NOTE: This section contains information about primary bone cancers (cancers that begin in the bone), which are very rare. It is much more common for bones to be the site of metastasis (spreading) from other cancers, such as breast, lung, or prostate cancer. For information about cancer that has started in another part of the body and spread to the bone, please see the information for that type of cancer.
Bone is a tissue. The human skeletal system is made up of more than 200 bones that protect the internal organs, allow people to stand upright, and attach to muscles that allow movement.
Bones are connected to other bones by ligaments, which are bands of tough, fibrous tissue. Cartilage is the tough, fibrous material that covers and protects the joints where bones come together. Bones are hollow and filled with marrow, the substance that produces blood cells.
Bone consists of soft fibrous tissue called collagen and calcium phosphate, a mineral that helps harden and strengthen the bone. There are three types of bone cells:
Osteoclasts break down and remove old bone.
Osteoblasts build new bone.
Osteocytes carry nutrients to the bone.
Cancer can occur in any of these parts of the bone. Cancer begins when cells in the bone change, grow uncontrollably, and form a mass called a tumor. Tumors can be benign (noncancerous) or malignant (cancerous). Even though benign tumors do not spread outside the bone, they can grow large enough to press on surrounding tissues and weaken the bone.
Malignant tumors can destroy the cortex (the hard outer portion of the bone) and spread to nearby tissue. Once bone tumor cells get into the bloodstream, they also can spread to other parts of the body, especially the lungs.
Bone cancer is rare and accounts for less than 1% of all new cancers. Osteosarcoma and Ewing’s sarcoma are two of the most common types of bone cancer and generally occur in children and young adults. Chondrosarcoma is cancer of the cartilage and is more common in adults.
Rare, soft-tissue sarcomas that begin in the bone include malignant fibrous histiocytoma (MFH) and fibrosarcoma. MFH makes up less than 1% of primary bone tumors. It is usually found in adults. The arms and legs, especially around the knee joint, are the most common sites for MFH to appear. Fibrosarcoma is also more common in adults, particularly during middle age, and most often begins in the thighbone. Paget’s disease of the bone generally occurs in older adults and involves the overgrowth of bony tissue.
Statistics
In 2008, an estimated 2,380 adults (1,270 men and 1,110 women) in the United States will be diagnosed with bone cancer. It is estimated that 1,470 deaths (820 men and 650 women) from this disease will occur this year. Primary bone cancers account for less than 0.2% of all cancers.
Osteosarcoma makes up 35% of all primary bone cancers, followed by chondrosarcoma (26%), Ewing’s Family of Tumors (16%), chordoma (8%), and malignant fibrous histiocytoma/fibrosarcoma (6%). There are other rare types of cancer that account for the remainder of cases.
Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with bone cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2008.
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors can raise a person's risk of developing bone cancer:
Genetics. Children with familial retinoblastoma (an eye cancer) have an increased risk of developing osteosarcoma.
Previous radiation therapy. People who have had radiation treatment for other conditions are at higher risk for developing bone cancer at the site of the radiation therapy. The majority of radiation therapy-caused bone cancers are osteosarcomas, but other types may also occur.
Chemotherapy. Some drugs, including alkylating agents and anthracyclines, used to fight cancer may increase the risk of developing a second cancer, usually osteosarcoma.
Benign tumors or other bone conditions. Paget’s disease may cause osteosarcoma. Other benign bone diseases, such as fibrous dysplasia, may also increase the risk of osteosarcoma.
Currently, there is no known way of preventing bone cancer. Early detection offers the best hope for successful treatment, so people with risk factors are encouraged to visit the doctor regularly. Still, most bone cancer occurs in people with no known risk factors.
People with bone cancer may experience the following symptoms. Sometimes, people with bone cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
When a bone tumor grows, it compresses normal tissue and destroys bone tissue, which can cause symptoms. The earliest symptoms of bone cancer are pain and swelling in the area of the tumor. The pain may come and go at first, then become more severe and steady later. The pain may worsen with movement, and there may be swelling in the soft tissues nearby. A tumor that occurs near or in joints may cause the joint to swell and become tender or stiff, which means a person may experience a limited and painful range of movement.
