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Ewing Sarcoma

Also called: Askin tumor, Ewing’s sarcoma, peripheral primitive neuroectodermal tumor, pPNET

What is Ewing sarcoma?

Ewing sarcoma is a cancerous tumor that grows in the bones or in the tissue around bones (soft tissue)—often the legs, pelvis, ribs, arms or spine. Ewing sarcoma can spread to the lungs, bones and bone marrow.

How common is Ewing sarcoma?

Ewing sarcoma is the second most common type of bone cancer in children, but it is very rare. About 200 children and young adults are found to have Ewing sarcoma each year in the United States.

  • About half of all Ewing sarcoma tumors occur in children and young adults between ages 10 and 20.
  • This type of cancer is rarely found in African-Americans and Asian-Americans.
  • It affects slightly more boys than girls.
  • It does not appear to be inherited (passed down in families).
  • Although not often seen, Ewing sarcoma can occur as a second cancer, especially in patients treated with radiation therapy.

What are the symptoms of Ewing sarcoma?

If your child has Ewing sarcoma, the following symptoms may be present:

  • Swelling and soreness around the tumor area (commonly mistaken for a sports injury or the “bumps and bruises” every child gets)
  • A low fever that at first may seem to be caused by an infection
  • Bone pain, especially pain that worsens during exercise or at night
  • Limping, which is caused by a tumor on a leg bone

How is Ewing sarcoma treated?

  • Chemotherapy (“chemo”)—is usually the first step in treating Ewing sarcoma. It uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
    • Chemo may be injected into the bloodstream, so that it can travel throughout the body.
    • Combination therapy uses more than one type of chemo at a time.
  • Surgery—may be done after several weeks or months of chemo have reduced the cancer to the point where surgery can be most effective.
    • Surgeons remove as much of the tumor as possible.
    • Sometimes the surgeons will graft (add on) bone or tissue (from either the patient or a donor) to replace diseased bone and tissue that have been removed. An artificial bone, called an implant, may also be used.
    • For some patients, amputation (surgical removal of an arm or leg) is required to ensure that the tumor is completely removed.
  • Radiation therapy—is used to kill or decrease cancer cells that cannot be removed surgically. This is followed by more chemo to kill any remaining cells. Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing:
    • External radiation uses machines outside the body to deliver the X-ray dose.
    • Internal radiation uses needles, seeds, wires or catheters (tubes) to deliver the radiation directly into or close to the cancer.

What are the survival rates for Ewing sarcoma?

  • About 70 percent of children with Ewing sarcoma are cured.
  • Teens aged 15 to 19 have a lower survival rate of about 56 percent.
  • For children diagnosed after their disease has spread, the survival rate is less than 30 percent.
  • Children whose tumors are larger or located in the pelvis, ribs or spine are less likely to be cured.

Why choose St. Jude for your child’s Ewing sarcoma treatment?

  • St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • St. Jude has a new clinical trial for patients with Ewing sarcoma that investigates new drug combinations at the beginning and end of therapy to improve survival.
  • New radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton beam radiation therapy may be used to decrease the side effects of treatment.
  • St. Jude has a specialized team of experts who perform limb-salvage procedures (surgery) in children with bone tumors such as Ewing sarcoma.
  • New imaging techniques allow St. Jude to better define the effects of treatment in children with Ewing sarcoma. These techniques include contrast-enhanced ultrasound and diffuse weighted imaging MRI.
  • Working with European researchers, St. Jude scientists have sequenced and are analyzing the genetic features of more than 100 children with Ewing sarcoma to find possible new targets for treating the disease.

Associated Clinical Trials

ONITT: Study of Onivyde with Talazoparib or Temozolomide in Children and Young Adults with Recurrent/Refractory Solid Tumors and Ewing Sarcoma

Phase 1/2 Study of Onivyde in combination with Talazoparib or Temozolomide in Children and Young Adults with Recurrent/Refractory Solid Tumors and Ewing Sarcoma

Diseases Treated:

Solid tumors
Ewing sarcoma


  • Ages 12 months old to 30 years
  • Diagnosed with recurrent or refractory solid tumor (Phase 1)
  • Diagnosed with recurrent or refractory Ewing sarcoma (Phase 2)
View Trial

PAINBDY1: Treating Pain in Children with Cancer: Pain Buddy

Treating Pain in Children with Cancer: A 21st Century Innovative Approach (Pain Buddy)

Diseases Treated:

Endocrine Tumors
Ewing Sarcoma


This is a research study open only to St. Jude patients and their caregivers.

  • 8 to 18 years old
  • Within 16 weeks of initial cancer diagnosis
  • Receiving outpatient chemotherapy treatment for cancer
  • Can speak, read and write English. Parents who can speak, read, and write in English and Spanish
  • Have Internet access
View Trial

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