NCCN Guidelines for Patients
Adolescents and Young Adults with Cancer, Version 1.2017
lacking energy (fatigue), the treatment team should
also set up a supportive care plan to prevent or
relieve these symptoms.
If the cancer does not change or continues to grow
during neoadjuvant treatment, your doctor may try a
different therapy such as a different chemotherapy
drug. The doctor can also stop neoadjuvant therapy
and move forward with surgery.
Primary or first-line therapy
Primary or first-line therapy is just what it sounds
like—the first attempt to get rid of (or control) the
cancer in your body. This can be done with local
therapies that target just the areas where cancer has
been found. It can also be systemic therapies that
attack cancer cells throughout the body. Treatment
can be delivered both locally or systematically or a
combination of both.
include surgery and radiation
targeted therapy, and immunotherapy. For
some patients, the best option for primary
therapy may be a clinical trial of a new
After the primary therapy is complete, your doctor will
run many of the same tests used during diagnosis
to see whether the treatment worked in removing or
controlling the cancer.
If there are no signs of cancer, you may be
declared to be in complete remission.
If some, but not all, signs and symptoms of
cancer have disappeared it may be called a
If the cancer has grown or spread to other
places in your body, it means the cancer has
A complete remission is great news, but it doesn’t
necessarily mean that every single cancer cell has
been destroyed. This is why additional rounds of
treatment are often given even after successful local
or systemic treatments.
Adjuvant therapy is given after a tumor (or tumors)
has been surgically removed or destroyed by
radiation. It is given after the primary treatment. The
goal is to get rid of any remaining cancer cells and
prevent a possible recurrence of the cancer. Adjuvant
therapy may include radiation therapy, chemotherapy,
targeted therapy, or immunotherapy, either alone or in
-line therapy (and beyond)
If cancer does not respond to initial therapy—or
reappears after a period of remission—it’s time
-line therapy. Some people may have many
remissions and recurrences, and require 3
even more lines of therapy. Treatment options in
these situations may include another round of the
first therapy that was given. This may be surgery,
radiation therapy, immunotherapy, targeted therapy,
chemotherapy, or a combination of all the above.
Clinical trials are also an option for treatment at any
stage of treatment.
Supportive care (also known as palliative care) is any
treatment that relieves your symptoms and improves
your quality of life. It can include everything from
radiation to shrink a painful tumor, to anti-nausea and
vomiting medication, to talking with a therapist about
handling stress at work.
For years, supportive care was thought of as the
treatment of last resort—something that was done
only when everything else had failed. This is no
longer true. Today’s clinical guidelines state that
supportive care should be included in every stage of
Navigating the treatment process
What are the stages of treatment?