Ewing Sarcoma
Ewing sarcoma is a rare cancer of cells that normally make up bone and soft tissue. It is more common in adolescents and young adults.
If you or your child has Ewing sarcoma, knowing what to expect may be helpful. Here you can find out all about the Ewing family of tumors, including risk factors, symptoms, and how they are found and treated.
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What is Ewing sarcoma?
Sarcomas develop from cells that normally make up connective tissues in the body, such as muscles, fat, bones, the lining of joints, or blood vessels. There are many types of sarcomas.
Ewing sarcomas are cancers that start in the bones or nearby soft tissues and have some common features. These tumors can develop in people of any age, but they are most common in adolescents and young adults.
This type of tumor was first described by Dr. James Ewing in 1921, who found it was different from the more common bone cancer, osteosarcoma. Seen with a microscope, its cells looked different from osteosarcoma cells. It was also more likely to respond to radiation therapy.
For information about the differences between childhood cancers and adult cancers, see Childhood Cancer.
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Types of Ewing sarcoma
To diagnose Ewing sarcoma, a biopsy must be done on the tumor. Special lab tests are done on the biopsy cells to diagnose the cancer. Then, other tests are done to find out if the tumor has spread to other parts of the body.
Ewing sarcoma of bone
This is the most common type of Ewing tumor. They develop most often in:
- The pelvis (hip bones)
- The chest wall (such as the ribs or shoulder blades)
- The legs, mainly in the middle of the long bones
Extraosseous Ewing tumor (EOE)
Extraosseous Ewing tumors start in soft tissues around bones, but they look and act very much like Ewing sarcomas in bones. They are also known as extra skeletal Ewing sarcomas.
Ewing sarcomas have unique gene changes that define them. The most common gene change is called an EWSR1-FLI1 fusion. There are slight differences among these tumors, but they're all treated the same way.
Other types of bone cancers
Several other types of cancers can start in the bones.
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These tumors can look like Ewing sarcoma under the microscope but have unique gene changes that make them different. These are:
BCOR gene changes
Tumors with BCOR gene changes are more common in males and most of them occur in children. Tumors with these gene changes are seen in the pelvis and long bones of the arms and legs.
CIC gene changes
Tumors with CIC gene changes are more common in males and young adults age 20 to 40. These tumors are more likely to grow in the soft tissues than the bones.
Other EWSR1 gene fusions
Tumors with non-Ewing EWSR1 gene fusions are more common in males and older adults. These tumors can have different characteristics depending on what specific gene change they have.
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Osteosarcoma (also called osteogenic sarcoma) is the most common primary bone cancer. It starts in an early form of bone cells. It most often occurs in young people between the ages of 10 and 30, but about 1 in 5 osteosarcomas develop in people older than 60. It's rare in middle-aged people and is more common in males than females. These tumors are often found in the bones of the arms, legs, or pelvis.
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Most of the other types of bone cancers are usually found in adults. These include:
- Chondrosarcoma (cancer that develops from cartilage)
- Undifferentiated pleomorphic sarcoma (UPS) of bone
- Fibrosarcoma of bone
- Malignant giant cell tumor of bone
- Chordoma
For more information on these cancers, see Bone Cancer in Adults.
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Many types of cancer that start in other parts of the body can spread to the bones. These are sometimes referred to as metastatic bone cancers, but they are not true bone cancers. For example, if a rhabdomyosarcoma?(a cancer that starts in muscle cells) spreads to the bones, it is still rhabdomyosarcoma and is treated like rhabdomyosarcoma. For more information, see Bone Metastases.
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- References
Developed by the P站视频 medical and editorial content team?with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Anderson ME, Dubois SG, Gebhart MC. Chapter 89: Sarcomas of bone. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Dehner CA, Lazar AJ, Chrisinger JSA. Updates on WHO classification for small round cell tumors: Ewing sarcoma vs. everything else. Hum Pathol. 2024;147:101-113.
Lessnick SL, Grohar PJ, DuBois SG, Hogendoorn PCW, et a. Chapter 27: Ewing Sarcoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Pediatric Oncology. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2021.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bone Cancer. v.1.2026 – September 11, 2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/bone.pdf on October 21, 2025.
Last Revised: January 12, 2026
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