Stage 4 bone cancer, also known as metastatic bone cancer, is where cancer has spread from the bone to other parts of the body. Treatment is palliative, which aims to improve a person’s quality of life rather than cure the disease.

Stage 4 bone cancer, which people also refer to as metastatic bone cancer, is the most advanced stage. In this stage, the cancer has spread, or metastasized, from the original site in the bone to other parts of the body.

Doctors categorize cancer into stages. This staging depends on several key factors:

  • the size of the tumor (T)
  • whether the cancer has spread to nearby lymph nodes (N)
  • the presence of metastasis (M), which means the spread of cancer to distant parts of the body

These parts combine to determine the overall cancer stage, which doctors typically denote as stages 1 through 4, with higher numbers indicating more advanced disease.

Stage 0 represents in situ cancer, where atypical cells are present but have not spread to nearby tissue. Stages 1–3 indicate increasing tumor size or the involvement of nearby tissues and lymph nodes. Stage 4, the most advanced, signifies that cancer has spread to distant organs or body parts.

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To diagnose stage 4 bone cancer, doctors may use the following tests:

  • Imaging tests: Doctors use X-rays, CT scans, MRI, and PET scans to identify the location and extent of cancer.
  • Biopsy: A pathologist examines a sample of the affected bone tissue under a microscope to confirm the presence of cancer cells.
  • Blood tests: These may include alkaline phosphatase tests and other markers to assess bone activity and overall health.

Read more about tests for bone cancer.

The symptoms of stage 4 bone cancer can vary depending on the extent of the disease and where it has spread. Symptoms can be either localized at the original site in the bone or systemic, which affects the whole body. Symptoms may include:

  • Pain and swelling: Persistent pain, often worsening at night or with activity, is a common symptom. Swelling may also occur at the site of the tumor.
  • Fractures: Bones that become weakened by cancer can break more easily, sometimes with little or no trauma.
  • Reduced mobility: As the cancer progresses in the bones, it may lead to mobility difficulties, especially if it affects weight-bearing bones.
  • Weight loss and fatigue: Weight loss and persistent fatigue are common in advanced cancer stages.
  • Anemia: Symptoms such as fatigue, dizziness, and pallor, the latter of which refers to skin paleness, can occur due to anemia. Anemia is a condition where there are not enough healthy red blood cells to carry enough oxygen to the body’s tissues.

Read more about bone cancer symptoms.

Treatment of stage 4 bone cancer is usually palliative, which focuses on managing symptoms and improving a person’s quality of life. Treatment may include:

  • Chemotherapy: This can slow cancer growth and relieve symptoms.
  • Radiation therapy: This may relieve pain and control the growth of the cancer cells in the bone.
  • Surgery: In some cases, surgery can remove the tumor, alleviate pain, or stabilize the bone.
  • Targeted therapy: These are drugs that target specific aspects of cancer cells. For example, doctors may recommend hormone therapy for breast cancer that has spread to the bone.
  • Bone-strengthening medications: These include bisphosphonates to help strengthen bones and reduce the risk of fractures.
  • Pain management: This can include medication, physical therapy, and complementary therapies.

The American Cancer Society (ACS) determines the 5-year relative survival rates for various types of bone cancer based on people who have had cancer in previous years.

The following sections outline the typical outlooks for different types of primary bone cancer:

Osteosarcoma outlook

Osteosarcoma is the most prevalent form of bone cancer, typically occurring in the long bones of the arms and legs. It rarely appears in the tissue outside of the bone.

For localized tumors confined to the bone, the 5-year relative survival rate is 76%. This means that 76% of people with localized osteosarcoma are 76% as likely to be alive 5 years after diagnosis as those without it.

When the cancer is regional, meaning it has spread to nearby structures, the survival rate is 64%.

For cases where the cancer has spread to distant parts of the body, the rate drops to 24%.

Stage of osteosarcoma5-year relative survival rate


Chondrosarcoma usually begins in the bones or surrounding tissues, often affecting the hip, pelvis, and shoulder areas.

The 5-year relative survival rate for localized cases is 91%.

At the regional stage, where the cancer has spread to nearby areas, the survival rate is 76%.

For distant-stage chondrosarcoma, where the cancer has metastasized further, the survival rate is 17%.

Stage of chondrosarcoma5-year relative survival rate


Chordoma typically occurs along the spine or at the base of the skull.

The 5-year survival rate for localized chordoma is 87%.

In the regional stage, the rate is slightly lower at 84%.

For distant-stage chordoma, where the cancer has spread more extensively, the 5-year survival rate is 69%.

Chordoma stage5-year relative survival rate

People need to remember that statistics cannot predict individual outcomes. Some may live significantly longer than average, while others may have a shorter survival time.

Ongoing research and clinical trials continuously improve the understanding and treatment of bone cancer, which could positively affect future survival rates.

A person’s healthcare team can provide medical guidance, help manage symptoms, and offer referrals to other support services.

In-person and online support groups can provide a platform for sharing experiences and advice with others who understand the unique challenges of living with cancer. Organizations, such as the ACS or Cancer Support Community, offer such groups.

Many organizations dedicated to cancer support offer a range of resources, including information, financial assistance, and emotional support. Examples include the Bone Cancer Research Trust and the National Cancer Institute.

Stage 4 bone cancer is the most advanced stage and has a much more negative outlook than earlier stage cancers. A person may lose weight and experience fatigue and reduced mobility.

Treatment is often palliative, meaning it aims to improve a person’s quality of life rather than cure the cancer. People with stage 4 bone cancer and their carers can find support from online groups or national organizations.

Cancer resources

To discover more evidence-based information and resources for cancer, visit our dedicated hub.

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