Bone Sarcomas
Ewing sarcoma and osteosarcoma are two major bone sarcomas affecting children and adolescents.
Childhood Cancer and Sarcoma
Awareness creates urgency.
Trustworthy information helps families understand why specialist care, clinical research, and long-term support matter.
What Is Pediatric Sarcoma?
A diverse group of cancers arising in bone and soft tissue.
Sarcomas can begin in bone, muscle, tendons, fat, blood vessels, nerves, and other supporting tissues. Pediatric sarcoma includes many diagnoses with different biology, treatment approaches, and outcomes.
Soft-Tissue Sarcomas
These include rhabdomyosarcoma, synovial sarcoma, infantile fibrosarcoma, and many rarer subtypes.
Specialized Care
Rare pediatric sarcomas benefit from coordinated multidisciplinary care involving experienced specialists.
Sources: NCI Soft Tissue Sarcoma Overview and NCI Childhood Soft Tissue Sarcoma PDQ.
Explore by Diagnosis
Find information specific to a sarcoma type.
Each sarcoma subtype has distinct biology, treatment considerations, and research needs. These summaries are starting points and do not replace guidance from a specialized oncology team.
Ewing Sarcoma
A bone or soft-tissue sarcoma affecting many children, adolescents, and young adults.
Ewing sarcoma often begins in bone but can also arise in soft tissue. Treatment commonly uses multi-drug chemotherapy together with surgery, radiation therapy, or both for control of the primary tumor.
Questions to Ask
Ask about tumor location, whether disease is localized or metastatic, the local-control plan, fertility preservation, and clinical-trial options.
Relapse
Recurrent Ewing sarcoma may require combinations of chemotherapy, surgery, radiation, or clinical-trial treatment. Early consultation with a relapse-focused sarcoma center may be useful.
Trusted Starting Point
Specialist review matters.
Because Ewing sarcoma is rare, diagnosis and treatment planning should involve a multidisciplinary team experienced in pediatric and young-adult sarcoma.
Bone Sarcoma
Care often combines chemotherapy and surgery.
Rehabilitation, mobility, prosthetic or limb-sparing considerations, and long-term monitoring are important parts of care.
Osteosarcoma
The most common primary bone cancer in children and adolescents.
Osteosarcoma most often develops in the long bones. Treatment commonly includes chemotherapy before and after surgery, with additional approaches considered according to disease location, response, and whether the cancer has spread.
Surgical Planning
Ask about limb-sparing surgery, reconstruction, expected function, rehabilitation, and whether a second orthopedic-oncology opinion would be helpful.
Lung Monitoring
The lungs are an important site of evaluation and follow-up. Ask how chest imaging and any pulmonary nodules affect the treatment plan.
Rhabdomyosarcoma
A soft-tissue sarcoma related to developing skeletal-muscle cells.
Rhabdomyosarcoma can begin in many areas of the body. Treatment commonly uses chemotherapy, surgery, and radiation therapy, with the plan shaped by tumor site, histology, stage, and risk group.
Location Matters
Ask how the tumor’s location affects biopsy, surgery, radiation planning, function, and possible long-term effects.
Risk Group
Ask the care team to explain the tumor’s subtype and risk classification and how those findings shape the treatment schedule.
Soft-Tissue Sarcoma
Treatment is individualized.
Because rhabdomyosarcoma can occur in many body sites, local-control decisions require close coordination among oncology, surgery, and radiation specialists.
Other Pediatric Soft-Tissue Sarcomas
Many rare diagnoses require subtype-specific expertise.
This group includes synovial sarcoma, infantile fibrosarcoma, desmoplastic small round cell tumor, malignant peripheral nerve sheath tumor, and other rare subtypes. Treatment may involve surgery, radiation therapy, chemotherapy, targeted therapy, or a clinical trial depending on the exact diagnosis and molecular findings.
Confirm the Subtype
Ask whether pathology and molecular testing have been reviewed by experts familiar with the suspected sarcoma subtype.
