Ayurvedic Treatment of Ewing’s Sarcoma

Abstract

Ewing’s Sarcoma is a very rare type of cancer that occurs in bones or soft tissue. It can spread from bones to soft tissues. It affects about one in a million people per year. It is slightly more often seen in males than in females. White people or Caucasians are mostly affected than African Americans or Asians. Ewings sarcoma in adults is uncommon. Its exact cause is not clear yet, the gene mutation is considered to cause it. The most common system is pain and swelling at the site of the tumor. It can be diagnosed based on blood investigations and imaging tests. Lifestyle and diet changes, home remedies, and herbs are helpful in EWING’S SARCOMA.

Introduction to Ewing’s Syndrome

In 1920, James Ewing established that the tumor is a distinct type of bone cancer named Ewing’s sarcoma. Ewing’s sarcoma is a rarest type cancerous tumor that forms in bones or the soft tissues around bones which supports bones such as cartilages, muscles, tendons, or the nerves. The most common site where it begins is the pelvis, long tubular bones including the femur, humerus, and chest wall. It occurs usually in teenagers and young adults, often in people from the ages of 10 to 20 years. It has a high rate of being cured.

Ayurvedic Aspect of Ewing’s Syndrome

Cancer is not a new term in Ayurveda. In Ayurvedic concept, according to our trio ‘Acharya  Charaka’ and ‘ Acharya Sushruta ‘  and ‘Acharya vagbhat’  cancer or tumor is described as inflammatory or non-inflammatory swelling and described either as ‘Granthi’ (minor neoplasm) or ‘Arbuda’ (major neoplasm) in their respective Samhitas

• Charaka Samhita, Sushruta Samhita, and ashtanga Samhita.
• In Ayurveda three basics to maintain normal body function are the nervous system is considered as Vata or air, the venous system is considered as Pitta or fire and the arterial system is considered as Kapha or water.
• In the case of malignant tumors, all three basic systems ( Vata, pitta, and Kapha dosha) get out of control and lose mutual coordination that causes healthy and normal cell damage, tissue damage, resulting in devastating critical condition. Tridoshas cause excessive metabolic crises that result in excessive and uncontrolled proliferation of cells which is known as cancer.

According to Ayurveda cancer can be of following types –

1. Based on doshas:- Vaataj, pitta, kaphaj, sannipattaj
2. Based on dhatus:- Raktarbuda, Mansaarbuda, Medojarbuda.
3. Based on metastasis: – Raktarbuda, adhyarbuda, dviarbuda.
4. Based on pathogenesis:- Sadhya and asadhya.

Granthi is classified into the following types:-

• Vaataj granthi
• Pittaj hranthi
• Kaphaj granthi
• Raktaj granthi
• Mamsa granthi
• Medaj granthi
• Asthi granthi
• Sira granthi
• Vrana granthi

The main aim of ayurvedic therapy to cure any disease or ailment is to find the exact cause of the illness and to eliminate that cause if possible.

While the therapeutic approach of treatment by Ayurveda is of four main types categorized as follows:

1) Prakritisthapani chikitsa (General health maintenance)
2) Rasayana chikitsa (rejuvenation or restoration of normal function)
3) Roganashani chiktsa (cure of the disease)
4) Naishthiki chikitsa (Spiritual way of treating)

In Ayurveda commonly herbal decoctions or formulations used are prepared from polyherbal having great potential for the cure of cancer. On a scientific basis, formulations are used for the treatment of cancer work by acting on multiple biochemical pathways of the body involved in the pathology of cancer and affect multiple organ systems altogether. These formulations help to nourish the whole body, support body defense mechanism, and the immune system.

TYPES OF EWING’S SYNDROME

Ewing’s Sarcoma is of three main types depending upon the spread of tumors from bone or soft tissue in which it is started. Types are as follows:-

1. Localized Ewing’s Sarcoma

It is a type of Ewing’s sarcoma in which cancer remains localized to the site from where it is started and does not spread to other areas of the body.

2. Metastatic Ewing’s Sarcoma

It is a type of Ewing’s sarcoma in which cancer spreads to the surrounding soft tissue, other bones, bone marrow, other body parts even including vital organs such as the lungs, heart, kidneys.

