Additional anamnesis

1. Is the past incident make the bone having any fracture?

2. Is his pain radiates?
3. What kind of treatment/medication that he received from the past?
4. Is there any family relatives that experienced same situation/cancer?
Further examination
Imaging Tests
First, a doctor uses imaging studies to create detailed pictures of the affected area. These include x-rays,
magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and bone scans.

This x-ray shows the knee of a 14-year old girl with Ewing's sarcoma. The tumor is toward the top of the
fibula and has destroyed a portion of the bone.
Reproduced from Domson G, Scarborough M, Gibbs CP: Malignant bone tumors in children. Orthopaedic
Knowledge Online 2007. Accessed September 2011.


Biopsy
To confirm that the tumor seen in imaging studies, your doctor will do a biopsy. This involves taking a
piece of tissue from the tumor and looking at it under a microscope. A biopsy is a simple procedure that
may be done in an operating room or x-ray department.
Staging
Once the tumor is identified, your doctor will conduct more tests to determine whether the cancer has
spread. This process is known as "staging." These additional tests may include:
Blood tests
CT scan of the lungs
Bone scan
Bone marrow biopsy
The part of the body where the first tumor develops is called the "primary" site. Any parts of the body
where it has spread are called "metastatic" sites.
By identifying the stage of the tumor, your doctor can determine the most effective treatment strategy.
Ewings sarcoma
Ewing sarcoma is a cancerous tumor that grows in bones or soft tissue near bones and usually
affects adolescents.
Named after Dr. James Ewing, the American pathologist who identified the cancer in the 1920s,
it can develop anywhere in the body, but most commonly affects the arms, legs, ribs, spinal
column, and pelvis.
Treatment for Ewing sarcoma involves a combination of chemotherapy, surgery,
and/or radiation. With early diagnosis and proper treatment, many kids who develop it have a
good chance of recovery.
Signs and Symptoms
Ewing sarcoma often goes unnoticed or misdiagnosed as growing pains (due to its subtle,
gradual onset) or a sports injury because symptoms often mimic those of injuries kids can get
out on the field.
Soreness at the tumor site, accompanied by swelling or warmth, is common. Pain may be worse
during exercise or at night, and a tender lump may develop in the affected area a few weeks
after pain begins. If the tumor grows in a leg bone, the child may have an unexplained limp. A
low-grade fever also can develop.
If cancer has spread, or metastasized, to other areas of the body like the lungs or bone marrow,
symptoms may appear there as well. In some cases, the first sign of the disease is a broken arm
or leg that occurs for no reason at all (or after a minor accident) because the cancer has
weakened the bone, making it vulnerable to a break.
A child who experiences any of these symptoms should see a doctor as soon as possible. Waiting
to seek treatment or assuming that symptoms will resolve on their own without treatment may
lead to a more advanced form of the disease at diagnosis.
Diagnosis
To diagnose Ewing sarcoma, a doctor will ask for your child's medical history, perform a physical
examination, and order X-rays, an MRI (magnetic resolution imaging), or bone scans to detect
abnormalities in bone structure. A tissue sample of the tumor (biopsy), which is later analyzed in a lab,
must be performed in order for a diagnosis to be made.
Sometimes the doctor orders a needle biopsy, using a long hollow needle to take a sample of the tumor.
Alternatively, the doctor may order an open biopsy, in which a portion of the tumor is removed. These
are performed in the operating room by a surgeon while a child is under general anesthesia.
If a diagnosis of Ewing sarcoma is made, the doctor will order additional imaging tests to determine if
the cancer has spread to any other part of the body. Other exams will make sure that vital organs, such
as the heart and kidneys, are functioning normally and able to tolerate treatment.
Once treatment begins, doctors monitor the patient and order additional imaging tests to determine
how well it is working and whether the cancer continues to spread.
Chemotherapy/Radiation
The course of treatment for Ewing sarcoma depends on many factors, including the size and location of
the tumor and whether the disease has metastasized.
Regardless of a tumor's characteristics, every patient with Ewing sarcoma undergoes chemotherapy
initially to shrink the tumor (before surgical removal or radiation) and prevent the spread of cancer cells
to other parts of the body. Chemotherapy is also given after a tumor is removed to help ensure that
cancer cells do not come back.
A typical course of chemotherapy lasts 6 to 9 months. Children are required to stay in the hospital for a
few days during treatment, which occurs every 2 to 3 weeks. Some kids may need to be hospitalized
between treatments for complications or side effects, like fever or infection. Chemotherapy drugs are
delivered intravenously (through a vein).
If surgery is needed, radiation may be given to shrink the tumor before surgical removal. Radiation also
may be recommended in place of surgery if the tumor's location would make surgery too dangerous or
difficult. During radiation, high-energy X-rays are directed at the tumor site to kill cancer cells and keep
them from growing and multiplying.
Most kids who undergo radiation don't need to stay at the hospital overnight; they usually visit the
hospital 5 days a week for several weeks.
Surgical Removal
After a course of chemotherapy, and possibly radiation, most tumors are removed surgically. Tissue that
is removed during the procedure may need to be replaced with a live tissue graft (from the patient's
own body), donor tissue (usually from a bone bank), or artificial tissue (made from metal or other
synthetic material).
If a tumor has attached itself to nerves and blood vessels, amputation (removing part of a limb along
with the tumor) might be the only choice. The amputated limb will be replaced with an artificial limb,
usually made from metal.
Side Effects
Amputation carries its own short- and long-term side effects. It usually takes at least several months
until a young person learns to use a prosthetic leg or arm. Learning to cope with the psychological and
social aspects takes longer, but many children find they can resume favored activities in the long run.
With a tissue graft (donor or otherwise), one usually starts moving the affected body part almost
immediately. Physical therapy and rehabilitation for 6 to 12 months after surgery usually helps a child
recovering from Ewing sarcoma of the leg to walk, initially with a walker or crutches, and then without
assistive devices.
Early complications after surgery include infection and slow healing of the surgical wound, and the metal
prosthetic device or the bank bone might need to be replaced in the long term. Other late problems
might include fracture of the bank bone or failure of the bank bone to heal to the child's bone, which
might require more surgery. Some kids will be limited in the types of sports they can play due to the risk
of breakage.
Many chemotherapy medications also carry the risk of both short- and long-term problems. Short-term
effects include anemia, abnormal bleeding, and increased risk of infection due to destruction of the
bone marrow, as well as kidney, liver, or heart damage. Some drugs carry a risk of bladder inflammation
and bleeding into the urine. Years after chemotherapy for Ewing sarcoma, patients have an increased
risk of developing other cancers and may have difficulties with fertility.
Prognosis
A child with Ewing sarcoma who is diagnosed early on and does not have metastatic disease has up to a
70% chance of being cured of the cancer.
When the disease has spread, successful treatment is much more difficult. However, with the potent
combination of treatments currently available and powerful new therapies on the horizon the
outlook for kids with advanced disease is improving.