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BC Cancer Agency Process

hi to all; I’d like to hear from people that have gone thru the BC Cancer Agency process.  How many people have had Chemo prior to surgery and why.  I’ve always thought surgery was 1st, then chemo.  I would think that chemo works better fighting against a smaller volume of cancer?  I meet with an oncologist in a couple of days, and I’m so concerned that I won’t be having a surgery scheduled.  Reason being, that you’d think your 1st appt. would be with a surgeon.  That’s why I’d like to know more about BC Cancer Agency’s process.  I just want the cancer out, before it spreads any further.   Am I allowed to be proactive in saying I’d like surgery as my 1st line of treatment? Sorry, as you can see, this is all I think about. I have to be patient for 2 more days👍


  • I @LUCY_BC I can't comment with any experience in the BC process, however, I can suggest , first of all, you order the guide By Your Side from OCC.  It will be enormously helpful in guiding your through diagnosis and first line treatment.  It will give you information and ideas about questions you should be asking at that first appointment.

    Secondly, generally speaking oncologists are of two types that directly treat us. The first a gynecological oncologist and they are surgeons. The other medical oncologists who are more focused on chemical treatment for cancer. Both usually collaborate on your treatment plan.

    Treatment plans differ. There is no one stop protocol that's better than another. Much is dependent on your type of cancer, the stage you are at, dispersion of cancer in your body...and multiple personal health factors.  But never feel you can't ask about options that have been considered and why they are not recommended.

    I am one who "needs to understand", so I drove my oncologist crazy with questions and didn't let up until I felt I clearly understood his answers. Fortunately mine had enormous patience.  But I can recall pressing and pressing to understand why traditional chemo is usually the infusion of two separate drugs and what each does separately and in combination. 

    I'm sure you'll be hearing from our gals in BC, there are lots of them. But in the meantime, do order By Your Side.  Chapter 5 on page 51 is full of information on treatment options and even provides a list of questions to think about and ask your oncologist when discussing your treatment plan.  You can get it soft and hard copy. I'd recommend ordering both since your appointment is imminent and you can get the soft copy immediately. I keep a hard copy of it, and Still By Your Side (for recurrence, which I am in) handy on my desk for ongoing reference.

    Good luck with your meeting. I hope all of your questions and concerns are addressed and you come out of it feeling fully supported. Let us know and do continue to reach out here or by joining our Teal Thursday live chats as the need arises. We've all walked in your shoes, and we 're all here to help support you.  
  • Hi,  

    I am also in BC.  I had one chemo prior to surgery and then 5 after.  Prior to the decision I did have a biopsy and it indicated I have low grade.  I was told that typically surgery first then chemo for low grade, while high grade they would have done 3 sessions of chemo first, they surgery and then 3 more chemo’s.  I had one chemo first as I was waiting for surgery and had ascities (fluid in my belly) they wanted cleared up prior to surgery.  

    I hope your appointment goes well, I have found all the medical staff I have dealt with to be really great. 
  • Yes, I agree....everyone that I’ve come in contact with, have been so, so nice.  May I ask, who your surgeon was?  Plus, the most important has your recovery been?
  • @LUCY_BC. I originally saw Dr. McAlpine but ended up with Dr. Lily Proctor as the surgeon.  I had a full hysterectomy and my Omentum removed.  I was in the hospital for 3 nights and the recovery went really well.  I had 5 chemos after surgery (every 3 weeks cycle).  I would have chemo on Monday and found Thursday /Friday I would feel a off but not too bad.  Then good for the next two weeks.  I still get Avastin every three weeks and take Letrozole and feel pretty normal ! 