3. Recurrent Ewing’s Sarcoma

It is a type of Ewing’s sarcoma which is recurrent even after a successful course of complete treatment. In such cases, cancer does not respond to the treatment. It is most often seen in lung cancer.

Ewing’s sarcoma can also be classified based on-site or area in which it is present, following are types:-

1. Bone Tumor

85-87% of Ewing’s sarcoma occurs in bones. Most often it starts in the pelvis, followed by proximal tubular bones such as femur bone (thigh bone), shoulder blades, and ribs. It can occur any bone of the body.

2. Soft Tissue (Extra-Osseous) Tumour

It is the type of Ewing’s sarcoma that affects soft tissues surrounding bones such as cartilages, muscles, tendons, fat. It can also affect soft tissues of vital organs – lungs, heart, kidneys. It is rare in soft tissues of the head, neck, chest, arms, legs, abdomen, and back.

3. Peripheral Primitive Neuroectodermal Tumour (PPNET)

It is a type of Ewing’s sarcoma in which cancer occurs in nerves of the different body parts.

4. Askin Tumour

It is a type of Ewing’s sarcoma which is a type of peripheral primitive neuroectodermal tumor that affects the chest region mainly.

Symptoms of Ewing’s Syndrome

Tumors usually occur in the pelvis, legs, chest region but symptoms may depend on the site of the tumor where it is present. Often seen symptoms are:-

• Pain, swelling, or stiffness in the area of the tumor
• visible lump on the surface of the skin, the area may also be warm and soft to touch.
• Anorexia
• Persistent low-grade fever
• Malaise
• Weight loss when not even trying
• Anemia
• Leukocytosis
• Unexplained tiredness
• Breakdown of bone without any known reason
• Limping
• Bone pain gets worsened while exercising or at night
• Shortness of breath if the tumor is present in the chest area.
• Paralysis or loss of bladder control when the tumor is present near to the spine. Also, pain, swelling, tenderness noticed near the affected part.

Causes of Ewing’s Syndrome

The exact cause of Ewing’s sarcoma is not clear. Most cases appear to occur randomly in life. It is not inherited.

• It appears that the DNA changes most often affect a gene called EWSR1 which occurs after birth. It can be related to non-inherited changes in some specific genes of chromosome numbers 11 and 12 i.e reciprocal; translocation which activates hyperplasia and hypertrophy of cells that can occur in person during a lifetime.
• The changes occur in cells so quickly and go on living when that healthy cells die normally. The mass of abnormal cells can break away and metastasize to any part of the body where it destroys healthy tissues of the body.
• Another cause of Ewing’s sarcoma could be secondary cancer in people who have been treated with radiation therapy and chemotherapy for another type of carcinoma in any other part of the body.

COMPLICATIONS IN EWING’S SYNDROME

Complications in Ewing sarcoma can occur in 2 main following ways:-

1. Metastatic Ewing’s sarcoma

When Ewing’s sarcoma spread from the site of origin to other areas of the body, it makes treatment and recovery more difficult. Complications depend on the site where it has spread such as:-

• Lungs – Pleural effusion, lung sarcoma.
• Heart- cardiac sarcoma, heart failure.
• Kidneys- Renal sarcoma, renal failure.
• Brain –paraplegia, brain sarcoma.
• Chest- breast carcinoma, lymphoma.

2. Side effects of long term treatment

The treatment used in Ewing’s sarcoma is so aggressive that it causes ill effects in the body in the short and long term. Its treatment use chemotherapy and radiotherapy which harms the body in many ways –

• Flu-like symptoms
• Pain in muscles, abdominal pain, and headache
• Throat, mouth, gum sores
• Gastrointestinal problems: nausea, vomiting, diarrhea, constipation
• Hair loss
• Weight loss
• Skin rashes

Diagnosis of Ewing’s Syndrome

In about 25-30% cases, Ewing’s sarcoma has already spread to the other body parts at the time of diagnosis. There is a wide range of tests to know the presence of Ewing’s sarcoma and to know the spread and extent of Ewing’s sarcoma. It includes:-

