Usually you begin by seeing your GP, who will examine you and may arrange tests or x-rays. If Ewing's sarcoma is suspected, you should be referred to a specialist hospital or bone tumour centre for further investigations. Many of the specific tests for diagnosing bone tumours, such as bone biopsies, need to be done by an experienced team using specialist techniques.
The doctor at the hospital will ask you about your general health and any previous medical problems. They will examine you, which will include an examination of the painful bone to check for any swelling or tenderness. You will probably have a blood test to check your general health.
A variety of tests and investigations may be needed to diagnose Ewing's sarcoma. An x-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see.
A small piece of the tumour may be removed and looked at under a microscope (a biopsy). Other tests are done to check whether the cancer has spread elsewhere.
This involves the use of x rays to show the structure of the bone.
The doctor will take a sample of cells (a biopsy) to be examined by a pathologist (a doctor that specialises in cell types). If your doctor thinks you have bone cancer, the biopsy should be done at a specialist bone cancer centre.
A small sample of the tumour is taken from the affected bone using a needle. You will be given a local anaesthetic to numb the area. Sometimes a general anaesthetic is used.
Open or surgical biopsy
This type of biopsy is not often used, as the needle biopsy is much quicker and simpler. In an open biopsy, a small piece of bone is removed during a minor operation while you are under a general anaesthetic. It may be necessary if a needle biopsy can’t be done, or if it doesn’t give a clear diagnosis.
MRI (magnetic resonance imaging) scan
An MRI scan uses magnetism to build up a detailed picture of areas of your body. Before the scan, you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan. Before having the scan, you’ll be asked to remove any metal belongings, including jewellery.
During the test, you'll be asked to lie very still on a couch inside a long cylinder. The whole test may take up to an hour. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you will be given earplugs or headphones. You'll be able to hear, and speak to, the person operating the scanner.
CT (computerised tomography) scan
In some people with Ewing’s sarcoma, the cancer may spread to the lungs. A CT scan may be done to check for this. The scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes just a few minutes. CT scans use small amounts of radiation, which are very unlikely to harm you or anyone you come into contact with. You'll be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or an injection of dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
You will probably be able to go home as soon as the scan is over.
A bone scan is a more sensitive test than the bone x-ray, and shows up any abnormal areas of bone more clearly. A small amount of a mildly radioactive substance is injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as ‘hot spots’.
PET (positron emission tomography) scan
A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue, so they show up on the scan.
Sometimes a type of scan that combines a CT scan and a PET scan may be used (called PET-CT), as it can give more information about the position and size of a tumour.
Bone marrow sample
The bone marrow is the spongy material inside the bones where our blood cells are made. Ewing’s sarcomas can sometimes spread to the bone marrow.
When Ewing’s sarcoma has been diagnosed or is suspected, a small sample of bone marrow is taken from the hip bone (pelvis) and looked at under a microscope to see whether it contains any abnormal cells. The bone marrow sample may be taken under a local anaesthetic, but in younger children it is usually done under a general anaesthetic.
Waiting for test results can be an anxious time for you. It may help to talk about your worries with a relative or friend. You could also speak to one of our cancer support specialists.