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Stage 4 metastatic bone cancer

This page was reviewed under our medical and editorial policy by

Lee M. Zuckerman, MD.

This page was updated on December 1, 2022.

When cancer cells break away from the original tumor, they may travel through the bloodstream or lymphatic system to other parts of the body. This spread of cancer to a new part of the body is called metastasis. When cancer spreads to a new area, it is still named after the part of the body where it started. For example, breast cancer that spreads to the bone is still called breast cancer, not bone cancer. Likewise, metastatic bone cancer, also called stage 4 bone cancer, forms in the bone and spreads to other areas of the body.

What is metastatic bone cancer vs. bone metastases?

Metastatic bone cancer occurs when primary bone cancer spreads to other parts of the body. This means the cancer started in the bone but later spread to another organ, tissue or body part. When cancer starts elsewhere in the body and spreads to the bone, the process is called bone metastasis. Cancers that may spread to the bone include:

There are also some cancers that develop from blood cells that can be found inside the bone. These include leukemia, lymphoma and multiple myeloma. These cancers can be found in the bone marrow, but are not considered primary bone cancers.

Primary bone cancer, called sarcoma, is very rare in adults but can occur at any age. The many different types of primary bone sarcomas are named based on the type or appearance of the cells forming the tumor. Bone cancer may occur in any bone in the body, but it most often develops in the long bones of the arms and legs. The information in this guide is about stage 4 metastatic bone cancer (sarcoma).

Metastatic bone cancer symptoms

Symptoms of metastatic bone cancer vary depending on the area to which the cancer has spread. For example, if the cancer spreads to the lungs, it may cause breathing difficulties.

Other common metastatic bone cancer symptoms include:

  • Unexplained pain or swelling
  • Lethargy or fatigue
  • Loss of appetite, nausea or vomiting
  • Unexplained weight loss

Metastatic bone cancer treatment

During metastatic bone cancer treatments, cancer experts create personalized treatment plans using conventional, evidence-based medical treatments to attack the cancer, while providing supportive care services designed to help reduce side effects.

The primary treatment for most types of metastatic bone cancer is anti-cancer drug therapy. Metastatic bone cancer treatments may include:

  • Surgery: The care team may perform surgery to remove affected cancer cells, depending on the stage, location and size of the bone cancer.
  • Chemotherapy: The cancer team may recommend chemotherapy to treat certain metastatic bone cancers. In some types of primary bone cancers, such as Ewing sarcoma and osteosarcoma, chemotherapy is recommended even if the cancer has not spread.
  • Radiation therapy: In some cases, the care team may recommend radiation therapy to target tumors that form due to metastatic bone cancer.
  • Targeted therapy: In some situations, specialized drugs are prescribed or administered to directly target receptors, proteins or gene mutations found only on specific cancer cells. The patient's care team will provide information on whether targeted therapy is recommended for his or her specific metastatic bone cancer type and location.
  • Bone-building drugs: Intravenous and oral bone-building medications may be used to help strengthen bones, prevent further metastases and reduce pain from metastatic bone cancer.
  • Pain management medications and steroids: To reduce the pain associated with metastatic bone cancer, the patient's care team may recommend pain medications, including steroids and prescription pain relievers.

In addition to treating the cancer, other palliative therapies may be used to help manage pain, discomfort, functional limitations and other side effects and to improve quality of life.

Metastatic stage 4 bone cancer survival rate

The prognosis for metastatic bone cancer varies from person to person and differs between the types of bone sarcomas. The American Cancer Society shares survival rates for metastatic bone cancer and metastatic osteosarcoma (a type of bone cancer). Keep in mind that these statistics only apply to cancer that forms in the bones and spreads elsewhere, not to cancers that form in other body parts and later spread to the bones.

The survival rates below are listed by the type of primary bone cancer and whether it's regional (meaning it's grown outside the bone, and in rare occasions, spread to local lymph nodes) or distant (meaning the cancer has spread from the initial location in the affected bone to a separate location in the same bone, another bone, the lungs or other areas separate from the primary cancer). There are also subtypes of these sarcomas that have different survival rates. For example, parosteal osteosarcoma has a higher survival rate than conventional osteosarcoma, while dedifferentiated chondrosarcoma has a lower survival rate than conventional chondrosarcoma.

Conventional osteosarcoma: Regional osteosarcoma has a five-year relative survival rate of 65 percent, and metastatic osteosarcoma has a five-year relative survival rate of 26 percent.

Conventional chondrosarcoma: The five-year relative survival rate for regional chondrosarcoma is 75 percent, and the five-year relative survival rate is 23 percent for metastatic chondrosarcoma.

Chordoma: Regional chordoma has a five-year relative survival rate of 85 percent, and distant forms of the condition have a five-year relative survival rate of 61 percent.

Malignant giant cell tumors of bone: The five-year relative survival rate for a regional malignant giant cell tumor of bone is 74 percent. Patients with distant metastatic giant cell bone tumors have a five-year relative survival rate of 42 percent.

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