foods so that you get all of the energy, vitamins and minerals you need. This will help your body and keep your immune system working well.

You can download a booklet produced by the Children’s Cancer and Leukaemia Group (CCLG) called ‘Helping your child to eat well during cancer treatment’. Or call them on 0333 0507 654 to request a copy.

Surgery

After having chemo most people with Ewing sarcoma will have surgery to remove the main tumour. The type of surgery will depend on:

where the tumour is
the size of the tumour
if the tumour has grown into nearby tissues or spread to other parts of the body

The surgeon will explain what type of surgery is best for you.

The aim of surgery is to completely remove the primary tumour and keep the body working as normally as possible. For some people it is very difficult to remove the tumour. For example, if the tumour is in the pelvis or the spine. The decision about whether surgery is possible is usually taken by the MDT, which includes expert surgeons.

If the tumour has spread to other parts of the body, your oncologist and surgeon may want to think about removing these secondary tumours by surgery.

Most people have surgery after cycle 9 of chemo. Your surgeon and oncologist will talk to you about when the surgery will be carried out. It might depend on if you also need radiotherapy.

Limb-sparing surgery

If the Ewing sarcoma is in a limb (arm or leg) the medical team will do their best to save the limb by doing ‘limb-sparing surgery’. This is where the whole tumour is removed and the space left is replaced with a piece of bone from another part of the body or from another person (a bone graft). In some people, part or all of the bone is replaced with a metal implant called an ‘endoprosthesis’. The implant may be a complete joint if the tumour was near a knee, hip or shoulder.

If you need limb-sparing surgery, a 'physiotherapist' will visit you to talk about what will happen before and after the operation, and about rehabilitation (also called ‘rehab’). You may also talk to an ‘occupational therapist’ about how you can prepare for day-to-day life after surgery and changes you can make at home to help you move around safely and stay independent.

Rehab is the process of making your body stronger after surgery and learning to live with the changes to your body. The physiotherapist will also give you some exercises to do before the operation. If you still feel weak after your chemo, the exercises will also help you to strengthen your muscles.

You will start rehab very soon after surgery. The physiotherapist will get you to do lots of exercises to help you strengthen your muscles, limbs and get you moving again.

You will have regular check-ups with your surgeon, after surgery. They will check how you are recovering and if the implant or bone graft is working well and is not damaged. They will also check for signs of infection.

Amputation

Sometimes, it is not possible to remove a bone tumour from an arm or leg (limb). In this case, limb-sparing surgery will not work and an ‘amputation’ may be needed instead. This is when all or part of an arm or leg is removed.

An amputation may be needed if the tumour:

has grown into important nerves and, or blood vessels
is in a place where the arm or leg would not work properly after limb-sparing surgery
has not shrunk enough with chemo

Your multi-disciplinary team (MDT) will decide if an amputation is the best treatment for you. Your surgeon will talk to you about this.

Find out more on our Amputation webpage.

Radiotherapy

Radiotherapy means treating the tumour with high doses of concentrated radiation.

Radiotherapy may be used:

before surgery to shrink the cancer
after surgery to destroy any cancer cells that remain in the area after the operation
instead of surgery if the tumour cannot be removed by surgery
in combination with surgery and chemo if the tumour cannot be fully removed or if full removal would limit how well the body works

Radiotherapy is usually given as a single dose each day for about 5 to 6 weeks. It should only take a few minutes to have the dose. Chemo will usually continue during radiotherapy treatment.

The NHS website shows a video of what happens during radiotherapy.

Proton Beam therapy (PBT)

Proton Beam Therapy (PBT) is a type of focused radiotherapy that delivers the radiation dose to the tumour. This means healthy tissue around the tumour is less likely to be affected by radiotherapy.

If you are eligible for this treatment, it is available at The Christie Hospital, Manchester and at University College London Hospital, London. Only a small number of people are likely to benefit from PBT. Your medical team will tell you if your case should be reviewed by an expert panel.

If you are having PBT, the BCRT offers financial assistance to support the extra costs associated with travel and hospital stays. You can find out more about this on our Financial Assistance Grants webpage.

Tests during treatment

You will have different tests and scans during treatment. These are to check if the treatment is working and to check for any side effects of the treatment. Chemotherapy may affect your hearing, heart and kidneys, so these tests are important.

Clinical trials for Ewing sarcoma

You can find out more about clinical trials and which trials are open to Ewing sarcoma patients on our clinical trials webpage. You can also contact our Support and Information Team for more information by emailing us or calling 0800 111 4855.

Setbacks

Things may not always go as smoothly as you and the doctors would like. There may be times when you feel really unwell, get an infection or need to have more surgery. These setbacks are a normal part of cancer treatment. People will have different setbacks at different times, but it does not mean that the treatment is not working.

It might help to read stories from other people who have been treated for primary bone cancer. You can visit our patient stories webpage.

Support after treatment

The end of treatment will come as a welcome relief, but it can also be a time of worry and anxiety. You may be worried about the cancer coming back. You may feel lost and alone or be worried about leaving behind the medical team and support network at the hospital. Your family may also feel like this. These are all normal feelings.

You may like to join a support group or contact other primary bone cancer patients through blogs or on social media. Our Support and Information Team at the Bone Cancer Research Trust provide support and information for people affected by primary bone cancer. They can also connect people with others who have experience of primary bone cancer.