1. History of disease and family history.
2. Physical examination- checking around the painful areas for signs such as tenderness, swelling, redness,
lumps, stiffness.
3. Histomorhphic findings
4. Immunohistochemistry and molecular pathology.
5. Blood investigations – CBC to check the count of RBCs, WBCs, platelets, and hemoglobin range.
6. Medical imaging –It includes the following ways:-

• X-rays
• Bone scan
• Magnetic resonance imaging (MRI)
• Computed tomography scan (CAT/CT scan)
• Positron emission tomography scan (PET scan)
• Ultrasonography

7. Biopsy – It can be a Needle biopsy or surgical biopsy.

8. Bone marrow aspiration and biopsy.

Herbs for Ewing’s Sarcoma

Naturally occurring herbs help in total healing, reducing side effects, and complications associated with cancer. The following herbs have scientific evidence of anti-cancer property.

1. Kalmegh (Andrographis paniculata) – It has a blood purifier, anti-inflammatory, antipyretic, antiparasitic, purgative action used to relieve inflammation, fever, constipation, skin rashes.

2. Bhumi amla (Phyllanthus niruri)- It is a potent hepatoprotective drug, it also has melanoma cells growth-inhibiting properties

3. Pippali (Piper longum) – It is an herb used traditionally as an immunomodulatory agent in inhibiting the growth of abnormal cells of cancer or cancer-like conditions.

4. Bhallatak (Semecarpus Anacardium) – It contains alkaloids bhilwanol and semecarpol having anti-inflammatory, scraping action, it can be used in Ewing’s sarcoma for scraping of tumors.

5. Guduchi/giloy (Tinospora cordifolia) – It is the potent detoxifying herb of hot potency having antipyretic, analgesic, blood purifier,  immunomodulator, anti-emetic and anti-oxidant in actions and used in pain, persistent fever, vomiting.

6. Vikankat (Flacourtia romantchi) – It is an herb having mainly anti-inflammatory and blood purifying action. It helps decrease inflammation.

7. Danti (Baliospermum montanum) – It is a pot potency herb which as a laxative, anti-inflammatory, anti-pyretic, anti-asthmatic action It can be used in decreasing swelling, fever, breathing problem in Ewing’s sarcoma.

8. Sairayak (Barleria priorities) – This herb has anti-inflammatory, analgesic, wound healer, strengthening, blood purifier and can be used in relieving inflammation, fever, pain, also good for hair growth.

9. Manjistha (Rubia cordifolia) – It is a herb of hot potency having anti-inflammatory, wound healing, blood purifying, anti-pyretic, digestive, strengthening action, can be used in fever, relieving inflammation, skin conditions, weakness.

10. Shobhana (Moringa oleifera) – It is commonly known as drumstick having analgesic, anti-inflammatory, digestive, nerve strengthening, anti-pyretic, scraping action, and can be used in treating paraplegia, nerve weakness, anorexia, indigestion, pain.

11. Katuka (Picrorrhiza kurroa) – It contains glycosides picrorhizin and kutkin helpful in indigestion, anorexia, inflammation, generalized weakness, constipation.

12. Kalonji (Nigella sativa) – It is a herb used mainly in inflammatory conditions, skin diseases, fever, diarrhea, headache, pain in the body, indigestion, baldness, or hair loss.

13. Dhatura (Datura metel) – It has anthelminthic, anti-inflammatory, analgesic properties, useful in abdominal pain, inflammation in any part of the body. Also, it has some anti-cancerous properties.

14. Shwet Ark (Calotropis gigantia) – It has wonderful results in digestive disorders-diarrhea, constipation, pain in joints, bones, ulcers of the mouth, gastric ulcers.

15. Garlic (Allium sativum) – It is an herb of hot potency having analgesic, anti-inflammatory, diuretic action. It can be used to relieve pain associated with Ewing’s sarcoma.

16. Suran (Amorphophallus campanulatus) – It is an herb having mainly analgesic and anti-inflammatory, cell growth-inhibiting properties. So it can be used in Ewing’s sarcoma for restricting the growth of the tumor.