    Have you met with the surgeon or oncologist yet? 
  • My 1st appt. with the Oncologist was yesterday and I had my biopsy today.  I learned that all the Gyno Oncologist surgeon’s have weekly conferences regarding how to treat each patient.  They will get together on May 18th to discuss my best approach (as long as they have the biopsy results back). The Oncologist seems to be leaning towards my treatment being 3 chemos first before surgery.  Not my choice, but I have to respect the specialists treatment plan. I’m hearing more and more, that chemo is used prior to surgery.  I will wait patiently (kind of) and wait for biopsy results and the surgeon’s decision.  I’ll go hat & scarf shopping😁 
  • The waiting is hard for sure.  I have heard they have meeting to discuss (the surgeon said - were your ears burning lol).  My surgeon had said that 3 chemos before is the standard.   Happy shopping for wigs and scarves.  I found some good ones on Amazon!
  • @LUCY_BC LOL, don't go hat and scarf shopping too soon. I did just that....and over spent to boot.  Only to find I had an allergy to the Paclitaxel which is the chemo drug that causes hair loss. So I was switched to Gemcitabine as the second drug in combination with the Carboplatin prescribed for me, neither causing anything more than a wee bit more natural thinning of my hair. So I ended up filling up the bin at my cancer clinic with my donations.  
  • Interesting point, thank you.  May I ask what type of reaction you had with Taxol?  My Mom had a reaction to the carboplatin, her whole body felt like it was on fire.  They finally put her on a slow drip and that helped.
  • @LUCY_BC The taxol issue was five years ago and my first time in chemo.  i went in for my first treatment and they started with it. Within the first few seconds I suddenly got major cramping all around my abdomen and lower back, tightness in my chest, a red flush that started at my chest and travelled upward.....but more important my BP dropped way down.  The nurse was there, so as soon as I called out she stopped the drip and then they administered a cortosteroid to mellow me out and rushed me up to acute care.  The blood pressure problem indicated I could possibly have a heart attack so I spent 7 hours up there having it all flushed out of my system and under observation.  Taxol sensitivity is not unusual, but mine was a one in million in intensity. Generally, it's all managed just fine with slower drips and desensitizing drugs.  But they weren't willing to chance another try for me so that's what prompted the switch to Gemcitabine. 

    This time around I developed a sensitivity to the Carboplatin. No problem at all with it five years ago. But this time, about half way through my 5th cycle my palms turned red and started itching and my sinuses plugged up so I knew immediately I was reacting.  We stopped it, injected a cortisone and I was fine in 15 minutes.  I went back the next week to try again with a slower drip, some extra premeds, and heavy premed dosing day of and still reacted, this time before they could finish even a quarter of the dose.  So there was no point trying again and they've switched me to Cisplatin since I'm very platinum sensitive and so far so good after two treatments using it.  As I understand it it's not at all unusual to build up an intolerance to the Carbo over time. In fact pretty unusual that it didn't happen five years ago.  

    In either case, don't let it all scare you.  I never felt for a moment that the nurses and staff in the chemo room weren't totally in control and I was never in any danger.  And as for discomfort, they move so fast to counter the effects that you're back to normal incredibly quickly.  

  • @LUCY_BC. I am being treated by bc cancer.  My surgeon was Dr Proctor, a wonderful, kind and caring doctor.  I had tumour and ovaries and fallopian tubes removed and diagnosed at a local hospital and then referred to vancouver cancer clinic. My gynecologist, who has since retired, said he preferred to treat with chemo for 3 treatments, surgery and three more.  My first chemo I reacted poorly for many days.  What I didn't realize is that if i had  phoned the chemo helpline, I could have avoided all the issues.  They are there to help.  Phone as many times as you need to.  I also had a  reaction to taxol. The nurses are very attentive when this drug is being given, and monitor your condition closely.  Let them know if you feel anything different, perhaps even just a warm hot face and chest.  For me treatment was stopped, oxygen and drugs given and then we tried again at a slower rate.  I still had a reaction and they slowed it again, and was tolerated. The nurses in chemo are fantastic.  
    What I really wanted to share with you is that there is a wonderful hat store in Granville Island.  Tell the store you are a cancer patient and they give you a discount!