Some people experience a pronounced limp (if the leg is affected) or even a fracture in the affected bone. These symptoms indicate that the disease may be more advanced. Symptoms such as fever, malaise (feeling unwell), weight loss, and anemia occur rarely with bone cancer.
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
The following tests may be used to diagnose bone cancer:
Blood tests. Some laboratory tests may provide useful evidence in detecting bone cancer. Alkaline phosphatase and lactate dehydrogenase levels may be higher in patients with osteosarcoma or Ewing's sarcoma. However, it is important to note that alkaline phosphatase is normally high when cells that form bone tissue are very active (for example, when children are growing or a broken bone is mending), so high levels do not always mean cancer. Patients with chondrosarcoma may have abnormal glucose tolerance tests.
Imaging tests
X-rays, computed tomography (CT or CAT) scans, magnetic resonance imaging (MRI) scans, and bone scans can provide useful information about the location and spread, if any, of the tumor.
Benign and malignant tumors usually look different on imaging tests. Benign tumors have round, smooth, well-defined borders. Malignant tumors have irregular, poorly defined margins due to their aggressive growth. There may also be evidence of bone destruction on an image of a malignant tumor.
X-ray. An x-ray is a picture of the inside of the body. Typically, if an x-ray suggests cancer, the doctor would order other imaging tests.
CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
MRI scan. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI scans are useful to check for tumors in nearby soft tissues.
Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient's vein. It collects in areas of the bone and is detected by a special camera. Normal bone appears gray to the camera, and areas of injury, such as those caused by cancerous cells, appear dark.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination.
Integrated PET-CT scan. This scanning method collects images from both CT and PET scans at the same time, and then combines the images. This technique has the advantage of looking at both the structure and metabolism of the tumor and normal tissues. This information can be helpful in the planning of treatment and determining the benefits of different treatments.
Imaging tests may suggest a diagnosis of bone cancer, but a biopsy will always be performed to confirm the diagnosis and determine the subtype. It is vitally important for a patient to be seen by a sarcoma specialist before any surgery or a biopsy is performed.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy (needle or incisional) performed will depend on the location of the cancer.
For a needle biopsy, a small hole is made in the bone, and a tissue sample is removed from the tumor with a needle-like instrument. In an incisional biopsy, the tissue sample is removed after a small cut is made in the tumor.
Note: There are some cases where a biopsy may not be able to be performed.
Staging is a way of describing a cancer, such as where it is located, if and where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe a patient's condition in more detail. Specific tumor stage information for bone cancer is listed below.
TX: The primary tumor cannot be assessed.
T0: There is no evidence of a primary tumor.
T1: The tumor is 8 centimeters (cm) or smaller.
T2: The tumor is 8 cm or larger.
T3: There is more than one separate tumor in the primary bone site.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection.Lymph nodes near the site of the cancer are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Spread to the regional lymph nodes is rare for primary bone cancer.
NX: The regional lymph nodes cannot be assessed.
N0: The cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to the regional lymph nodes.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.
MX: Metastasis cannot be assessed.
M0: The cancer has not metastasized.
M1: There is metastasis to another part of the body.
M1a: There is metastasis to the lung.
M1b: There is metastasis to another organ.
Grade. A cancer may also be graded, which describes how much cancer cells look like normal cells under a microscope. If they look like healthy cells, the cancer is a low-grade tumor. If they look very little like healthy cells, the cancer is a high-grade tumor. A tumor's grade is described using the letter "G" and a number. The grade of cancer can help the doctor predict how quickly the cancer will spread.
GX: The tumor grade cannot be identified.
G1: The cancer cells are well-differentiated (the cells look more like normal cells).
G2: The cancer cells are moderately differentiated (the cells are somewhat different).
G3: The cancer cells are poorly differentiated (look very much unlike normal cells).
G4: The cancer cells are undifferentiated (do not resemble normal cells).
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications. In general, patients with the best prognosis have:
T1 or T2 tumors
Lower grade tumors (G1, G2)
Tumors that are easily removed with surgery, such as those located in the arms or legs
Localized tumors that have not spread
Certain genetic abnormalities
Stage IA: The tumor is low grade (G1 or G2) and 8 cm or smaller (T1). It has not spread to lymph nodes or to other parts of the body (N0, M0).
