Cancer is a leading cause of death in the United States. Despite the development of advanced treatment for many malignancies, a large number of patients will require evaluation and possible surgical intervention for lesions which have metastasized to or directly invaded the spinal column. The recommendations for operative intervention on these patients should be made following evaluations by multiple specialties, both medical and surgical. An improved understanding of the pathophysiology of malignancy and the development of advanced adjunctive treatment modalities have improved the quality and duration of life in many patients. Recent studies have demonstrated the utility of early surgery when combined with other treatment modalities. Surgical techniques for tumor resection and spine stabilization have improved the outcome of patients reported in multiple surgical series. A multidisciplinary approach to treatment of cancer patients with spinal involvement affords the patient an optimal outcome.