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The History Behind Ewing Sarcoma?

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Image - James Ewing 1866 to 1943James Ewing 1866 to 1943

James Ewing first described the tumour that was to be named after him in the 1920's.

Ewing Sarcoma is a type of bone cancer found in children and young adults which accounts for 10-15% of all primary malignant bone tumour. The tumour is composed of small round cells, untreated the disease will spread to the lungs and other bones. Any bone can be affected, though the most common sites are the pelvis, thigh, lower leg, upper arm, and rib. Occasionally it can found entirely restricted to soft tissue (Extra osseous Ewing's Sarcoma).

The tumour is rare with an estimated incidence of 0.6 per million, it is less common in black and Chinese populations. Ewing distinguished the tumour from Osteosarcoma on the grounds that it was responsive to radiotherapy. In the past only around 10% of patients were long term survivors when surgical amputation or radiotherapy were the only treatments, however, drastic improvements in outlook have been achieved with the advent of modern chemotherapy.

Ewing first described the tumour as an "endothelium of bone" believing that it arose from the blood vessels of bone tissue. He later recognized that the histopathologic features were more complex and went on to describe it as a "endothelial Myeloma". He described the histopathology as "broad sheets of small polyhedral cells with pale cytoplasm, small hyper chromatic nuclei, well-defined cell borders and complete absence of inter-cellular material". Reports of similar tumours were made in earlier literature (Lucke, 1866; Hildebrand, 1890), but it was the work of Ewing which established that the disease was separate from lymphoma or Neuroblastoma.

Today it is known that Ewing's sarcoma covers a spectrum ranging from classical Ewing's to those tumours which are positive for neural markers (Peripheral Neuroectodermal Tumours). This range of tumours all share the same genetic features, namely a translocation. Today the origin of Ewing's Tumour still remains unclear.

James Ewing (childhood, education, and early career)

Born 25th December 1866 in Pittsburgh, Pennsylvania, James was the third of five children of Judge Thomas Ewing and Julia Ewing. At age 14 he suffered from osteomyelitis of the femur which confined him to bed for two years. During this time he was tutored by Henry Gibbons who encouraged his academic skills. Whilst bed bound he entered various competitions and won a microscope, the instrument that was to play a strong role in his future interests in cancer.

Ewing attended Amherst College (Massachusetts) taking a B.A. in classics and philosophy, and excelled in his studies. Despite the injury to his leg Ewing was also a keen tennis player, and maintained this interest throughout his life. In 1888 he was accepted into the College of Physicians and Surgeons of New York, and graduated from the Collage three years later.

After briefly working at the Western Pennsylvania Hospital Dr. Ewing returned to New York and was given a prestigious internship at the Roosevelt Hospital and Sloane Maternity. He spent much of this time in the hospital laboratory and developed a keen interest in pathology. In 1898 he volunteered as contract surgeon to the US army, treating soldiers evacuated from Cuba and Manila. He published several papers on malaria from which many of the soldiers suffered.

James Ewing (cancer pathologist, 'The Chief')

In 1899 Ewing was appointed as the first Professor of Pathology at Cornell University, a position which he kept for 33 years. His first book Clinical Pathology of blood was published in 1901. In mid 1900 he married Catherine Halsted and his son James was born two years later, sadly his wife and unborn second child died in 1903.

Doctor Ewing had a growing interest in tumours, and was instrumental in establishing the P. Huntington Fund for Cancer Research in 1902. Linked with this he became a leading cancer pathologist and was prolific in writing papers about cancer. Ewing was a co-founder of the American Association for Cancer Research in 1907. This brought him into contact with James Douglas who was a mining engineer but with a medical background. Douglas had an interest in the possible therapeutic potential of radium and went on to found the National Radium Institute in 1913. In the same year Ewing co-founded the American Society for the Control of Cancer (now the American Cancer Society). The friendship between Douglas and Ewing grew, and Ewing became one of the pioneers in using radiotherapy for cancer.

After many years work Ewing's successful textbook Neoplastic Diseases was published in 1919. The following year at a meeting of the New York Pathological Society Ewing presented his paper on the malignant bone tumour that was later to became known as Ewing sarcoma.

Ewing was one of the first to recognize the potential of radiation as cancer therapy, stating in 1922; 'From the most unexpected source, experimental physics, a new and powerful weapon has been brought into play'. He also had a role in the development of surgical oncology by encouraging surgeons to gain a better understanding of the natural course of cancer. Ewing laid the foundations of what is now known as the Memorial Sloan-Kettering Cancer Centre, building up a strong team of physicians who later distinguished themselves in the various specialties in oncology. His reputation was widespread, his peers referred to him as "The Chief" and "Mr. Cancer".

James Ewing (Cover of Time Magazine 1931)James Ewing on the Cover of Time Magazine 1931

James Ewing died from bladder cancer at the age of 76. He had a large influence in the development of oncology, over a thousand people attended his last rites in 1943.

Information Reference:

Information regarding Dr James Ewing was obtained from the Children's Cancer Web (Cancer Index)

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Established since 1995 The Adam Dealey Foundation for Ewing Sarcoma.
The Adam Dealey Foundation is a non-profit charity working in partnership with the Bone Cancer Research Trust to bring public awareness of Ewing Sarcoma and help people who are suffering from.

Site last updated: 22 July 2009

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