Stage IB: The tumor is low grade (G1 or G2) and 8 cm or larger (T2). It has not spread to lymph nodes or to other parts of the body (N0, M0).
Stage IIA: The tumor is high grade (G3 or G4) and 8 cm or smaller (T1). It has not spread to lymph nodes or to other parts of the body (N0, M0).
Stage IIB: The tumor is high grade (G3 or G4) and 8 cm or larger (T2). It has not spread to lymph nodes or to other parts of the body (N0, M0).
Stage III: There are multiple tumors of any grade in the primary bone site (T3), but they have not spread to lymph nodes or to other parts of the body (N0, M0).
Stage IVA: The tumor is of any size or grade and has spread to the lung (any T, N0, M1a, and any G).
Stage IVB: The tumor is of any size or grade and has spread to the lymph nodes (any T, N1, any M, and any G) or the tumor is of any size or grade and has spread to another organ (any T, any N, M1b, any G).
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002)published by Springer-Verlag New York, www.springer-ny.com.
The treatment of bone cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
For low-grade tumors, the primary treatment is surgery. The goal of surgery is to remove the tumor and a margin of healthy bone or tissue around the tumor to make sure all the cancer cells are gone.
For high-grade tumors, oncologists (a doctor who specializes in the care and treatment of people with cancer) often use multimodal treatment (using more than one strategy), including surgery, chemotherapy, and radiation therapy.
Surgery
Surgery for bone cancer often involves a wide excision of the tumor. A wide excision removes the tumor along with a margin of normal tissue in all directions. Limb-sparing techniques are used whenever possible. However, amputation may be performed depending on the tumor's size or location.
In recent years, wide excision surgical techniques have reduced the number of amputations performed on patients with bone cancer. About 75% to 80% of patients can be treated with conservative surgery compared with amputation. These surgeries often require prostheses, such as metal plates or bone from other parts of the body, to replace the missing bone and provide strength to the remaining bone.
For some patients, amputation may offer the best option. These include patients whose cancer is located where surgery cannot completely remove it, patients who cannot undergo reconstruction, or when the surgical area cannot be adequately covered with soft tissue. (Surgeons use soft tissue, such as muscle, to cover the reconstruction area. The tissue helps in healing and reduces the risk of infection.)
Children with bone cancer may require amputation more often than adults since their bones grow more. To avoid amputation, some children can be fitted for expandable joint prostheses that adjust as the skeleton grows. These prostheses require multiple operations to adjust bone length as the child grows.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy travels through the bloodstream to cancer cells throughout the body. Most chemotherapy is given by injection into a vein (called intravenous [IV] injection). Chemotherapy for bone cancer can usually be given as an outpatient treatment, which is treatment that can be given at a clinic or doctor's office instead of being admitted to a hospital.
Chemotherapy is often useful in cases in which a cancer has already metastasized. Fast-growing bone cancer can be treated with chemotherapy before surgery. This often reduces the size of the main tumor and may destroy tiny areas of metastasis if some of the cancer cells have already drifted into other areas.
Surgery alone is not usually sufficient treatment for patients with some bone cancers, particularly osteosarcoma. These cancers sometimes recur (come back) as distant metastases (most often in the lungs) that were most likely present in a microscopic form when the person was diagnosed. The use of chemotherapy regimens has dramatically increased survival rates for some types of bone cancer.
For most high-grade tumors, the oncologist gives chemotherapy for three to four cycles before surgery to shrink the primary tumor, so the tumor is easier to remove. Chemotherapy before surgery may also improve survival, since it may kill cells that have broken away from the original tumor. The tumor’s response to chemotherapy, observed under the microscope when the primary tumor has been removed, can be used to better determine the prognosis. Chemotherapy that is given before surgery is called preoperative chemotherapy, neoadjuvant chemotherapy, or induction chemotherapy.
After the patient has recovered from surgery, the oncologist will give more chemotherapy to kill any remaining tumor cells. This is called postoperative or adjuvant chemotherapy. The approach of shrinking the tumor, performing surgery, then giving more chemotherapy has saved many lives and many patients' limbs.
