Treatment of Ewing Sarcoma in Germany

As a type of bone cancer, Ewing sarcoma is more common in children than in adults. It accounts for up to 15% of all malignant neoplasms in childhood. The tumor is prone to early metastasizing. Metastases are found in 30% of patients at the time of confirming the diagnosis. However, radical bone cancer treatment in Germany is carried out even at the advanced stages.

Content

1. The process of Ewing sarcoma development
2. Risk factors
3. Where Ewing sarcoma is often found?
4. Symptoms
5. Diagnostics of Ewing sarcoma
6. Stages
7. Treatment of Ewing sarcoma
8. How recurrent Ewing sarcomas are treated?
9. Rehabilitation period
10. Why treat Ewing sarcoma in Germany?
11. Hospitals for Ewing sarcoma treatment in Germany
12. The cost of Ewing sarcoma treatment in Germany
13. Cancer treatment in Germany with Booking Health

The process of Ewing sarcoma development

Ewing sarcoma is characterized by an extremely aggressive clinical course and early metastasizing. The time period from the onset of the oncological process to the manifestation of the disease is from 5 to 7 months. Because of this, almost half of patients already have metastases at the time of diagnosis making, and many of them have metastases to different organs already before a diagnosis is made.

Risk factors

There is no reliably confirmed medical data on factors affecting the formation of Ewing sarcoma. In some patients, a correlation of cancer with bone injury or post-traumatic changes in the bone tissue is established.

Some experts say that tumor development is based on a hereditary predisposition, including various types of gene mutations. However, in the overwhelming majority of patients, there is no connection with predisposing factors.

Where Ewing sarcoma is often found?

Generally, Ewing sarcoma can appear in any bone. Various bones can be involved in the oncological process. However, common areas of tumor localization include the tibia, bones of the pelvis, shoulder blades, vertebrae, and rib bones.

Unlike other types of tumors of the skeletal system, Ewing sarcoma affects flat bones in the vast majority of cases.

Symptoms

The most universal symptom Ewing sarcoma patients experience is pain and swelling in the area of the tumor growth.

Pains appear spontaneously, usually when patients are physically active. These pains often do not completely go away even at rest. The more the tumor grows, the more the swelling becomes visible. If the swelling is not visible yet, it can already be felt. Sometimes the area of tumor growth may become reddish, and that part of the body stops functioning normally. It is not uncommon for doctors to initially mistake these symptoms for bone inflammation, or a physical injury.

Since Ewing sarcomas can grow in almost any bone and soft tissue, symptoms can be different in different patients. For example, if a tumor grows in the area of the spine or peripheral nerves, patients may first develop such abnormalities as loss of motor ability (paralysis). If a tumor grows in the pelvic bones, or in the chest area, or in the thigh bones, there are no distinct signs of Ewing sarcoma and it can remain undetected for a long time.

It usually takes about 6 months before patients see the doctor. By this time, the pain becomes intense, and the functioning of the affected area is impaired. Half of the patients already have metastases, which is associated with an active malignant process or probable long-term self-medication.

The formation itself can be felt already at the advanced stages.

Diagnostics of Ewing sarcoma

The following diagnostic procedures are used to make an accurate diagnosis and to identify the level of spreading of the oncological process:

• Physical examination
• X-ray examination, angiography
• Ultrasound scan of various systems and organs
• Computed tomography scan of the primary malignant focus
• Histological examination of the tissue sample
• Blood tests
• Consultations of related specialists (if necessary)

To find metastases, X-rays and computed tomography of the lungs, as well as bone scintigraphy are performed. In some cases, positron emission tomography (PET) scans are also required. Additional studies and tests can be necessary depending on each specific case of the disease and the choice of treatment tactics.

Stages

Basically, both Ewing sarcoma and tumors of the same group are poorly differentiated or completely undifferentiated formations with high malignancy. There are four stages of their development.

1. The first stage includes neoplasm less than 8 centimeters in size
2. At the second stage, the tumor is more than 8 centimeters in size
3. At the third stage, several tumor focuses are formed

Only at the advanced stage metastasizing to distant organs occurs. Ewing sarcoma rarely spreads to the lymphatic system; more often it spreads to the lungs.

The progression between stages takes little time, sometimes it takes only few months.

Treatment of Ewing sarcoma

Patients with Ewing sarcoma are treated with surgery and radiation therapy, chemotherapy, and bone marrow transplantation or with combination of these therapeutic techniques.

Experts say that chemotherapy courses are performed because Ewing sarcoma has high risks of metastasizing. Previously, when patients were only operated on or irradiated, almost all of them developed metastases. Therefore, a systemic treatment that would affect the entire body is needed in the case of Ewing sarcoma. Typically, local therapy is performed between two chemotherapy sessions.

