Ewing Sarcoma vs Osteosarcoma: Key Differences Explained

16 June 2024

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Osteosarcoma and Ewing sarcoma are both kinds of bone cancer. They mostly affect kids and young adults. They begin in bone tissue but show different signs, need different treatments, and grow in different places.¹ It’s key to know how osteosarcoma and Ewing sarcoma differ. This knowledge helps doctors treat them better. Let’s look at these cancers’ unique features such as when they appear, where they grow, and how we treat them.

More people get osteosarcoma than Ewing sarcoma. It mainly hits those aged 10-30 and over 60.¹ Ewing sarcoma strikes more kids and teens, especially between 10 and 15.¹ Survival chances vary. For osteosarcoma, they range from 24% to 76%. For Ewing sarcoma, over 70% survive.¹

Survival in Ewing sarcoma can go up if it has not spread much, if chemo works well, if the tumor’s in arms or legs, and if it’s totally taken out.¹ Both types can spread elsewhere, causing more problems.¹ Doctors use imaging, blood tests, and taking tiny samples to detect these cancers. Sometimes they need genetic tests or in-depth analysis to tell them apart.¹

Key Takeaways

Osteosarcoma is more common than Ewing sarcoma, but both largely affect young people.
Osteosarcoma hits those aged 10-30 and over 60, while Ewing sarcoma targets children and teens.
The 5-year survival rates for both cancers depend on how advanced they are. Early treatment is key for better results.
Getting the right diagnosis involves imaging, sampling, and sometimes genetic tests. This guides the best treatment.
Research is ongoing to find better ways to fight these cancers, like targeted therapies and immunotherapy.

Overview: Bone Cancers Affecting Children and Young Adults

Osteosarcoma and Ewing sarcoma are two common bone cancers. They mostly affect children, teens, and young adults. Osteosarcoma is found more often, making up about 2% of childhood cancers. Ewing sarcoma accounts for about 1% of childhood cancers.²

Osteosarcoma and Ewing Sarcoma Characteristics

These two cancers are rare. Ewing sarcoma often affects those between 10 and 20 years. Osteosarcoma is seen more in those between 10 and 30 years old. It’s less common in adults, but adults over 60 can face higher osteosarcoma risks again.²

Bone Cancer Rarity and Age Groups Affected

Ewing sarcoma targets those aged 10 to 20 mostly, while osteosarcoma occurs more in age groups 10 to 30. Both are relatively rare in adults.²

Characteristic	Osteosarcoma	Ewing Sarcoma
Incidence among Childhood Cancers	2%²	1%²
Age of Onset	10-30 years, with increased risk over age 60²	10-20 years²
Long-term Disease-free Survival	Approximately 60%³	Approximately 60%³

Tumor Location: Distinguishing Osteosarcoma from Ewing Sarcoma

Osteosarcoma tumors mainly grow near the edges of long bones. They are often found in the knee and upper arm bones.⁴ You may also find them in the pelvis, shoulder, and skull.⁴

Osteosarcoma: Long Bones of Arms and Legs

This cancer usually affects young people. It starts in the middle part of the long bones.⁴ The places you see it often are the femur, tibia, and humerus.⁴

Ewing Sarcoma: Pelvis, Ribs, Spine, and Long Bones

Ewing sarcoma is known for its round blue cells in the bones. Any bone can get it, but it’s more common in the pelvis, thighs, ribs, and upper arms.⁴

Extraosseous Ewing Sarcoma: Rare Form in Muscles and Soft Tissues

Sometimes, Ewing sarcoma shows up outside the bones. It starts in muscles and soft tissues instead.⁴

ewing sarcoma vs osteosarcoma: Age of Onset

Osteosarcoma usually starts between ages 10 and 30, and again after 60.¹ Ewing sarcoma happens mostly in kids and teens, with the most cases from 10 to 15 years old.¹

Osteosarcoma: Typical Age Range of 10-30 Years and Over 60 Years

Osteosarcoma mostly affects those from 10 to 30 years old or over 60.¹ It’s the top bone cancer type,¹ especially in these age ranges.