17. Shami (Prosopis cineraria) – It has Patulitrin flavones glycoside helpful in various skin conditions, vertigo, in nervine weakness as a nervine tonic, diarrhea.

18. Shyonaak (Oroxylum Indicum) – This herb helps in removing generalized weakness, gastrointestinal problems, fevers.

19. Vat (Ficus bengalensis) – Vat has analgesic, anti-inflammatory, anti-emetic, astringent action, so can be used in decreasing inflammation, bleeding disorders, wound healing,

20. Muchkund (Pterospermum acerifolium) – It is hot in potency and has analgesic, anticoagulant action so it can be used in relieving pain.

Also, some herbal components are used as anticancer drugs including vinblastine, vincristine, etoposide, teniposide, taxol, navelbine, Taxotere, topotecan.

Home Remedies of Ewing’s Sarcoma

Some of the home remedies that may be helpful in Ewing’s sarcoma:

1)  Consumption of ginger in the form of ginger juice or with water helps in managing nausea and vomiting due to chemotherapy.

2)  Ginseng use helps relieve cancer-related fatigue.

3)  In peripheral neuropathy, glutamine is beneficial to reduce it. Also in mouth sores and soreness, it is helpful.

4) Zinc helps prevent taste changes occurs usually as aside effect of radiation therapy and chemotherapy.

5)  Herbal Remedies by Planet Ayurveda for Ewing’s sarcoma. It includes combinations of effective herbal formulations as CRAB CARE PACK. It is helpful in healing, reducing side effects, and complications associated with cancer treatment.

It includes the following remedies:-

1. Ashwagandha capsules

It has anti-oxidant and anti-inflammatory properties. It is helpful in the nourishing brain and for maintaining healthy well being.

Dosage- 2 capsules twice daily after meals.

2. Guggul capsules

Guggul has anti-oxidant property, so helpful in cell and tissue growth and repair.

Dosage-2 capsules twice daily after meals.

3. Curcumin capsules

Curcumin is the active constituent of the herb turmeric. It also possesses antioxidant, anti-inflammatory, and healing properties. So, it helps reduce free radicals in the body.

Dosage- 2 capsules twice daily after meals.

4. Tulsi capsules

Tulsi is traditionally used in houses, it has anti-oxidant properties and helpful in malignant tumors,

Dosage- 2 capsules twice daily after meals.

5. Chanderprabha vati

It is the classical ayurvedic formulation prepared from different herbs helpful in calming various conditions of the body.

Dosage- 2 capsules thrice daily after meals

6. Kanchnaar guggul

It is a polyherbal formulation having kanchnaar (Bauhinia variegate) and guggul (Commiphora Mukul) as the main active ingredients. It helps control various growths of the body and promotes the healthy growth of cells and tissues.

Dosage- 2 capsules thrice daily after meals

Diet and Lifestyle Changes

Ewing’s sarcoma has no direct correlation with any diet and lifestyle changes as its cause is supposed to be changed in the genes of some specific chromosomes. But following a healthy diet and lifestyle changes is beneficial for a healthy body.

Diet Changes

• Diet should be taken according to the body’s constitution.
• Biological fresh fruits, vegetables, cereals must be consumed as much possible.
• Consume herbal tea, butter, cheese, fresh nuts, milk, sprouts.
• Consume fresh meat and alternatives of meat in less quantity especially red meat.
• Reduce the use of meat in the growth phase.
• Increase the intake of water.
• Always try tale small frequent meals.
• If the patient has good metabolism and strength (pitta constitution) can have raw vegetables, sprouted food along with ginger and garlic, germ milk.
• Patients who underwent radiotherapy should use immunomodulators such as – ashwagandha, neem, dashmool, giloy, tulsi, pippali, Triphala, yashtimadhu, etc.

