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Ewing Sarcoma



Staging Investigations


Currently, there is no internationally recognized staging system for Ewing sarcoma (ES). 


A complete work-up for ES is outlined below:

Systemic evaluation

  • History


  • Physical examination


  • Blood tests (include LDH)


Evaluation of extent of primary tumor site

  • Physical examination


  • CT – define tumor extent and bone involvement


  • MRI – define soft tissue and bone marrow extent


  • Planned biopsy


Evaluation of metastatic disease

  • Chest CT


  • Bone scan


  • PET scan (if available)


  • Bone marrow aspirate


  • If a tumor is invading base of skull and is associated with intracranial extension (or there is extension into the spinal canal), MR scanning of the craniospinal axis and CSF cytology would be recommended to exclude leptomeningeal disease.




NB Important to consider strategies to protect fertility initially e.g. sperm banking prior to chemotherapy.


Blood work should include a baseline lactase dehydrogenase (LDH) level: 

  • An elevated LDH has adverse prognostic significance and suggests very bulky or metastatic disease. 




Bone Marrow Aspiration Biopsy

  • Essential to stage ES and exclude bone marrow metastases.


Imaging investigations


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