Departments

The Department of Therapeutic Radiology works closely with the Yale Cancer Center to comprehensively evaluate and treat patients in need of any form of radiation therapy. We are widely known for our innovative approach to treatment, and have extensive experience in the following specialized areas: Breast cancer radiotherapy Central nervous system radiotherapy Gastrointestinal radiotherapy Head and neck radiotherapy Pediatric radiotherapy Prostate and genitourinary cancer radiotherapy Spine radiosurgery Stereotactic body radiotherapy (SBRT) and Gamma Knife® radiosurgery Thoracic radiotherapy Total skin electron beam therapy (TSEBT) Our primary goal is to ensure our patients receive the right amount of radiation at the tumor site, with as little impact as possible on the surrounding healthy tissue. Our treatment planning program, also known as medical dosimetry, is focused on just that, providing a highly individualized external or internal radiation treatment course for each patient. Site of the only Gamma Knife® center in Connecticut One of the largest U.S. centers for stereotactic body radiotherapy (SBRT) First program in Connecticut to incorporate SpaceOAR hydrogel technology in prostate radiotherapy First and only program in New England to combine SpaceOAR technology with Calypso radiofrequency tracing for precision prostate surgery

The focus of the team of clinicians who form the Gynecologic Oncology Program at Smilow Cancer Hospital is to provide comprehensive and compassionate care for women with gynecologic cancers. Women diagnosed with vulvar, vaginal, cervical, uterine, fallopian tube, or ovarian cancers are provided with exceptional care from Yale’s experienced team of gynecologic oncologists at the hospital’s dedicated Women’s Center. In addition, the team also treats soft tissue tumors of the pelvis, gestational trophoblastic disease, as well as women with precancerous changes that have been identified in the vulva, vagina, and cervix, including dysplasia and carcinoma in situ, or premalignant changes of the endometrium, including adenomatous hyperplasia. The physicians of the Gynecologic Oncology Program offer a wide spectrum of advanced strategies for the diagnosis and treatment of gynecologic cancers, including colposcopy evaluation, conformal radiotherapy, and novel, targeted chemotherapies. The multidisciplinary program has experts from the obstetrics, gynecology, and reproductive sciences; radiation oncology; radiology and biomedical imaging; genetics; pathology; pharmacy; and social work. A dedicated patient coordinator facilitates patient appointments and communication, coordinates services, and supports each patient and their family. Surgery for previously untreated gynecologic cancer Surgical treatment of cancer is the most common option for previously untreated cancers. These operations include radical hysterectomies for cervical cancer, cytoreductive surgery for ovarian cancer, radical vulvectomies for vulvar cancer and total abdominal hysterectomies, bilateral salpingo-oophorectomies, and lymphadenectomies for the staging and treatment of endometrial cancers. Conventional laparoscopic and robotic surgery is available to women in need of surgery for uterine cancer, as well as for removal of the uterus, tubes, and ovaries. Prophylactic surgery, including hysterectomy, bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian conservation, is also available to women looking to prevent ovarian cancer occurrence. Preservation of fertility in women with gynecologic cancers whenever possible is always a priority. We perform radical trachelectomies in women with early-stage cervical cancer who desire fertility preservation. For women with early-stage, low-grade endometrial cancers, hormonal therapy is prescribed. Chemotherapy Management The Gynecologic Oncology Program provides a full spectrum of chemotherapeutic agents used in the management of ovarian cancer, fallopian tube cancer, uterine cancer, mesenchymal tumors of the uterus, cervical cancer, vaginal cancer, and vulvar cancer. These chemotherapeutic agents may be used either for primary treatment or treatment of recurrent disease. Neoadjuvant chemotherapy, i.e., chemotherapy prescribed before surgical treatment, is often used for women with advanced ovarian cancer to reduce the s

Yale Cancer Center is Connecticut's only cancer center designated as a Comprehensive Cancer Center by the National Cancer Institute—and one of only 57 in the nation. The significance of this designation has profound implications for those who choose Smilow Cancer Hospital as the place where they will be cared for and receive treatment for their cancer. National Cancer Institute cancer centers are national leaders in cancer research, prevention, detection, and treatment. This provides patients at Smilow Cancer Hospital with novel treatment options and expert care.

Established in 1990, the Ovarian Cancer Early Detection Program provides women with new methods for the prevention, early detection, and treatment of gynecologic cancers. The direct connection between the research lab and patient care makes ours the leading center for women’s reproductive cancer research and treatment. The ovary is the fifth most common site for cancer to develop in American women. However, it is the fourth leading cause of cancer deaths in American women. There are more deaths from ovarian cancer than from cervical and uterine cancers combined. The program aims to identify ovarian cancer in its early stages when it is highly curable. We are committed to providing a comprehensive approach to treating reproductive cancers. Our multidisciplinary team is composed of physicians, scientists, nurses, genetic counselors, geneticists, and other medical staff. The Ovarian Cancer Early Detection Program was established in order to identify: Screening tests that are the most appropriate for detecting early ovarian cancer The frequency with which these tests should be employed How frequently these tests are normally performed We offer the following specialized services for women: Risk assessments, including genetic counseling and physical examinations The latest surgical interventions and postoperative treatment New diagnostic imaging and ultrasound technologies Opportunities for women with normal physical and ultrasound examination results and also for women with ovarian cancer to participate in approved clinical trials to develop new treatments Our approach to ovarian and other gynecological cancers is rooted in a program called Discovery to Cure, a broad initiative launched by Yale to combat all reproductive cancers. The program combines the cutting-edge research we do in the lab with a multidisciplinary team approach to patient care and the latest early detection methods.

