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Ewing Family of Tumors


Note: The health professional version of this summary was extensively revised in July 2007. The patient version of this summary will reflect these changes shortly.

What is the Ewing family of tumors?

The Ewing family of tumors include: Ewing tumor of bone; extraosseous Ewing (tumor growing outside of the bone); primitive neuroectodermal tumor (PNET), also known as peripheral neuroepithelioma; and Askin’s tumor (PNET of the chest wall). These tumors are rare diseases in which cancer (malignant) cells are found in the bone and soft tissues. Ewing family of tumors most frequently occurs in teenagers.

If a patient has symptoms (such as pain, stiffness, or tenderness in the bone) the doctor may order x-rays and other tests. The doctor may also cut out a piece of tissue from the affected area. This is called a biopsy. The tissue will be looked at under a microscope to see if there are any cancer cells. This test may be done in the hospital.

The chance of recovery (prognosis) and choice of treatment depend on the location, size, and stage of the cancer (how far the cancer has spread), how the cancer cells react to the treatment, and the patient’s age and general health.

Stage Explanation

Stages of the Ewing family of tumors

Once one of the Ewing family of tumors has been found, more tests will be done to find out if cancercells have spread to other parts of the body. This is called staging. At present, there is no formal staging system for the Ewing family of tumors. Instead, most patients are grouped depending on whether cancer is found in only one part of the body (localized disease) or whether cancer has spread from one part of the body to another (metastatic disease). Extraosseous Ewing has been grouped using the rhabdomyosarcoma staging system because they are both soft tissuetumors. (Refer to the PDQ summary on Rhabdomyosarcoma Treatment for more information.) Your doctor needs to know where the cancer is located and how far the disease has spread to plan treatment. The following groups are used for the Ewing family of tumors.


The cancercells have not been shown to have spread beyond the bone in which the cancer began or are found only in the bone and nearby tissues.


The cancercells have spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lung, other bones, and bone marrow (the spongy tissue inside of the large bones of your body that makes red blood cells). Spread of cancer to the lymph nodes (small bean-shaped structures found throughout your body which produce and store infection-fighting cells) or the central nervous system (brain and spinal cord) is less common.


Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the tissues where it first started or it may come back in another part of the body.

Treatment Option Overview

How the Ewing family of tumors are treated

It is important for patients to be evaluated by several specialists as early as possible so that treatment may be coordinated effectively from the beginning. These specialists may include: a radiologist, chemotherapist, pathologist, surgeon, or orthopedic oncologist and a radiation oncologist. Before treatment decisions are made patients will probably be required to undergo several diagnostic tests including tissue sampling, x-rays, magnetic resonance imaging (MRI) scans, and computed tomography (CT) scans.

There are treatments for all patients with one of the Ewing family of tumors. Three kinds of treatment are used:

Surgery may be used in certain cases to try to remove the cancer and some of the tissue around it. Surgery may also be used to remove any tumor that is left after chemotherapy or radiation therapy.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for the Ewing family of tumors usually comes from a machine outside the body (external radiation therapy). Clinical trials are evaluating radiation given inside the body during surgery (intraoperative radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the blood stream, travels through the body, and can kill cancer cells throughout the body. When more than one drug is given to kill tumor cells, the treatment is called combination chemotherapy. Treatment for the Ewing family of tumors may include surgery or radiation to remove or shrink the tumor as much as possible, followed by chemotherapy to kill any cancer cells that remain in the body.

A supplement to the treatment options listed above is myeloablative therapy with stem cell support. Myeloablative therapy is a very intense regimen of chemotherapy designed to destroy all cells that divide rapidly. These cells include some blood cells and hair cells, as well as malignant (cancer) cells. Stem cells are self-renewing cells that create all of the other various types of blood cells. Stem cell support involves enriching the stem cells to increase the number of these important cells circulating in the blood after the chemotherapy has been given to kill the remaining tumor cells.

Treatment for the Ewing family of tumors depends on where the cancer is located, how far the cancer has spread, the stage of the disease, and the age and general health of the patient.

A patient may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials for the Ewing family of tumors are ongoing in many parts of the country. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Localized Tumors of the Ewing Family

Treatment for localizedtumors of the Ewing family may be one of the following:

  1. A clinical trial of chemotherapy followed by radiation therapy

  2. Combination chemotherapy followed by surgery with or without radiation therapy

  3. A clinical trial of intensified chemotherapy

  4. A randomized trial of post-surgical chemotherapy with or without stem cell transplant

Metastatic Tumors of the Ewing Family

Treatment for metastatictumors of the Ewing family may be one of the following:

  1. Combination chemotherapy followed by radiation therapy and/or surgery

  2. High-dose chemotherapy with or without radiation therapy plus additional stem cell support

Recurrent Tumors of the Ewing Family

Treatment depends on where the cancerrecurred, how the cancer was treated before, as well as individual patient factors. Chemotherapy may be used for patients who did not receive previous chemotherapy. Radiation treatment may be given to reduce symptoms. Surgery may be used to remove tumors that have spread to the lungs or other organs. Clinical trials are testing new treatments.

Changes to This Summary (08/06/2007)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary to match those made to the health professional version. Extensive content revisions to match those made to the health professional version will follow shortly.

To Learn More


For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.


The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.


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Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.