Ask About Molecular Results
Some rare sarcomas have characteristic gene fusions or alterations that confirm the diagnosis or may influence treatment.
Consider a Specialized Center
Rare pediatric soft-tissue sarcomas should be coordinated by a multidisciplinary team with sarcoma experience.
Possible Warning Signs
Symptoms can resemble common injuries.
- Persistent or unusual bone pain
- Swelling or a growing lump
- Pain that worsens at night
- Unexplained limping or reduced movement
- A fracture after minor injury
- Unexplained fever, fatigue, or weight loss
These symptoms are usually caused by conditions other than cancer. Persistent or worsening concerns should still be evaluated by a healthcare professional.
Diagnosis
Accurate diagnosis guides treatment.
Imaging
X-rays, MRI, CT, PET, bone scans, or other studies may evaluate the primary tumor and possible spread.
Biopsy
A tissue sample is usually required to confirm the diagnosis and should be planned with the treating surgical team.
Pathology
Specialized pathology and molecular testing may confirm the exact subtype and characteristic genetic changes.
Staging
Staging evaluates tumor size, location, and whether disease is localized or metastatic.
Treatment
Plans are tailored to diagnosis, location, and risk.
Chemotherapy
Systemic treatment is central to care for several pediatric sarcomas, including Ewing sarcoma and osteosarcoma.
Surgery
Surgery aims to remove the tumor when feasible while preserving function.
Radiation
Radiation may be used for local control, before or after surgery, or when surgery is not appropriate.
Trials and Targeted Therapy
Some sarcomas may respond to targeted therapy. Clinical trials evaluate new medicines and combinations.
Sources: NCI Ewing Sarcoma Treatment, NCI Osteosarcoma Treatment, and NCI Childhood Soft Tissue Sarcoma Treatment.
Localized, Metastatic, and Relapsed Disease
Where disease is found affects treatment and prognosis.
Localized Disease
The cancer is limited to the primary area and nearby tissues. Treatment often combines systemic therapy and local control.
Metastatic Disease
The cancer has spread to another site, often the lungs or other bones in bone sarcomas. Treatment is generally more intensive.
Relapsed or Refractory Disease
The cancer has returned or has not responded adequately. Families may discuss specialized centers and clinical trials.
NCI reports that progress has been limited in developing effective therapies for Ewing sarcoma that has spread or returned, highlighting the need for continued research.
Clinical Trials
Research studies may offer new approaches.
Trials can study new medicines, combinations, radiation approaches, surgical strategies, and ways to reduce treatment complications. Participation is voluntary.
Questions to Ask
What is the study's purpose? Why might my child qualify? What extra visits, tests, risks, and costs are involved?
ClinicalTrials.gov
Search studies by diagnosis, age, location, and recruitment status.
Search Trials →NCI Trial Search
Review NCI-supported studies and information about participating in research.
Search NCI Trials →Survivorship and Late Effects
Survival is not the end of the medical journey.
Long-term follow-up is based on the treatments received and may address heart health, hearing, kidney function, bone health, hormones, fertility, mental health, second cancers, mobility, school, and work needs.
- Keep a complete treatment summary.
- Ask for a risk-based survivorship care plan.
- Attend recommended screening visits.
- Discuss emotional health, fertility, rehabilitation, school, and employment needs.
COG Long-Term Follow-Up Guidelines
Evidence-based, treatment-exposure-related recommendations for childhood, adolescent, and young adult cancer survivors.
View GuidelinesWhy Research Matters
Children deserve treatments designed for them.
Research is needed to identify new targets, improve survival after relapse, reduce toxicity, preserve function, and support lifelong health.
Strides funds research because current options are not enough.
Sources
Trusted starting points.
National Cancer Institute: Cancer in Children and Adolescents
National Cancer Institute: Ewing Sarcoma Treatment
National Cancer Institute: Osteosarcoma Treatment
National Cancer Institute: Childhood Soft Tissue Sarcoma
Children's Oncology Group: Survivorship
Medical disclaimer: This page provides general education and does not diagnose cancer or recommend an individual treatment plan. Consult the treating oncology team.