Initial symptoms and clinical features in osteosarcoma and Ewing sarcoma

Background: The time between the initial symptoms of osteosarcoma and Ewing sarcoma and the correct diagnosis and treatment is long. Over the last two decades, the prognosis for patients with these diseases has dramatically i mproved due to a new chemotherapy regimen. As a consequence, a limb-sparing operation has become an alternative to amputation. The aim of this study w as to establish the initial symptoms and physical signs of osteosarcoma and Ewing sarcoma from the records of the first medical visit and to identify early characteristics of the diseases to shorten the delay to diagnosis. Methods: A group of patients with osteosarcoma or Ewing sarcoma was identif ied from the Swedish Cancer Register of patients thirty years old and young er. Records from the first medical visit due to symptoms related to the bon e tumor were obtained for 102 patients with osteosarcoma and forty-seven pa tients with Ewing sarcoma, Results: Pain related to strain was reported by eighty-seven (85 percent) o f the patients with osteosarcoma and thirty (64 percent) of those with Ewin g sarcoma, but only twenty-one (21 percent) of the patients with osteosarco ma and nine (19 percent) of those with Ewing sarcoma reported pain at night , Forty-eight (47 percent) of the patients with osteosarcoma and twelve (26 percent) of those with Ewing sarcoma related the onset of symptoms to mino r trauma occurring around the same time. A palpable mass was noted in forty (39 percent) of the patients with osteosarcoma and sixteen (34 percent) of those with Ewing sarcoma at the first visit, and in most cases the tumor d iagnosis was suspected. There was a broad spectrum of misdiagnoses; the mos t common was tendinitis, which was the initial diagnosis in thirty-two (31 percent) of the patients with osteosarcoma and ten (21 percent) of those wi th Ewing sarcoma, The doctor's delay (the period from the first medical vis it due to the symptoms to the correct diagnosis) was longer for Ewing sarco ma than for osteosarcoma (nineteen weeks and nine weeks, respectively; p < 0.0001), Conclusions: An initial symptom of both osteosarcoma and Ewing sarcoma was pain, which was intermittent and often related to strain but not frequently felt at night. A history of trauma was common, but the clinical course oft en diverged from what was expected from trauma. The clinical course of oste osarcoma and particularly of Ewing sarcoma was not steadily progressive but intermittent, which often misled the doctor into believing that the condit ion was temporary, The most important clinical feature was a palpable mass, which was noted in more than one-third of the patients at the first visit. This finding emphasizes that a thorough physical examination is absolutely necessary.