Other services are available which offer support, these include:

Psychological support and services: Psychologists will support people with any concerns, feelings of anxiety or depression.
Local support groups: Many support groups are organised and run locally. Clinical nurse specialists can usually provide information on local services.
Charitable organisations: There are lots of charities that provide support and information. See our other useful organisations webpage for details about how other organisations can help.

You may find the following resources from ‘The Children’s Cancer and Leukaemia Group (CCLG)’ helpful:

My child has finished treatment: Useful information for children and their parents about what to expect once treatment is finished
I have finished cancer treatment. What happens next?: A booklet for 10 to 16
year olds who have reached the end of their cancer treatment.
Finishing treatment: a parents guide: A booklet for parents or carers of a child who has had cancer.

Follow-up care

When you finish treatment, your doctors will want to monitor you for a long time. This is called ‘follow-up care'.

You will need to attend outpatient hospital visits on a regular basis. How often you visit is different for each person. It might be every 3 months for the first 2 years, every 6 months for the 3 to 5 years after that, and then once a year after that.

At these visits, doctors will check your general health, talk about concerns and run some important tests to:

check if the cancer has come back (called ‘relapse’ or ‘recurrence’)
check for any ‘late effects’ from the cancer treatment (find out more about late effects on our about primary bone cancer webpage)

These visits can also be useful to talk about any emotional or practical worries or problems you may have.

You may also have follow-up care with a surgical team. They will look out for surgery-related problems.

In-between visits, it is important to get in touch with your key worker or doctor straight away if you have any problems.

Rehabilitation

During and after treatment, many people benefit from ‘rehabilitation’ or ‘rehab’. This is a form of therapy that helps them regain strength, tackle day-to-day activities and return to normal life.

Rehab services include:

Physiotherapists: Help people return to an active lifestyle, restoring strength, movement and function.
Occupational therapists: Help improve peoples’ ability to do everyday tasks.
Dieticians: Offer advice on what to eat (nutrition) during and after treatment.
Prosthetists: Design and create prosthetic limbs for people who have had amputations.
Orthotists: Provide aids for people who have had surgery, such as splints or special footwear.

You might find it helpful to watch our Support and Information videos about rehab.

Scanxiety

Scan anxiety, or ‘scanxiety’, is the anxiety, worry, or fear you might feel in the lead-up to a scan or scan results. These feelings and any others that might come up are normal.

During the time between your outpatient visits, you may feel unable to plan for the future, 1 year, or even 3 months ahead. Try to not let cancer rule your life. It might help to have medium and long-term goals.

You may find Maggie’s information on the fear of cancer returning helpful.

If the Ewing sarcoma comes back

Sadly, Ewing sarcoma can come back in some people. If the cancer does return, it may feel like the bottom has fallen out of your world, but there are treatments that you can be given.

You may be given a different mix of chemo medicines. The treatment may be more aggressive than before, meaning that higher doses are used. You may need more surgery and maybe radiotherapy. You may be asked to take part in a clinical trial. Everyone is different and treatments will depend on each person.

Your medical team will talk you through the treatment options in detail.

Advanced Ewing sarcoma

Your doctor may have told you that your cancer can no longer be cured, and that the focus now is to make you comfortable and give you as much time as possible with your loved ones. Your hospital team may talk about palliative care and ways to manage your pain. They may also talk to you about hospice care. You can ask the team to help direct you to a local hospice or you might like to search for one yourself.

You can find more information on this and coping with your emotions by contacting our Support and Information Team.

The Bone Cancer Research Trust's information has been created using peer reviewed clinical and scientific publications, reviews, case studies and reference books. Peer review is when the work of one scientist or doctor is checked by other experts in the same subject area. This helps make sure the study data is 'reliable'.

If you are interested in reading more, below is a list of key references used to compile our information about Ewing sarcoma.

For a full list of references and further reading, or for more information, contact our Support and Information Service. You can also visit our Request Information Materials page to order printed resources.

Books

Alberts B, Heald R, Johnson A, Morgan D, Raff M, Roberts K et al. Molecular Biology of the Cell. 7th edition. New York: W.W. Norton & Company;2022. ISBN-13: 978-0393884852
Weinberg RA. The Biology of Cancer. 3rd edition. New York: W.W Norton & Company;2023. ISBN-13: 978-0393887655
Mackay J. The Chemotherapy and Radiation Therapy Survival Guide. 2nd edition. Oakland: New Harbinger;2002. ISBN-13: 978-1572240704
Mackay J, Schacher T. The Chemotherapy Survival Guide. 3rd edition. Oakland: New Harbinger;2009. ISBN-13‏: ‎978-1572246218
WHO Classification of Tumours Editorial Board. WHO Classification of Tumours: Soft Tissue and Bone Tumours.5th edition. Geneva: World Health Organisation; 2020. p. 323-34. ISBN-13: 978-92-832-4502-5 p.
Tirode, F. Biology of Ewing sarcoma. In: Heymann, D, editor. Bone Cancer: Primary bone cancers and metastases. 2nd edition. Academic Press;2015. p. 245-55. ISBN-13: 9780124167216
Cullinane CJ, Burchill SA, Squire JA, O'Leary JJ, Lewis IJ (eds). Molecular Biology and Pathology of Paediatric Cancer. Oxford: Oxford University Press; 2003. ISBN-13: ‎978-0192630797
Cidre-Aranaz F, Grünewald TGP. Ewing Sarcoma: Methods & Protocols. New York: Springer; 2021. ISBN: 978-1-0716-1020-6

Journal articles and websites

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