Surgery is a standard treatment option for Ewing sarcoma, a rare bone cancer mainly affecting children and young people. Surgery aims to directly remove the tumor or tumors from the body.

Doctors often recommend surgery in combination with chemotherapy and radiation therapy.

This article discusses surgery for Ewing sarcoma, including its types, what to expect, and outlook.

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Ewing sarcoma, Ewing’s sarcoma, or Ewing tumors most commonly occur in the bones of the arms, legs, chest, spine, or pelvis.

Ewing sarcomas may also affect soft tissue, including muscle, fat, blood vessels, nerves, tendons, and joints. Less often, the tumors can develop in the head and neck.

A doctor may recommend surgery for two reasons:

  • to diagnose Ewing sarcoma and assess the stage and size of the tumor
  • to remove the tumor, also called a surgical resection

A surgical resection aims to treat Ewing sarcoma by removing as much of the tumor as possible without harming the bone, cartilage, and surrounding tissue.

Surgery for tumors in the arms or legs tends to be less complex than for tumors in body parts, such as the chest wall or the pelvis.

Doctors may recommend the following procedures for a tumor in the arm or leg.

Limb-sparing surgery

This procedure aims to remove the affected bone while leaving the limb intact. It involves surgically removing the bone where the cancer is present and replacing it with a prosthetic bone.

Doctors may also be able to replace it with another bone from elsewhere in the body, called a bone graft. This is a complex procedure, but it means the person will still have a functioning limb.

Radiation therapy

Although not a surgical procedure, doctors may recommend radiation therapy as an alternative to surgery if the person’s tumor is in a complex area.

For example, a doctor may not be able to remove a tumor that extends into important blood vessels or nerves without severely damaging the limb.

Radiation therapy may be able to shrink the tumor enough for the doctor to recommend surgery.


Rarely, a doctor may recommend amputating part or all of the limb where Ewing sarcoma is present.

This may be the best option in some cases, particularly if the cancer has returned or previous radiation therapy was unsuccessful.

After amputation, a person may be able to receive a prosthetic limb.

Ewing tumors in the chest wall may be more complicated to remove than tumors in the arms or legs.

Surgeons must remove the tumor and the affected areas and may also need to remove nearby ribs. They can replace these with artificial ribs.

If the tumor has spread to the lungs, a doctor may recommend a thoracotomy. This involves opening the chest can and removing the tumors from the lungs.

Tumors in or near the spine can be difficult to remove altogether, and doctors may recommend radiation therapy as an alternative to surgery.

However, if the tumor is compressing the spinal cord and there is a risk of neurological effects, some professionals may order emergency surgery.

If a person does receive surgery, doctors may perform radiation therapy afterward to treat any remaining tumor cells.

It can be challenging to treat pelvic tumors with surgery. As a result, doctors may instead recommend radiation therapy.

However, if the tumor shrinks in response to chemotherapy, they may consider surgery followed by radiation therapy.

Doctors may have to remove pelvic bones, but they can sometimes reconstruct them following surgery. Sometimes, a surgeon may have to amputate a leg alongside removing some of the pelvic bones.

Surgery for Ewing sarcoma can involve some risks and side effects, such as:

Additionally, those with limb-sparing surgery may experience a breaking or loosening of their prosthesis or bone graft.

Amputation may have psychosocial side effects, such as an altered body image or reduced self-esteem. However, learning to use prostheses and adjusting to life with an amputated limb can improve these side effects over time.

Every surgery is different, but people undergoing any complex surgery will receive a general anesthetic and be unconscious during the procedure.

A medical team will make sure the person and their family are familiar with the specific process and recovery.

There will be a long-term follow-up, with medical professionals closely monitoring a person’s progress.

Surgery aims to improve the outlook of a person with Ewing sarcoma. It can potentially prolong a person’s life and alleviate symptoms of the disease.

However, the outlook after surgery will differ from person to person. Multiple factors may affect a person’s outlook after surgery, including:

  • tumor size
  • how far cancer has spread, called metastasis
  • how the cancer responds to chemotherapy

Additionally, surgery can cause lasting effects such as scars or the loss of a limb. A person will need to adjust to such changes emotionally and physically, so most need rehabilitation.

Individuals who undergo surgery for Ewing tumors will need long-term follow-up care to monitor for any further issues.

Support for those with Ewing sarcoma

Many organizations offer support for people with Ewing sarcoma and their families. A person can visit the following sites for information and advice:

This section answers some common questions about surgery for Ewing sarcoma.

What is the best treatment for Ewing sarcoma?

Where possible, surgery to completely remove the tumor is generally the preferred approach to treating Ewing sarcoma in the United States.

However, the best treatment depends on the person’s individual case. Some people are not eligible for surgery — in these cases, doctors may recommend radiation therapy or chemotherapy.

Can Ewing sarcoma be cured without surgery?

Surgery is not always the best option to treat Ewing sarcoma, as some tumors are difficult to remove.

For those who are unable to undergo surgery, doctors may recommend chemotherapy or radiation therapy.

However, whether or not this cures the cancer depends on multiple factors, such as the size, stage, and location of the tumor, as well as the person’s age and overall health.

A person should consult a medical professional for an in-depth outlook on an individual case.

Surgery plays an important part in treating Ewing sarcoma by aiming to completely remove the tumor and the affected areas.

Surgeons may need to remove a bone to do this. They will replace the bone with artificial material or a bone graft.

Rarely, a person may require limb amputation.

The outcomes of surgery largely rely on the location, size, and stage of the tumor, alongside the person’s age and overall health.