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Cancer remains a major cause of global mortality, while late-stage diagnosis and therapeutic resistance highlight the need for individualized strategies. Nanotheranostics has emerged as a promising paradigm by integrating cancer diagnosis and treatment within multifunctional nanosystems. However, most current approaches remain technology-driven rather than truly patient-specific. This review examines the emerging convergence of adaptive nanotechnology, artificial intelligence (AI), molecular profiling, and precision medicine to develop intelligent nanoplatforms capable of responding to individual biological characteristics. Based on a literature search of PubMed, Scopus, and Web of Science (January 2010-June 2026), we review nano-enabled diagnostic approaches, including SERS-based nanoprobes and circulating tumor DNA detection, therapeutic strategies such as stimuli-responsive drug delivery, CRISPR-Cas9 nanodelivery, and personalized nanovaccines, and integrated multimodal imaging-guided theranostic systems. We further evaluate clinical trials and translational studies, highlighting biological, manufacturing, regulatory, and ethical barriers to clinical implementation. Although generalized nanoparticle platforms have reached Phase II/III trials and some have received regulatory approval, truly patient-specific nanotheranostic systems remain largely at early clinical stages. AI may bridge patient molecular profiles and nanoplatform design by optimizing nanoparticle properties, predicting biological interactions, and enabling personalized treatment selection. This review provides a roadmap toward adaptive, intelligent, and patient-specific cancer nanotheranostics, supporting a paradigm shift from generalized treatment toward precision-guided personalized healthcare.