Ewing Sarcoma Diagnosis

A definitive diagnosis of Ewing sarcoma begins with a biopsy of the tumor. If possible, this first biopsy should be performed at the cancer center where you will receive treatment. Having the biopsy done by an experienced specialist ensures the tumor is sampled accurately and minimizes the risk of complications or spread.

At MD Anderson Cancer Center, our specialized pediatric and adult sarcoma teams—including surgeons, oncologists, radiologists, pathologists and genetic counselors—have extensive experience in pinpointing this type of cancer. Coordinated care by a multidisciplinary team ensures the most precise diagnosis and helps plan the most effective treatment.

Diagnostic tests

If you have symptoms that may indicate Ewing sarcoma, the doctor will perform a thorough examination and review your medical and family history. Several tests may be used to confirm the diagnosis, determine the tumor’s location and size, and see if the cancer has spread.

Biopsy
A biopsy removes a small sample of bone or soft tissue to confirm the presence of cancer cells. It is the only way to definitively diagnose Ewing sarcoma. The biopsy type depends on tumor location, size and other factors.

• Needle biopsy: A hollow needle is inserted through the skin to the tumor site, sometimes guided by CT scans. This method removes a small cylinder of tissue for microscopic examination. Local anesthesia or sedation may be used.
• Open or surgical biopsy: An incision is made and a small portion of the tumor is removed. Rarely, the entire tumor may be removed. General anesthesia is typically required and some recovery time is needed.

Whenever possible, the surgeon performing the biopsy should also perform the surgery to remove the tumor. Although the biopsy and the tumor removal are separate procedures, having the same surgeon helps with precise planning and can reduce the risk of surgical complications.

Imaging tests
Imaging helps determine the tumor’s exact location, size and whether it has spread. Tests may include:

• CT or CAT scans: Show detailed X-ray images to assess tumor location and nearby structures.
• MRI scans: Provide high-resolution images of soft tissue involvement and bone marrow.
• PET scans: Detect potential spread to other organs.
• X-rays: Show bone abnormalities or fractures.

Genetic testing
Most Ewing sarcomas are sporadic and not inherited. However, genetic testing is often performed on biopsy tissue to confirm the diagnosis and to distinguish Ewing sarcoma from other small round cell tumors.

Blood tests
Bloodwork helps evaluate overall health, organ function and readiness for treatment.

Ongoing monitoring

Diagnostic testing does not end after the initial diagnosis. Imaging and lab tests are often repeated during treatment to monitor tumor response and detect any changes early.

Second opinions

At MD Anderson, we welcome second opinions. Our sarcoma experts can review prior tests and provide recommendations to ensure you receive the most accurate diagnosis and most effective treatment. To request a second opinion at MD Anderson, call 1-855-520-3334 or request an appointment online.