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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.


Local therapies

include surgery and radiation



Systemic therapies

include chemotherapy,

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

partial remission.


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

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

for 2


-line therapy. Some people may have many

remissions and recurrences, and require 3


, 4


, or

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

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?