Chart — Pediatrics
Osteosarcoma vs Ewing Sarcoma Chart
Two adolescent bone cancers that present with bone pain and a mass. The discriminators: where in the bone (metaphysis vs diaphysis), how systemic the picture, and the classic X-ray pattern.
Educational use only. Diagnosis, staging, and treatment belong to the pediatric oncology and orthopedic teams. Chemotherapy care is shared with other pediatric cancers — see the chemotherapy reference. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Osteosarcoma | Ewing sarcoma |
|---|---|---|
| Typical age | Adolescence (growth spurt) | Childhood to adolescence (can be younger) |
| Bone location | Metaphysis of long bones — around the KNEE (distal femur, proximal tibia), proximal humerus | Diaphysis (shaft) of long bones and FLAT bones (pelvis, ribs) |
| Systemic symptoms | Usually localized — pain and a mass; less systemic | More systemic — fever, weight loss, elevated inflammatory markers (can mimic infection) |
| Classic imaging | 'Sunburst' pattern, Codman triangle | 'Onion-skin' (laminated) periosteal reaction |
| Treatment | Chemotherapy + surgery (limb salvage or amputation); not very radiosensitive | Chemotherapy + local control with surgery and/or RADIATION (radiosensitive) |
| Nursing priorities | Pain control, surgical/amputation support, body image, pathologic-fracture precautions | Same plus systemic-symptom and infection-mimic awareness; radiation skin care |
Exam Traps
- ✦Osteosarcoma = metaphysis, around the KNEE; 'sunburst' pattern on X-ray.
- ✦Ewing = diaphysis and FLAT bones; 'onion-skin' periosteal reaction.
- ✦Ewing is more systemic (fever, weight loss) and can mimic osteomyelitis/infection.
- ✦Ewing is radiosensitive (radiation is used); osteosarcoma relies on chemo + surgery.
- ✦Both: night/rest bone pain is the red flag; protect against pathologic fracture.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →