How Does My Doctor Know I Hav... Health Article

You should report any symptoms of Ewing’s sarcoma to your doctor. Symptoms may be caused by cancer or by other, less serious problems. To find out what is causing your symptoms, your doctor will ask you about these things.

• Your health history

• Your family’s history of cancer

• Your lump, if you have one

• Your pain, if you have any

Your doctor will also give you a careful physical exam. If you have a lump, the doctor will look at its size and shape of the lump and the effect it has had on surrounding areas. The doctor may also schedule one or more of these tests.

X-rays.  Doctors can identify most Ewing’s tumors with an X-ray. An X-ray uses very low doses of radioactive rays to see through your skin. It imprints an image of the inside of your body onto a piece of film. Sometimes doctors skip the X-rays and go right to the computed tomography scan (CT scan).

Computed tomography scan (CT scan). A CT scan can help your doctor identify more clearly a Ewing’s tumor. A CT scanner takes X-rays of your body from different angles as you slide through it on a table. A computer combines these pictures to produce a more complete picture of the inside of your body.

Magnetic Resonance Imaging (MRI).  An MRI can more clearly define abnormalities to see if they are really a Ewing’s tumor. During an MRI, large magnets and radio waves produce detailed pictures of the inside of your body. The energy from the radio waves creates patterns formed by different types of tissue and diseases. This produces cross-sectional pictures that look like slices of your body. Your doctor may order an MRI of a certain area of bone if you are having a lot of pain at a certain spot. These pictures will also help a him or her see what part of a lump to take out in a biopsy.

For this test, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of radio waves at the area being examined. A computer uses data from the radio waves to create pictures of the inside of your body. You may need more than one set of images.

Radionuclide scanning, also called scintigraphy or bone scan. For this test, a nurse or technician injects you with radioactive dye. Then he or she takes pictures or X-rays of your bones about 2 hours later. The picture shows areas of cells where the dye is concentrated. Concentrations can mean that there is something abnormal. It does not necessarily mean there is a tumor. Other things, such as arthritis or bone fractures, can also make a bone scan abnormal. Your doctor may also use this test to find out if a bone tumor has spread to other bones or if a soft tissue tumor has spread to bone.

These tests can help show where the tumor is and whether it has spread. They may give enough information for a doctor to tell the cause of the problem, or you may need further testing. 

When You May Need More Tests

In some cases, the doctor will remove a sample of tissue from your tumor. This is called a biopsy. A doctor who specializes in identifying disease, called a pathologist, will look at the sample under a microscope to check for cancer.

Your doctor may send you to a surgeon or another doctor for a biopsy. Although a physical exam and the pictures of the growth may suggest that a tumor is cancerous, a biopsy is the only way to be certain. The biopsy tells the doctor what, if any, type of tumor you have. Your doctor might perform one of these 3 different types of biopsy.

Excisional biopsy. If your tumor is small, a surgeon can cut through your skin and take out the whole tumor. You will be given anesthesia to put you to sleep during the procedure.

Incisional biopsy. If your tumor is large, the surgeon removes only a small part of the tumor. If the tumor is close to your skin’s surface, the surgeon may numb the area. If the tumor is deep inside your body, you will be given anesthesia to put you to sleep.

Needle biopsy. The doctor inserts a thin needle through your skin to remove tiny bits of tissue from the tumor. This type of biopsy does not require surgery, and you are awake during this test. The doctor may use a CT scan to guide the needle. Sometimes, this test does not remove enough tissue to know whether the lump is a sarcoma, but it can tell whether it is something else, such as an infection.