Ewing Sarcoma: Surgery

Surgery is often part of the treatment for Ewing sarcoma. Different kinds of surgery may be done. The type you have depends on where the cancer is, how much it’s spread, and other factors. 

When is surgery used for Ewing sarcoma?

Surgery is often part of the main treatment for Ewing sarcoma. It’s normally done after chemotherapy (and sometimes radiation) to try to shrink the cancer. This may make it easier to remove. For more advanced cancers, surgery can also sometimes be used to remove tumors in other parts of the body. 

Surgery for Ewing sarcoma is a complex operation. It can have major side effects, so it’s important to have it done at a center that has experience treating this cancer.

Types of surgery for Ewing sarcoma

Different types of surgery are used to treat Ewing sarcoma. The type you have depends on where the tumor is located and how far it’s grown or spread. The type of surgery also depends on how it might affect the part of the body being operated on.

Some tumors that involve soft tissue or certain bones can be removed without harming your child's movement or function. However, tumors in the main bones in the arms or legs usually can’t be removed without affecting how the arm or leg works.

In the past, healthcare providers would often amputate limbs when they couldn’t remove just the tumor. Today, they can often use limb-sparing surgery instead of amputation. During this procedure, the surgeon replaces the removed part of the bone with either a bone graft (from another part of the body or from another person). Or he or she replaced it with a prosthesis made of metal and/or plastic. Sometimes children with prosthesis will need more surgery as they age. This is done to replace the prosthesis because their bones are still growing.

Limb-sparing surgery isn’t always an option. The bone may be hard to replace or surgery may harm the limb. If limb-sparing surgery isn’t a good option, your child's healthcare provider may recommend radiation or amputation.

Tumors in other parts of the body, such as the pelvis (hip bones), can be harder to fully remove. But surgery is still often an option.

Possible risks, complications, and side effects of surgery

All surgery has risks. Some of the risks of any major surgery include:

• Reactions to anesthesia

• Heavy bleeding

• Blood clots in the legs or lungs

• Damage to nearby organs

Risks from surgery for Ewing sarcoma

Along with the risks above, surgery for Ewing sarcoma can sometimes cause other problems. These can include:

• Infections at the surgery site

• Loose or broken bone grafts or prostheses (after limb-sparing surgery)

• Scars and other changes in appearance

Surgery on arm or leg might affect how it works. Physical rehabilitation (rehab) after surgery is important. It can help make sure your child recovers as much function as possible.

As noted above, growing children who have limb-sparing surgery might need more operations as they get older. This may be done to replace the prosthesis with a larger one.

Getting ready for surgery

Before the surgery, you'll meet with the surgeon to talk about the procedure. At this time, you can ask any questions and talk about any concerns you may have. This is also a good time to review the possible side effects of the surgery and to talk about its risks. You might ask how the surgery will affect the function of the area being treated. You might also want to ask about rehab and when your child can expect to return to normal activities. After you’ve discussed all the details with the surgeon, you’ll sign a consent form that says that the healthcare provider can do the surgery.

On the day of surgery, you should arrive at the hospital admission area a couple of hours before the time the surgery is supposed to start. There, you'll do the needed paperwork and then go to a preoperative area. In this area, your child will put on a hospital gown. During this time, the healthcare providers will ask about any medicine allergies and discuss the upcoming surgical procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.

In the preoperative area, an anesthesiologist or a nurse anesthetist will do an evaluation. He or she will also explain the anesthesia your child will have during your surgery. Be sure to answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have about the anesthesia.

Your child's surgeon will also see you in the preoperative area. You can ask any last-minute questions you have. This can help put your mind at ease.

What to expect during surgery

When it’s time for your child's surgery, he or she will be taken into the operating room. There will be many people there. They include the anesthesiologist, surgeon, and nurses. To ensure sterility, everyone will wear a surgical gown and a face mask. Once in the room, medical staff will move your child onto the operating table. There the anesthesiologist or nurse will place an intravenous line (IV) into your child's arm. This requires just a small skin prick. Sometimes the IV may be started in the preoperative area instead. EKG wires with small, sticky pads on the end will be attached to your child's chest to monitor his or her heart. A blood pressure cuff will be wrapped around his or her arm. When all the preparation is complete, you child will receive the anesthetic through the IV and will fall asleep.

During surgery, a Foley catheter may be placed through your child's urethra and into their bladder. This is a hollow tube used to drain urine. You child will also have a breathing tube placed in his or her windpipe. A breathing machine will control his or her breathing. 

What’s removed during surgery and where the incisions are depend on the type of surgery. This is based on where the tumor is.

After the surgery is done, medical staff will move your child to the recovery room. There the staff will monitor him or her. When your child is fully awake, you can see him or her. Don't be alarmed by the number of tubes and wires attached to your child. These are normal postoperative monitors. Once your child is awake and stabilized, the staff will transfer him or her to the regular hospital floor.

What to expect after surgery

When your child first wakes up, he or she might have some pain. The healthcare provider will give him or her pain relievers as needed for comfort. The pain medicines will also help your child get up and walk the day after surgery. This is important for your child’s recovery.

It will take some time to get back to eating normally and having regular bowel movements. Your child will still have the Foley catheter in his or her bladder to drain urine. It allows healthcare providers to measure urine output. This helps keep track of your child's fluid status. It’s often removed before he or she goes home.

How long your child stays in the hospital will depend on the type of surgery. Your child can slowly return to normal activities. But you should always follow the instructions you get from your child's healthcare provider.

After surgery, your child may feel weak or tired for a while. The amount of time it takes to heal from an operation is different for each person. Your child's healthcare provider will give you instructions about whether and when the incisions can get wet.

Talk to your healthcare team

If you have any questions about your child's operation, be sure to talk to your healthcare team. They can help you know what to expect before, during, and after the surgery.