In the United States in 1993 the American Cancer Society estimated that there were about 1, 300, 000 new cases of invasive cancer diagnosed. At the time of presentation about 70% of those patients represented limited local regional disease without evidences of distant dissemination. About 30% of the patients had demonstrated metastatic disease at the time of initial diagnosis or about 390, 000 patients. Of those patients with local regional disease about 56% would be cured by the best treatment programs including surgery, radiation therapy with or without chemotherapy when given for cure. Therefore, of the 1, 300, 000 new cases of invasive cancer, about 509, 000 would be cured by the best treatments available. However, about 790, 000 patients will have metastatic disease as a part of initial presentation or following the completion of definitive treatment. The majority of the patients with metastatic disease will have metastases to bone as the dominant site of metastatic disease primarily from cancers of the breast and lung but other metastatic sites will be common including lung, liver, mediastinal and retro-peritoneallymph node groups as well as brain and spinal cord. It has been suggested by SMITHERS, CARLING and WINDEYER that the management of the patient with metastatic disease or recurrent disease can be a more difficult problem in management than a patient who is treated for cure.
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