+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma



Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma



Journal of Bone and Joint Surgery. American Volume 82(5): 667-674



The time between the initial symptoms of osteosarcoma and Ewing sarcoma and the correct diagnosis and treatment is long. Over the last two decades, the prognosis for patients with these diseases has dramatically improved due to a new chemotherapy regimen. As a consequence, a limb-sparing operation has become an alternative to amputation. The aim of this study was to establish the initial symptoms and physical signs of osteosarcoma and Ewing sarcoma from the records of the first medical visit and to identify early characteristics of the diseases to shorten the delay to diagnosis. A group of patients with osteosarcoma or Ewing sarcoma was identified from the Swedish Cancer Register of patients thirty years old and younger. Records from the first medical visit due to symptoms related to the bone tumor were obtained for 102 patients with osteosarcoma and forty-seven patients with Ewing sarcoma. Pain related to strain was reported by eighty-seven (85 percent) of the patients with osteosarcoma and thirty (64 percent) of those with Ewing sarcoma, but only twenty-one (21 percent) of the patients with osteosarcoma and nine (19 percent) of those with Ewing sarcoma reported pain at night. Forty-eight (47 percent) of the patients with osteosarcoma and twelve (26 percent) of those with Ewing sarcoma related the onset of symptoms to minor trauma occurring around the same time. A palpable mass was noted in forty (39 percent) of the patients with osteosarcoma and sixteen (34 percent) of those with Ewing sarcoma at the first visit, and in most cases the tumor diagnosis was suspected. There was a broad spectrum of misdiagnoses; the most common was tendinitis, which was the initial diagnosis in thirty-two (31 percent) of the patients with osteosarcoma and ten (21 percent) of those with Ewing sarcoma. The doctor's delay (the period from the first medical visit due to the symptoms to the correct diagnosis) was longer for Ewing sarcoma than for osteosarcoma (nineteen weeks and nine weeks, respectively; p < 0.0001). An initial symptom of both osteosarcoma and Ewing sarcoma was pain, which was intermittent and often related to strain but not frequently felt at night. A history of trauma was common, but the clinical course often diverged from what was expected from trauma. The clinical course of osteosarcoma and particularly of Ewing sarcoma was not steadily progressive but intermittent, which often misled the doctor into believing that the condition was temporary. The most important clinical feature was a palpable mass, which was noted in more than one-third of the patients at the first visit. This finding emphasizes that a thorough physical examination is absolutely necessary.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 046416422

Download citation: RISBibTeXText

PMID: 10819277


Related references

Ewing sarcoma of the rib--initial symptoms and clinical features: tumor missed at the first visit in 21 of 26 patients. Acta Orthopaedica 78(6): 840-844, 2008

Ewing sarcoma of the ribinitial symptoms and clinical features: Tumor missed at the first visit in 21 of 26 patients. Yearbook of Diagnostic Radiology 2009: 140-142, 2009

Presenting symptoms and treatment delay in osteosarcoma and Ewing's sarcoma. Acta Radiologica. Oncology 23(2-3): 159-162, 1984

Comparative analysis between osteosarcoma and Ewing's sarcoma: evaluation of the time from onset of signs and symptoms until diagnosis. Clinics 61(2): 99-106, 2006

The role of basic research in clinical treatment of Ewing's sarcoma and osteosarcoma. La Chirurgia Degli Organi di Movimento 88(2): 201-209, 2004

Prognostic features of Ewing's sarcoma on radionuclide bone scan after initial treatment. European Journal of Radiology 19(1): 1-6, 1994

Prognostic features of Ewing's sarcoma on plain radiograph and computed tomography scan after initial treatment. Cancer 74(3): 988-989, 1994

A phase II study of clinical activity of SCH 717454 (robatumumab) in patients with relapsed osteosarcoma and Ewing sarcoma. Pediatric Blood and Cancer 63(10): 1761-1770, 2017

Incidence of osteosarcoma, chondrosarcoma and Ewing's sarcoma in east Denmark: Reverse male to female ratio in osteosarcoma. European Journal of Orthopaedic Surgery & Traumatology 8(3): 147-148, 1998

Soft-tissue Ewing sarcoma in a low-incidence population: comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Japanese Journal of Clinical Oncology 40(11): 1060-1067, 2010

Clinical and X-ray features of Ewing sarcoma of the fibula. Zh Eksp Klin Med 6(1): 47-56, 1966

Preclinical analysis of tasidotin HCl in Ewing's sarcoma, rhabdomyosarcoma, synovial sarcoma, and osteosarcoma. Clinical Cancer Research 13(18 Pt 1): 5446-5454, 2007

Demographic Analysis of Patients with Osteosarcoma, Chonddrosarcoma, Ewing's Sarcoma from one Sarcoma Center in Switzerland. Praxis 104(13): 673-680, 2015

Proton radiotherapy for pediatric Ewing's sarcoma: initial clinical outcomes. International Journal of Radiation Oncology, Biology, Physics 82(3): 1142-1148, 2012

Neoadjuvant chemotherapy of sarcoma. The experiences of the German Society for Pediatric Oncology studies on osteosarcoma, Ewing's sarcoma and rhabdomyosarcoma. Deutsche Medizinische Wochenschrift 112(36): 1385-1390, 1987