Ewing Sarcoma: Surgery

Surgery is often part of the treatment for Ewing sarcoma. Different kinds of surgery may be done. The type depends on things like where the cancer is, the size of the tumor, how much it’s spread, and how surgery would change how the body works.

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) has been used to try to shrink the tumor. This may make it easier to remove. Sometimes surgery is used to remove tumors that have spread to other parts of the body, too. 

Surgery for Ewing sarcoma can be very complex, such as when tumors are in bones of the skull or spine. It also can have major side effects and long-term changes in how the body works. It’s important to have surgery done by providers who have a lot of experience treating this cancer.

Types of surgery for Ewing sarcoma

Different types of surgery are used to treat Ewing sarcoma. The type done 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 grow in soft tissue or certain bones can be removed without harming body movement or function. But, 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 often amputated limbs when they couldn’t remove just the tumor. Today, limb-sparing surgery can often be done instead of amputation. This means 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 with a prosthesis made of metal, plastic, or both. Sometimes children with prosthesis will need more surgery as they age. Prostheses may need to be replaced as their bones grow.

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 hip bones (pelvis) and spine, can be harder to remove. But surgery may still be 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

  • Bleeding

  • Blood clots in the legs or lungs

  • Damage to nearby organs

  • Infection

Risks from surgery for Ewing sarcoma

Along with the risks above, surgery for Ewing sarcoma can sometimes cause other problems. These depend on where the surgery was done and can include:

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

  • Wound healing problems, especially if chemotherapy is part of treatment

  • Scars and other changes in appearance

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

As noted above, growing children who have limb-sparing surgery might need more surgery 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 you 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, you'll put on a hospital gown. During this time, the healthcare providers will ask about any medicine allergies and discuss the upcoming surgery. 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 that will be used during your surgery. Answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have about the anesthesia.

The 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 the surgery, you'll 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 medical gown and a face mask. Once in the room, medical staff will move you onto the operating table. There the anesthesiologist or nurse will place an IV (intravenous) line into your arm. This requires just a small skin prick. Sometimes the IV is started in the preoperative area instead. EKG wires with small, sticky pads on the end will be attached to your chest to monitor your heart. A blood pressure cuff will be wrapped around your arm. When all the preparation is complete, you'll get the anesthetic through the IV and will fall asleep.

During surgery, a Foley catheter may be put through your urethra and into the bladder. This is a hollow tube used to drain urine. A breathing tube will be placed in your windpipe so a machine can control your breathing. 

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

After the surgery is done, medical staff will move you to the recovery room. There the staff will closely watch you. When you're fully awake and stable the staff will transfer you to a regular hospital room.

What to expect after surgery

When you first wake up, you might have some pain. The healthcare provider will give you pain relievers as needed for comfort. The pain medicines will also help you get up and walk the day after surgery. This is important for recovery.

It will take some time to get back to eating normally and having regular bowel movements. You may still have the Foley catheter in your bladder to drain urine. It allows healthcare providers to measure urine output. This helps keep track of your fluid status. It’s removed before you go home.

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

After surgery, you may feel weak or tired for a while. The amount of time it takes to heal from a surgery is different for each person. Your healthcare provider will give you instructions about if and when the incisions can get wet and how to care for the site.

Talk with your healthcare team

If you have any questions about your surgery, talk with your healthcare team. They can help you know what to expect before, during, and after the surgery.

Understand the next steps of treatment before you go home. Also have a rehab plan in place. Which cancer treatment provider do you need to see and when? Will you get radiation or chemo after surgery? When will is start?

Talk with your healthcare providers about what signs to look for and when to call them. For example, surgery can lead to infection. Know what number to call with problems or questions. Is there a different number for evenings and weekends?

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