Many cancer patients and their family members are very afraid of metastasis, thinking that once metastasis occurs, it is “the end”. Let’s look at the cases of two patients. The first one is a 65-year-old female patient who suffered from rectal cancer 3 years ago and had surgery. A month or so ago, she felt pain in her back and numbness and weakness in her left leg, and went to the hospital for examination and found that the metastatic cancer in the thoracic spine and the tumor was compressing the spinal nerve. Considering that the patient and his family were in the advanced stage of the tumor, they thought that surgery was meaningless, so they just did pain relief treatment. However, the patient’s pain became heavier and heavier, and the effect of painkillers became weaker and weaker. It was not long before the patient found that in addition to the increasing weakness of his legs, his bowel and stool became impaired, and soon the patient became paraplegic, unable to take care of himself, and was bedridden all day long, requiring care. The second patient, male, 60 years old, was found to have lung cancer 1 year ago, underwent surgery, and always paid attention to regular review. After the surgery, the pain in the lumbar back was significantly relieved, and the sensory-motor function of the lower limbs was normal. The patient died of respiratory failure due to recurrence of lung cancer 9 months after surgery. These two cases have in common that they are both elderly patients with advanced cancer and bone metastases. The difference is that the latter has not only prolonged survival than the former, but the latter has a much improved quality of life. Therefore, we can see that even with bone metastases cancer, active management can still bring benefits to patients. Then what exactly are the symptoms that patients with bone metastases will have? Pain is the main and most influential symptom. The causes of pain include tumor destruction of bone and secretion of various inflammatory factors to stimulate. The pain worsens progressively with tumor development and can even reach a generalized pain that is difficult to be controlled by medication. Intense pain can make patients go into depression. Mental discomfort, depression and difficulty in sleeping and eating can lead to both physical and mental breakdown. Metastases in the spine can compress the central nervous system leading to paralysis of the limbs, leaving the patient immobile and bedridden for long periods of time. Other complications include pathological fractures, swelling of the limbs, urinary retention, and intestinal obstruction. All of these symptoms can indirectly hasten the patient’s death. Which patients need to undergo surgical treatment? 1. If the bone metastasis occurs in an important area, such as the spine, and there is a risk of compressed nerve paralysis if left untreated, then aggressive treatment is recommended. 2. Bone metastases that destroy bones and cause fractures, most commonly in the femur and humerus, also require surgery to fix the fracture, because unlike traumatic fractures, these fractures can grow on their own. When a fracture does not occur but the bone is damaged, it is likely that the fracture will occur soon, it is also necessary to perform preventive surgery. 3. If there is only one metastasis in the whole body, then aggressive surgery may still give the patient a chance to be cured. The principle of surgery for bone metastasis cancer is simple. Through simple surgery, all the above cases can get pain relief and bone fixation, and can resume life as soon as possible. Of course, not all patients with bone metastases are suitable for surgical treatment. Patients with poor general health, multiple metastases in the lungs or brain, and those who cannot withstand surgical trauma are not suitable for surgical resection. Not every lesion needs to be surgically removed if there are multiple bone metastases throughout the body. These patients may be considered for some minimally invasive or systemic treatment, as described in the previous article. In conclusion, surgical resection is the simplest, most direct and effective treatment for bone metastases. Surgery can significantly relieve the symptoms and improve the quality of life. The advice for cancer patients with bone metastases is to promptly visit a specialized bone oncology department to provide individualized and comprehensive treatment strategies for patients.