Lifestyle Changes

• Always do exercises, go for a walk.
• For mental and physical relaxation of the body should do meditation and yoga.
• For a healthy mind and nervous system listen to harmonious music that is smoothening, calming, healing.
• Maintain a healthy body weight

Other Precautions To Be Taken

As the exact cause of Ewing’s sarcoma is not known but the following preventions can be taken to prevent the body from getting harm:-

• Avoid snacks, junk, or fast food, and ready to eat food.
• Avoid or reduce the use of microwave ovens.
• Avoid smoking, taking alcohol, other drugs.
• Avoid unwanted exposure to harmful radiation.
• Never suppress the natural urges of the body as an urge to urinate or defecate.
• Get proper vaccination
• Maintain a healthy body by maintaining healthy body weight.

Conclusion

As we have studied ewings sarcoma is the rarest type of bone cancer and the ayurvedic approach to cancer diagnosis and treatment is a holistic approach and preferred these days. Many case reports and researches are available that show the efficacy of used herbs and treatment. The current treatment of cancer is focused at the molecular level than the whole organism level.

FAQ’S

1. What type of cancer is Ewing sarcoma?

Ewing’s sarcoma is the rarest type of cancer that forms in bone or surrounding tissues around a bone or anywhere in the body. It can occur in any bone of the body but most often occur in the pelvis, followed by femur bone (thigh bone), chest region, ribs, shoulder blades, arms, spine, feet, and hands.

2. Can adults get Ewing’s sarcoma?

Ewing’s sarcoma is a type of tumor that affects bones or surrounding soft tissues. It mainly occurs in children and young adults in people of ages 10 to 20 years. It is less common in adults usually.

3. What is the first sign of bone cancer?

Most common and first symptom and sign seen in Ewing’s sarcoma is the pain, swelling, tenderness, stiffness of the part, or area where the tumor is located. Pain can worsen with movement and at night. Also, it can become more severe and steady with time. The lump may present at the site of the tumor which may feel warm and soft to touch.

4. Has anyone survived Ewing’s sarcoma?

Ewing’s sarcoma has a high rate of getting cured. According to the five-year survival rate in localized Ewing’s sarcoma is 83% when it remains localized to the site of origin. The survival rate in Metastatic Ewing’s sarcoma when tumors spread to the body tissues is 70%. If Ewing’s sarcoma spread at the time of diagnosis its survival rate is about 37%.

5. How is Ewing’s sarcoma diagnosed?

Ewing’s sarcoma can be diagnosed based on physical examination, blood investigations, several medical imaging such as MRI, CT /CAT scan, PET scan, X-ray, bone scan, ultrasonography, biopsy, bone marrow aspiration.

6. Is Ewing sarcoma painful?

Pain is the most common symptom of Ewing’s sarcoma seen in 85% of children and young adults at the site of the tumor or nearby areas along with stiffness, swelling, redness, tenderness. Pain can become severe and can come and go at times. Pain often increases with exercise or doing the movement.

7. Does Ewing’s sarcoma run in families?

No exact cause is known of Ewing’s sarcoma and no evidence of genetic inheritance is seen. It is considered that it occurs due to changes in chromosomal patterns of tumor-forming cells. It clarifies that it does not run in families.

8. How can Ewing sarcoma be prevented?

As it is always good to follow a healthy diet pattern and lifestyle. Maintaining a healthy weight, avoiding alcohol, smoking, tobacco snd many more drugs that have degenerative effects in the body. But there are no lifestyle changes or diet pattern which can prevent Ewing’s sarcoma.

9. Can metastatic Ewing sarcoma be cured?

Metastatic Ewing’s sarcoma is a type in which the tumor spreads to other soft tissues of the body from the site of origin. The majority of the patients do not get cured completely and die of recurrent Ewing’s sarcoma. Also, it depends as if it spreads to the vital organs it becomes more difficult to treat. Continue investigations are done with treatment.

10. What does Ewing sarcoma look like?

Ewing’s sarcoma includes pain, stiffness, swelling, redness, and tenderness at or near the site of the tumor. The lump may be present over there which is warm and soft to touch often along with fever, tiredness, malaise, weight loss. Increase in pain with movement, at night.

REFERENCE

• Charak Samhita  by brahmanand Tripathi
• Sushrut Samhita by Ambika Dutt Shastri
• Dravyaguna vijnan by priyavart Sharma