Ewing sarcoma treatment scheme depends on the risk group the patient belongs to. There are three groups of patients:

• People with no metastases and a tumor that can be removed
• People with metastases in the lungs or in the axial skeleton
• People with no possibility of tumor removal; bone marrow is involved in the malignant process

Therapy for all patients begins with several courses of polychemotherapy. For cancer with metastases that does not respond to drug therapy well, radiotherapy is given. Ewing sarcomas usually respond to radiotherapy well.

In the patients from the first and second groups surgery is carried out after the chemotherapy course. Only if complete removal is impossible, partial excision is performed. If the resection is partial, then the radiation therapy is performed after it. For inoperable patients, several more cycles of chemotherapy are recommended. If the bone marrow is appeared to be affected by cancer, an aggressive course of chemotherapy is prescribed. Extensive dosage of drugs is administered, radiotherapy and subsequent bone marrow transplant are performed.

How recurrent Ewing sarcomas are treated?

Although the methods of treatment for Ewing sarcoma have become better and the overall treatment success is higher, recurrence is observed in 40% of patients.

There is no standard therapy for recurrent Ewing sarcoma in medicine yet. Depending on the specific case, recurrent cancer can be treated with courses of chemotherapy with several drugs, radiation therapy, surgery, or a combination of the mentioned treatment methods.

If the treatment results show that it is impossible to eliminate the disease completely, then the preservation of the high quality of life comes to the fore. Doctors administer pain-relieving therapy and support body functions (palliative therapy). Research protocols are working on how to improve the chances of recovery for these patients.

Rehabilitation period

In more than half of cases of Ewing sarcoma it’s possible to achieve permanent remission and overcome the survival threshold. For patients with progressive forms of Ewing sarcoma chances of recovery are lower, but in comparison with other malignant processes they are considered pretty good.

Thanks to the use of chemotherapy along with radiotherapy and bone marrow transplant, treatment outcomes and patient survival increase significantly, notwithstanding the advanced stages of cancer.

Why treat Ewing sarcoma in Germany?

Ewing sarcoma is a severe medical condition that is better to treat abroad. Here are several reasons why it is worth going to Germany for the treatment of Ewing sarcoma:

• In Germany, preference is given to operations with limb preservation. Amputation is used only in exceptional cases.
• Medical procedures are carried out by the best German specialists. Therefore, the rehabilitation process after treatment is easier.
• The latest methods of performing the therapeutic procedures are available in Germany.
• It is possible to remove the tumor and metastatic sites simultaneously in order to try to cure the disease even at the advanced stage.
• To replace the removed bones, the latest types of endoprostheses are used.

Hospitals for Ewing sarcoma treatment in Germany

If you need to undergo diagnostics or cancer treatment abroad, it’s important to choose the right medical institution.

Going for cancer treatment in Germany means that you will get professional medical care, accurate diagnostics, and effective therapy. Due to their extensive clinical practice, local doctors take on even the most difficult cases.

Hospitals in Germany, whether large or small, private or state, have modern equipment and experience in the implementation of up-to-date developments in medicine into clinical practice.

Here is the list of the TOP German hospitals that specialize in treatment of Ewing sarcoma:

1. MediClin Robert Janker Clinic
2. Medias Cancer Clinic Burghausen
3. University Hospital Ulm
4. HELIOS Clinic Krefeld
5. University Hospital Freiburg
6. University Hospital Frankfurt am Main
7. University Hospital Heidelberg
8. University Hospital RWTH Aachen
9. University Hospital Würzburg

The cost of Ewing sarcoma treatment in Germany

Cancer treatment in Germany is performed at its best and is cost-effective. Prices in German hospitals aren’t that much different from other European countries and often even lower.

The cost of treatment of Ewing sarcoma with chemotherapy and radiation therapy starts at 32,181 EUR. The cost of treatment of Ewing sarcoma with surgical treatment starts at 16,533 EUR. The price of diagnostics apart from the cost of treatment starts at 5,714 EUR.

By leaving the request on the Booking Health website, you will get an overall cost of treatment for your diagnosis.

Cancer treatment in Germany with Booking Health

To undergo cancer treatment in Germany, you can negotiate directly with the clinic or use the services of a medical tourism company. Most patients choose to use the help of professionals, as independent travel arrangements are associated with many obstacles.

Patients often experience that it is difficult to choose the right hospital and the right doctor, to make the correct request to the clinic and that it is not easy to get a quick response from hospitals. Patients also can wait long before treatment actually starts, and they are generally at the risk of unnecessary financial expenses.

Booking Health selects the best clinic for you, helps you optimize your medical program, and organizes trip to Germany for you. You can completely focus on restoring your health, avoiding organizational worries and saving your time.

Leave the request on the Booking Health website to find out how to start your treatment.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed