It is important to have an aggressive and appropriate treatment program for patients with metastatic cancer to bone. Metastasis to bone should no longer be considered the beginning of the end. It should be an invitation for appropriate orthopedic oncologic involvement and management. Impending pathologic fractures of the long bones can be quickly and relatively easily managed with intramedullary rod fixation. Patients with adenocarcinoma should be monitored periodically to identify the focus of metastatic lesions early. Patients with large lesions previously considered disastrous can be managed successfully using modular oncology systems. Patients with metastatic cancer to bone deserve evaluation and management by orthopaedic oncologists familiar with their treatment.