Stage 4 Metastatic Sarcoma

January 22, 2026

This page was reviewed under our medical and editorial policy by Lee Cranmer, M.D., Ph.D., professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte.

Patients diagnosed with sarcoma may be given a disease stage number by their doctor. The stage describes the amount of cancer in the body and, most importantly, how widespread it is. The higher the number, the more the cancer has spread (metastasized). Doctors use the stage to help guide each patient’s treatment plan.

Stage 4 sarcoma cancer is the highest-numbered stage. It is sometimes called “advanced” or “metastatic” sarcoma. Just because someone has “stage 4 sarcoma,” it does not mean that there is no treatment or that someone cannot be cured of their disease in all circumstances. At City of Hope, we seek an optimal treatment for all patients. Even some patients who have “stage 4” are ultimately cured of their disease. Even if they are not, we work to help people live longer and better lives, irrespective of their stage.

About 16% of all patients diagnosed with soft tissue or bone sarcomas are diagnosed as Stage 4, according to the National Cancer Institute and a 2023 study in Cureus — although it may be as high as 50% being diagnosed at Stage 4 for certain subtypes. There are patients who are diagnosed with Stage 1-3 sarcomas that may develop disease that has spread, as in Stage 4. Considering all patients with malignant sarcomas, about half will ultimately develop metastatic disease that has spread to other parts of their body.

What Is Metastatic Sarcoma?

Metastatic sarcoma, or Stage 4 sarcoma, is when the cancer spreads from the place it started to a new (distant) site in the body.

Where Do Sarcomas Spread?

In general, metastatic sarcomas tend to spread first and foremost to the lungs. Researchers believe this is because these diseases tend to spread through the blood. For this reason, after someone has been diagnosed and treated for a sarcoma, some of the testing that they will have thereafter focuses on the lungs to determine whether disease is present there.

The disease may also spread to other sites, such as:

• The liver
• Other bones
• Lymph nodes
• The peritoneum (tissues lining the abdomen walls and organs)

Sarcomas may spread anywhere in the body. But when patients are being followed after their initial treatment, examinations or imaging of the other parts of the body than the lungs is guided by symptoms that patients may be experiencing. It is not routine to use imaging studies, such as CT scans, to examine the entire body.

Even though there are common areas where metastatic sarcomas tend to spread, they may metastasize to any part of the body. There are certain subtypes of sarcomas that may have the tendency to spread to other, specific parts of the body. If this is relevant to a given patient, the physician will discuss the particular risks with them and adjust the surveillance plan accordingly.

Metastatic Sarcoma Symptoms

Symptoms of metastatic sarcomas may vary depending on where the cancer started, its subtype and where it spreads to. Before the advent of modern imaging techniques, such as CT scans or MRI scans, the development of symptoms from sarcomas that had spread in the body was often the first indication that metastasis, or spread of the cancer, had occurred.

With the availability of modern imaging, many patients, if not most, have no symptoms of metastasis prior to their identification through imaging. Nevertheless, some people do have symptoms. The symptoms are related to the size of tumors, how many there are, and their relationship to other structures in the body. If symptoms do occur, they may include:

• Pain, including bone pain and abdominal pain that worsens over time
• Difficulty breathing
• A lump that is visible under the skin, especially on an arm or leg
• Fatigue
• Weight loss
• Fevers
• Swelling of a leg or arm

People experiencing these or other symptoms should talk to their doctor right away. The care team may recommend diagnostic tests to help pinpoint the underlying cause of these changes and understand if treatment is necessary.

Treatment Options

Patients who are diagnosed with Stage 4 sarcoma have several treatment options available, including surgery, radiation therapy, medications and supportive therapies.

Doctors look at a number of factors to recommend each patient’s treatment plan, including:

• The type of sarcoma
• Where the cancer has spread in the body
• If all the cancer is able to be removed with surgery
• Different tumor characteristics, such as size and grade (how abnormal the cancer cells appear)
• The person’s age and overall health profile

If the cancer has spread to multiple places in the body (such as to both lungs) and the doctors do not believe it is removable with surgery, patients may receive treatments with medicines. These are therapies that treat the whole body.

Systemic treatments may include:

• Chemotherapy, which uses drugs that destroy cancer cells. These medicines are very similar to antibiotics, which are used to treat infections. Indeed, many chemotherapy medicines were first identified as potential antibiotics.
• Immunotherapy, which uses drugs or other substances that help the body’s immune system fight cancer
• Targeted drug therapy, which uses drugs or other substances that find and target the abnormal changes (mutations) in sarcoma cancer cells in order to inhibit their ability to grow and thrive

Even in someone with Stage 4 sarcoma that has spread to other parts of the body, local treatments may be used. They target just the area where the tumor to be treated is located. For example, if a tumor is causing a patient pain or discomfort, it may be possible to remove it with surgery, or treat it with radiation therapy. While such treatment may not prolong someone’s lifespan, it may improve their quality of life.

For treatment of metastatic sarcoma, medicines are generally the main treatment. However, the most effective approach often combines a variety of different types of treatment. The patient’s care team will discuss and consider what might be the best combination of treatment for each individual patient.

People with advanced sarcomas may also receive supportive therapies. These are a variety of different treatments that may not be able to control the disease, but help treat their symptoms, making patients more comfortable and improving their quality of life.

Stage 4 Sarcoma Survival Rates

For patients with Stage 4 sarcoma, how long they will live is affected by many different factors. Every person is unique. When researchers talk about survival rates, they are talking about statistics that represent outcomes for many different people. These may be important to understand and use in making decisions, but they may not accurately reflect the anticipated outcomes for a given person.

For many types of sarcomas, and other cancers as well, doctors will often talk about the five-year survival rate. This means the percentage of people with a specific diagnosis who are anticipated to be alive five years after the diagnosis. There are some cancers, including sarcomas, where patients often live longer than five years. In those cases, it may be important to be very careful in selecting treatments, especially those with significant side effects.

In other types of sarcomas that grow more quickly, the rate of survival at five years gives a good idea of the aggressiveness of the disease and the efficacy of current treatments. Again, a rate indicates the outcome when many people are considered together. For a single person, the only statistics that count are zero percent or 100 percent. Nevertheless, statistics may be helpful in choosing the best course of action.

Here are some five-year survival rates for different types of sarcomas when they have spread to distant parts of the body. Cancer experts are constantly striving to improve treatments for patients and these percentages have improved substantially over the years.

• Stage 4 bone and joint sarcomas overall: 32.5%
• Stage 4 soft tissue sarcoma: 17%
• Stage 4 Ewing sarcoma: 41%
• Stage 4 chondrosarcoma, which forms in bone cartilage: 28%
• Stage 4 chordoma, which typically forms at the skull base or in the lower spine: 54%
• Stage 4 giant cell tumor of the bone: 39%

Sarcoma treatments are being continually researched to change these numbers. Clinical trials offer patients both the newest treatments available and the opportunity to partner with scientists in changing the landscape faced by sarcoma patients in the future. Every new treatment was, at some point, “experimental.” Clinical trials are the means by which potential new therapies become the standard treatments of the future. If clinical trials are available and appropriate, the care team will discuss opportunities to participate in such treatments.