Ewing Sarcoma: More Common in Children and Adolescents, Peak at 10-15 Years

Ewing sarcoma is common in kids and teens, peaking from 10 to 15 years old.¹ It’s not as common as osteosarcoma.¹

Symptoms: Overlapping and Distinct Manifestations

Osteosarcoma and Ewing sarcoma both show bone pain and swelling near the tumor.⁵

Shared Symptoms: Bone Pain and Swelling

Both types can lead to pain and swelling in the bone. These are early signs that tell us to seek medical help.⁵

Osteosarcoma-Specific Symptoms: Intermittent Pain, Swelling, Tenderness, Lump

Osteosarcoma mainly brings on and off pain that gets worse. It also causes a swollen, sore area and a noticeable lump.⁵

If the tumor is near the pelvis or leg, you might see signs like broken bones, less movement, or a slight limp.

Ewing Sarcoma-Specific Symptoms: Weakness, Numbness, Fever, Weight Loss, Anemia

Ewing sarcoma shows various symptoms. These include pain, swelling, and weakness near the tumor. You may also feel numb, have a fever, lack energy, lose weight, and have low red blood cells.⁶

Diagnostic Approaches: Imaging and Biopsy

To diagnose osteosarcoma and Ewing sarcoma, doctors use imaging tests like X-rays, CT scans, and MRI scans. They also do a biopsy, taking a small sample of the bone or tissue.⁴ These methods help figure out where the tumor is and what it’s like. This is key for telling the two kinds of cancer apart.

X-rays, CT Scans, and MRI Scans

X-rays, CT scans, and MRI scans are common for finding Ewing sarcoma and osteosarcoma.⁴ They show the tumor’s size, where it is, and how it’s growing. Knowing this helps plan the right treatment.

Biopsy and Genetic Testing

Sometimes, a biopsy alone isn’t enough. Doctors might do genetic testing on the tumor. This helps them be sure which cancer it is.⁴ Getting the diagnosis right is critical. It means the treatment plan will be more effective.

Importance of Proper Diagnosis for Treatment Planning

Getting the right diagnosis is crucial for treating osteosarcoma or Ewing sarcoma.¹ Each cancer needs a special treatment. Some details, like where the tumor is and the patient’s age, matter a lot in deciding what treatment to use.

Treatment Strategies: Surgery, Chemotherapy, and Radiation Therapy

Osteosarcoma is often treated first with surgery to cut out the tumor. The aim is to save the limb, if it can be saved.⁷ Chemotherapy is crucial. It aims to get rid of any cancer cells left after surgery.

Osteosarcoma: Surgery and Chemotherapy

Surgery is the main step in treating osteosarcoma. It’s often used along with chemotherapy. The surgery tries to take out the whole tumor but save the affected limb, if possible.⁷ Before or after surgery, patients might get chemotherapy. This helps kill off any other cancer cells.

Ewing Sarcoma: Chemotherapy, Surgery, and Radiation Therapy

Chemotherapy usually starts the treatment for Ewing sarcoma. Then, surgery and/or radiation might follow. The goal is to get rid of or target the tumor.⁷ The plan depends on cancer stage and how the patient responds to the first treatments.

For Ewing sarcoma, chemotherapy is key and comes before surgery or radiation.⁸ If surgery happens, it’s to cut out the main tumor. Radiation might target any cells left or parts hard to reach surgically.⁷ This whole process is designed for each patient, focusing on their needs and the cancer‘s specific features.

Survival Rates and Prognostic Factors

The chance of recovery for people with osteosarcoma varies. It depends on when the cancer is caught. The American Cancer Society says that 76% of those with a local disease survive five years. For those whose cancer has spread nearby, it’s a bit lower at 64%. Sadly, only 24% of people with the disease that has spread far survive five years. Overall, the five-year survival rate stands at 59%⁹.

