trial is one of the final stages of a long and careful cancer research process. the search for new treatments begins in the laboratory, where scientists first develop and test new ideas. if an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. of course, treatments that work well in the lab or in animals do not always work well in people. studies are done with cancer patients to find out whether promising treatments are safe and effective. patients who take part may be helped personally by the treatment they receive. they get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. at the same time, new treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. there is no guarantee that a new treatment being tested or a standard treatment will produce good results. in children with cancer, a survey of trials found that those enrolled in trials were on average not more likely to do better or worse than those on standard treatment; this confirms that success or failure of an experimental treatment cannot be predicted. exosome research exosomes are lipid-covered microvesicles shed by solid tumors into bodily fluids, such as blood and urine. current research is being done attempting to use exosomes as a detection and monitoring method for a variety of cancers. the hope is to be able to detect cancer with a high sensitivity and specificity via detection of specific exosomes in the blood or urine. the same process can also be used to more accurately monitor a patient's treatment progress. enzyme linked lectin specific assay or ellsa has been proven to directly detect melanoma derived exosomes from fluid samples. previously, exosomes had been measured by total protein content in purified samples and by indirect immunomodulatory effects. ellsa directly measures exosome particles in complex solutions, and has already been found capable of detecting exosomes from other sources, including ovarian cancer and tuberculosis-infected macrophages. exosomes, secreted by tumors, are also believed to be responsible for triggering programmed cell death (apoptosis) of immune cells; interrupting t-cell signaling required to mount an immune response; inhibiting the production of anti-cancer cytokines, and has implications in the spread of metastasis and allowing for angiogenesis. studies are currently being done with "lectin affinity plasmapheresis" (lap), lap is a blood filtration method which selectively targets the tumor based exosomes and removes them from the bloodstream. it is believed that decreasing the tumor-secreted exosomes in a patient's bloodstream will slow down progression of the cancer while at the same time increasing the patients own immune response. complementary and alternative main article: alternative cancer treatments complementary and alternative medicine (cam) treatments are the diverse group of medical and health care systems, practices, and products that are not part of conventional medicine and have not been shown to be effective. "complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine. cam use is common among people with cancer; a 2000 study found that 69% of cancer patients had used at least one cam therapy as part of their cancer treatment. most complementary and alternative medicines for cancer have not been rigorously studied or tested. some alternative treatments which have been investigated and shown to be ineffective continue to be marketed and promoted. special circumstances in pregnancy the incidence of concurrent cancer during pregnancy has risen due to the increasing age of pregnant mothers and due to the incidental discovery of maternal tumors during prenatal ultrasound examinations. cancer treatment needs to be selected to do least harm to both the woman and her embryo/fetus. in some cases a therapeutic abortion may be recommended. radiation therapy is out of the question, and chemotherapy always poses the risk of miscarriage and congenital malformations. little is known about the effects of medications on the child. even if a drug has been tested as not crossing the placenta to reach the child, some cancer forms can harm the placenta and make the drug pass over it anyway. some forms of skin cancer may even metastasize to the child's body. diagnosis is also made more difficult, since computed tomography is infeasible because of its high radiation dose. still, magnetic resonance imaging works normally. however, contrast media cannot be used, since they cross the placenta. as a consequence of the difficulties to properly diagnose and treat cancer during pregnancy, the alternative methods are either to perform a cesarean section when the child is viable in order to begin a more aggressive cancer treatment, or, if the cancer is malignant enough that the mother is unlikely to be able to wait that long, to perform an abortion in order to treat the cancer. in utero fetal tumors are sometimes diagnosed while still in utero. teratoma is the most common type of fetal tumor, and usually is benign. in some cases these are surgically treated while the fetus is still in the uterus. racial and social disparities cancer is a significant issue that is affecting the world. specifically in the u.s, it is expected for there to be 1,735,350 new cases of cancer, and 609,640 deaths by the end of 2018. adequate treatment can prevent many cancer deaths but there are racial and social disparities in treatments which has a significant factor in high death rates. minorities are more likely to receive inadequate treatment while white patients are more likely to receive efficient treatments in a timely manner. having satisfactory treatment in timely manner can increase the patients likelihood of survival. it has been shown that chances of survival are significantly greater for white patients than for african american patients. the annual average mortality of patients with colorectal cancer between 1992 and 2000 was 27 and 18.5 per 100,000 white patients and 35.4 and 25.3 per 100,000 black patients. in a journal that analyzed multiple studies testing racial disparities when treating colorectal cancer found contradicting findings. the veterans administration and an adjuvant trial found that there were no evidence to support racial differences in treating colorectal cancer. however, two studies suggested that african american patients received less satisfactory and poor quality treatment compared to white patients. one of these studies specifically was provided by the center for intramural research. they found that black patients were 41% less likely to receive colorectal treatment and were more likely to be hospitalized in a teaching hospital with less certified physicians compared to white patients. furthermore, black patients were more likely to be diagnosed with oncologic sequelae, which is a severity of the illness in result of poorly treated cancer. lastly, for every 1,000 patients in the hospital, there were 137.4 black patient deaths and 95.6 white patient deaths. in a breast cancer journal article analyzed the disparities of breast cancer treatments in the appalachian mountains. african american women were found to be 3 times more likely to die compared to asians and two times more likely to die compared to white women. according to this study, african american women are at a survival disadvantage compared to other races. black women are also more likely to receive less successful treatment than white women by not receiving surgery or therapy. furthermore, the national cancer institute panel, identified breast cancer treatments, given to black women, as inappropriate and not adequate compared to the treatment given to white women. from these studies, researchers have noted that there are definite disparities in the treatment of cancer, specifically who have access to the best treatment and can receive it in a timely manner. this eventually leads to disparities between who is dying from cancer and who is more likely to survive. the cause of these disparities is generally that african americans have less medical care coverage, insurance and access cancer centers than other races. for an example, black patients with breast cancer and colorectal cancer were shown to be more likely to have medicaid or no insurance compared to other races. the location of the health care facility also plays a role in why african americans receive less treatment in comparison to other races. however, some studies say that african americans don't trust doctors and don't always seek the help they need and this explains why there are less african americans receiving treatment. others suggest that african americans seek even more treatment than whites and that it is simply a lack of the resources available to them. in this case, analyzing these studies will identify the treatment disparities and look to prevent them by discovering potential causes of these disparities.