The Oligometastatic Cancer Program at Smilow Cancer Hospital consists of a multidisciplinary team of nationally recognized physicians and clinicians who are experts in providing care for patients with oligometastatic cancer. Oligometastatic cancer is a concept in oncology that describes a state of cancer progression in which the cancer has spread, but only to a few specific areas. Unlike widespread metastatic disease, where cancer has spread extensively to distant organs, oligometastasis involves a more localized and contained pattern of metastatic spread. Effectively, oligometastatic cancer represents a middle ground between localized cancer (cancer of one area) and widespread metastatic cancer. The clinical significance of identifying patients with oligometastatic cancer lies in its potential for more targeted and aggressive treatment approaches. Unlike widespread metastatic disease, where the primary goal may be palliative or to control symptoms, oligometastatic cancer offers patients an opportunity for interventions that can lead to a cure. This identification has been facilitated by advancements in imaging technologies, particularly the use of positron emission tomography (PET) scans. These sophisticated imaging techniques enable our clinicians to detect and visualize small numbers of metastatic sites that might be overlooked by conventional imaging methods. Here at Smilow Cancer Hospital, our multidisciplinary teams treat oligometastatic disease using the following treatment types: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Hepatic Artery Infusion (HAI) The concept of oligometastatic cancer has gained increasing attention in the field of oncology, leading to clinical trials and extensive research aimed at refining its definition, understanding its behavior, and determining optimal treatment strategies. It is important to note that all cancer types are different and do not show an oligometastatic pattern, and the relevance of this concept varies across different tumor types. The management of oligometastatic cancer requires a personalized and multidisciplinary approach, considering factors such as the primary tumor type, the location of metastases, overall patient health, and treatment goals. Our team of clinicians collaborates directly with patients to identify the presence of oligometastatic disease, establish a tailored treatment plan, and enhance outcomes for patients in this unique stage of cancer progression. For gastrointestinal oncology-related appointments, view the profile of Kiran Turaga, MD, MPH . For gynecologic oncology-related appointments, visit the profile of Elena Ratner, MD, MBA .

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique that delivers high doses of heated chemotherapy directly to abdominal organs to kill cancer cells that may remain after the surgical removal of visible tumors. It is typically used in combination with cytoreductive surgery to treat advanced-stage abdominal cancers such as peritoneal mesothelioma, stomach cancer, appendix cancer, and colorectal cancer, as well as ovarian cancer. Smilow Cancer Hospital physicians are national leaders in the delivery of HIPEC therapy, with a deep understanding of the types of cancer it can be used to treat, the nuances of the therapy, and its effectiveness. Clinical trials using HIPEC therapy are also available. Hyperthermic (or heated) intraperitoneal chemotherapy, called HIPEC for short, is a treatment for cancers that begin in or have spread to the thin layer of tissue that lines the abdomen and abdominal organs known as the peritoneum. After a surgeon removes all visible tumors from the abdominal (peritoneal) cavity in a procedure called cytoreductive surgery (CRS), heated chemotherapy drugs are pumped into the abdomen where they bathe abdominal tissues for about 90 minutes before being drained and rinsed from the abdominal cavity. In many cases, the goal of the treatment is to cure patients of cancer by killing any cancer cells that remain after cytoreductive surgery. HIPEC is used to treat cancers in the peritoneum, including those that have spread—or metastasized—from the gastrointestinal tract, colon, appendix, and ovaries, among other organs, as well as cancerous tumors that started in the peritoneum. Cancer that originates in the peritoneum is very rare. However, each year, around 60,000 people in the United States are diagnosed with metastatic cancer that has spread to the peritoneum from elsewhere in the body. People with these cancers often experience debilitating symptoms, including abdominal and back pain, nausea, constipation, and fatigue, and can have a poor prognosis. However, HIPEC, combined with cytoreductive surgery, can improve the outlook for many people with these types of cancers, helping them live longer and with an improved quality of life. For some people, HIPEC can result in a long-term cure. In other cases, with HIPEC, doctors can manage incurable cancers as chronic illnesses rather than as terminal diseases. The benefits of HIPEC include: HIPEC delivers a concentrated and targeted dose of chemotherapy . In HIPEC, highly concentrated chemotherapy is delivered directly to the inner lining of the abdomen, where it comes into contact with and kills cancer cells. By contrast, traditional chemotherapy is a “systemic” treatment: It is infused into the blood and reaches cancer cells by traveling through blood vessels. Unfortunately, traditional systemic chemotherapy is often ineffective in treating cancers in the peritoneum. This is due, in part, to the peritoneal-blood barrier, which obstructs the delivery of chemotherapy. Few