Looking at Ewing sarcoma, more than 70% of patients survive five years. This number can change based on age, overall health, and how well the tumor responds to treatment. For Ewing sarcoma that is just in one spot, the rate jumps to 82%. If it’s spread nearby or far, these numbers drop to 71% and 39% after five years¹⁰.

Factors Affecting Prognosis: Age, Overall Health, Tumor Response

The cancer’s stage isn’t the only thing that matters when predicting outcomes. A person’s age, health, and how their tumor reacts to treatment are crucial too. Catching the cancer early and getting a good response to treatment means a better chance of beating it⁹¹⁰.

Follow-up Care and Monitoring for Recurrence

After treating osteosarcoma or Ewing sarcoma, follow-up care is key. The first few years post-treatment have the highest risk of tumor return.¹¹ Regular check-ups and tests are vital to catch any signs early. This helps achieve the best long-term results.

In 2005, the European Journal of Surgical Oncology studied surveillance in extremity sarcoma patients. A 2017 Bone & Joint Research article focused on the same for extremity sarcoma patients.¹¹ It mentioned facts and figures for conventional central chondrosarcoma from a 2015 Sarcoma article.¹¹

A 2019 study in the International Journal of Clinical Oncology looked at long-term outcomes of pulmonary metastasectomy for sarcoma.¹¹ Meanwhile, in 2009, the Journal of Thoracic and Cardiovascular Surgery featured a Scandinavian study. It looked at 106 patients with chest wall chondrosarcoma.¹¹

Regular check-ups and monitoring are key to ensuring positive long-term outcomes for those treated for osteosarcoma or Ewing sarcoma.

Ongoing Research and Emerging Therapies

Researchers look for new ways to treat osteosarcoma and Ewing sarcoma. They study special treatments like targeted therapies and immunotherapy. These new treatments are hoped to help patients with hard-to-treat or recurring cancer, using what we know about the cancers on a genetic level.¹²

Targeted Therapies and Immunotherapy Approaches

New treatments being looked into include targeted small molecules and immune therapy. These methods look very promising for improving how well treatments work and the outcomes for patients.¹²

Clinical Trials and Advancements in Treatment

Clinical trials test these new therapies. This includes using immunotherapy, like nivolumab, for cancers that have spread. These studies hope to bring about better chances of survival and a higher quality of life for patients as we learn more.¹²¹³

Looking into the genetics of Ewing sarcoma has given us helpful clues. Through genetic testing, we found that osteosarcoma has some similarities to BRCA gene problems. These findings can help us create better targeted treatments.¹³ There’s also a focus on certain types of molecules in these cancers that might lead to new treatments.¹³

One area of exciting research is using CAR T cells to go after B7-H3 in tumors. These special cells have shown some success against baby and young adult sarcomas.¹³ Also, studying how cancer immunotherapy works in pediatric sarcomas is promising for the future. It could open up new treatment options.¹³

Importance of Early Detection and Multidisciplinary Care

It’s key to catch osteosarcoma and Ewing sarcoma early for better treatment and survival chances. Osteosarcoma is the top bone cancer in kids and teens, with a rate of 5 to 7 per million in those 19 or younger.¹⁴ Slow diagnosis for osteosarcoma can really harm a patient’s outcome.¹⁴

A team of cancer experts, including doctors, surgeons, and others, is vital for top-notch care. This team effort is critical for the best possible result for patients with these bone cancers. For finding rare cancers like radiation-induced sarcomas, this group is indispensable.¹⁵ Detecting and treating these cancers early on is crucial for better health and survival rates.¹⁵

This group effort helps make sure patients get the right diagnosis and care. They tailor treatments for each patient and work together to meet all their needs.¹⁵ Working as a team really betters the odds for those with osteosarcoma and Ewing sarcoma.

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