Metastatic tumors of the musculoskeletal system are all derived from cancers and sarcomas of other systems. Many primary tumors may have no clinical presentation and the initial presentation may be a bone lesion. Common bone metastases include prostate cancer, breast cancer, lung cancer, thyroid cancer, kidney cancer, and can also come from the gastrointestinal tract, such as gastric cancer and liver cancer. Bone metastases in children are less common and can come from neuroblastoma. Female reproductive system, such as cervical cancer and ovarian cancer, can also have bone metastasis. The general route for cancer cells to enter the musculoskeletal system is through arterial or venous blood flow. The most common sites of bone metastases are the spine and pelvis. According to statistics, if a comprehensive skeletal autopsy is performed when a person dies of cancer, about 60% of bone metastases can be found. The earliest symptom of metastatic cancer is pain, which can occur days or weeks prior to evidence of x-ray destruction. The pain can be deep, dull, intermittent and unrelated to activity. Pain usually wakes up at night, and nocturnal pain is a feature. In later stages, the pain can be severe and persistent. X-ray manifestation of metastatic cancer is mostly destructive and penetrating osteolytic changes. The metastatic lesions can sometimes stimulate the appearance of reactive bone and show an osteogenic state. osteogenic metastases are mostly seen in prostate and breast cancers. ct examination can evaluate the potential for pathological fracture. Most metastatic cancers can be diagnosed definitively by puncture biopsy, but sometimes the primary disease cannot be clarified due to poorly differentiated or undifferentiated cancer cells. Most of them require surgery in order to relieve pain, improve quality of life, prevent pathological fractures or prevent paraplegia.