Some common chemotherapy drugs given to patients with bone cancer are ifosfamide (Ifex), methotrexate (MTX, Amethopterin), cyclophosphamide (Cytoxan, Neosar), etoposide (VePesid, Etopophos, Toposar), cisplatin (Platinol), doxorubicin (Adriamycin, Rubex), and dactinomycin-D (Actinomycin-D, Cosmegen).
In particular, Ewing's sarcoma responds well to chemotherapy. Some drugs used to treat Ewing's sarcoma are vincristine (Oncovin), dactinomycin-D, cyclophosphamide, doxorubicin, ifosfamide, and etoposide.
Because chemotherapy affects normal cells as well as cancer cells, may people experience side effect from treatment. Side effects depend on the drug and the dosage. Common side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Side effects usually go away when treatment is complete.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. External radiation therapy is given from a machine outside the body. Radiation therapy may be done before surgery to shrink the tumor, so it is more easily removed. Or, it may be done after surgery to eliminate any cancer cells left behind.
Radiation therapy makes it possible to do less extensive surgery, often preserving the arm or leg. Radiation therapy also damages normal cells, but since it is focused around the tumor, side effects occur mainly in those areas. Side effects of radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
For patients with Ewing's sarcoma, radiation therapy may also be used along with chemotherapy and surgery. However, oncologists have had good results in recent years using surgery for Ewing's sarcoma, with or without radiation therapy. Ewing's sarcoma that arises in bones that cannot be surgically removed is treated with chemotherapy and radiation therapy.
Radiation therapy plays a role in the treatment of bone cancer, most often for patients with tumors that cannot be operated on or may have cancer cells remaining after surgery. Radiation therapy may also be used to alleviate pain in advanced bone cancer.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to bone cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapeutic drugs or of radiation therapy to the pelvis, such as in women with uterine, cervical, or ovarian cancers. It can also be caused by certain tumors, such as pancreatic cancer.
Fatigue (tiredness). Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously affect family and other daily activities, can make patients avoid or skip cancer treatments, and may even affect the will to live.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Skin problems. The skin is an organ system that contains many nerves. Because of this, skin problems can be very painful. Because the skin is on the outside of the body and visible to others, many patients find skin problems especially difficult to cope with. Because the skin protects the inside of the body from infection, skin problems can often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapeutic drugs leaking out of the intravenous tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; pressure ulcers (bed sores) caused by constant pressure on one area of the body; and pruritus (itching) in patients with cancer, most often caused by leukemia, lymphoma, myeloma, or other cancers.
After treatment for bone cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. For bone cancer, follow-up care typically includes general physical examinations, blood tests, and imaging studies (such as a bone scan, CT scan, or x-rays) to check for signs that the cancer has come back. Tell your doctor about any new symptoms, such as swelling or bone pain, because they may be signs that the cancer has come back or signs of other medical conditions. Patients who undergo surgery for bone cancer, particularly amputation, often need physical therapy and other types of rehabilitative therapies. For more information, read Cancer Rehabilitation.
People recovering from bone cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For bone cancer survivors who smoke, quitting smoking may help recovery and reduce the risk of cancer recurrence. Learn more about Quitting Smoking.
Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What is my diagnosis, and what does it mean?
What type of treatment do I need?
What are the possible side effects of this treatment?
Am I eligible for a clinical trial?
What are the expected timelines for my treatment plan?
Research involving more advanced diagnostic procedures and treatment for bone cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Intraoperative radiation therapy. Clinical trials are evaluating the usefulness of radiation therapy given inside the body during surgery for some Ewing's tumors. This is called intraoperative radiation therapy or internal radiation therapy.
Myeloablative therapy. A supplement to the treatment options for Ewing's tumors is myeloablative therapy with stem cell support. Myeloablative therapy, an intense regimen of chemotherapy, destroys all cells that are dividing rapidly. This includes cancer cells but also some normal cells. Stem cells are cells that create all other types of cells in the body. They may be given to the patient after myeloablative therapy in order to boost the patient's recovery.
Doctors and scientists are always looking for better ways to treat patients with bone cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and therapies is the only way to make progress in treating bone cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bone cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
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