Yale’s Department of Obstetrics, Gynecology and Reproductive Sciences is dedicated to helping women at all stages of life. A global leader in women’s health, Yale is known for its innovative contributions to diagnosis and treatment, including: Developing the first fetal echocardiography Pioneering the first obstetrical ultrasound Developing the first fetal blood sampling and first fetal transfusion Offering the first chorionic villus sampling in New England Co-authoring the first U.S. study for first-trimester risk assessment Developing the first comprehensive first-trimester risk assessment program in New England Inventing fetal monitoring and many prenatal diagnostic and treatment techniques Our physicians tap into the broad expertise of our entire institution to provide compassionate, customized care for all of our patients, from adolescence through adulthood. Through eight subspecialty areas, we offer the most advanced diagnostics and therapies that harness the latest advances in technology. Recent clinical research includes a new emphasis on therapeutic vaccines in gynecologic oncology, novel treatments for endometriosis and menopause, a comprehensive patient safety program in maternal-fetal medicine, and an advanced fetal therapy program. Specialized care is offered in the following areas: Family planning Gynecologic oncology Gynecologic specialties Maternal-fetal medicine Obstetric specialties & midwifery Pediatric & adolescent gynecology Reproductive endocrinology & infertility Urogynecology & reconstructive pelvic surgery Maternal-fetal medicine service offers 24-hour on-site dedicated space for complex pregnancies and fetal care First in Connecticut to perform in-utero laser therapy in pregnancies complicated by twin-to-twin transfusion syndrome Outstanding survival outcomes for all types of gynecologic surgery, from open to robotic Pioneer in caring for patients with sexual intimacy issues after cancer surgery Fetal therapy program Midwifery and birthing center

Our program has a long history of developing and utilizing various brachytherapy procedures for gynecologic malignancies. We evaluate patients in a multidisciplinary fashion in conjunction with physicians from Yale Cancer Center’s Gynecologic Oncology program. We recommend individualized treatment programs after consultation with both gynecologic oncology and radiation oncology services. Our team has significant experience in caring for and treating women with all types of gynecologic malignancies. Our available therapies include external beam radiotherapy, intensity-modulated radiation therapy (IMRT), and treatment strategies combining external beam and brachytherapy (both interstitial and intracavitary). Chemotherapy is also available and can be incorporated into treatment plans.

The Hepatic Arterial Infusion (HAI) Program at Smilow Cancer Hospital consists of a multidisciplinary team of nationally recognized physicians who are experts in diagnosing, treating, and providing care for patients with colorectal cancer , cholangiocarcinoma (bile duct cancer), and liver cancer . HAI is a specialized and targeted approach to deliver chemotherapy directly to the liver, primarily used in the treatment of advanced liver metastases from colorectal cancer, in addition to intrahepatic cholangiocarcinoma. Traditional systemic chemotherapy and immunotherapy may not provide enough concentration of the drug within the liver while minimizing exposure to the rest of the body. The procedure involves implanting an HAI pump (the size of a hockey puck) under the skin between the patient’s ribs and pelvis. The pump contains a catheter connected to the hepatic artery, the main blood vessel that supplies the liver with blood. This catheter allows for the direct infusion of chemotherapy drugs into the arterial blood supply of the liver. By administering chemotherapy directly to the affected organ, HAI will maximize the concentration of the drugs in the tumor tissue while minimizing their dilution and distribution throughout the rest of the body. The procedure typically lasts about three hours, and the pump will remain in the patient for several years. Patients will need to visit their doctor every two weeks to have the pump filled with chemotherapy, which takes approximately 10 minutes. Generally, patients will not notice the presence of the HAI pump, but should avoid rigorous physical activity, contact sports, or exposure to extreme heat, which could allow too much chemotherapy to enter the liver. The benefits of HAI include: Fewer side effects: The HAI pump allows for chemotherapy to be released directly into the liver, which is significantly more effective than traditional chemotherapy treatment. This chemotherapy remains in the liver and does not circulate throughout the patient’s body, thus limiting the side effects of treatment. Better outcomes: Chemotherapy is released into the liver continuously and is highly effective in reducing the recurrence of, controlling, or shrinking cancerous tumors in the liver. While uncommon, the HAI procedure does present a risk of complications, including infection, bleeding around the pump, or damage to the hepatic artery. Patients can be assured that our clinicians have extensive processes and procedures in place to ensure that risks are reduced before, during, and after surgery. Despite its benefits, HAI is not suitable for all patients. It is typically considered when the cancer is confined to the liver and systemic disease is limited. Patient selection is crucial, and our multidisciplinary team of medical oncologists, surgical oncologists, and interventional radiologists collaborate to determine the most appropriate candidates for this treatment.