The Smilow Cancer Genetics & Prevention Program is a team of specialists, including physicians, geneticists, genetic counselors, genetics clinical coordinators, and advanced practice providers, who work together to provide cancer genetics education and coordination of genetic testing to inform cancer risk assessment, precision treatment for patients with cancer, and surgical management decisions. Patients seen in the Smilow Cancer Genetics & Prevention Program will typically first meet with a genetic counselor, a genetics clinical coordinator, or have a combined visit with one of our specialty providers and a genetic counselor. Genetic counselors are licensed medical professionals with advanced training in genetics who help patients understand and adapt to the medical, psychological, and familial implications of genetic contributions to diseases such as cancer. Genetics clinical coordinators are key team members who enable expedited evaluation and genetic testing for patients who meet the criteria for genetic testing as part of our novel Fast-Track Program. An initial pre-test visit in the program typically includes the following: Detailed review of a patient’s medical history and their family history of cancer Risk assessment of the chance that the cancer(s) in the family are hereditary Discussion of the risks, benefits, and limitations of genetic testing Coordination of genetic testing and detailed discussion of genetic test results Discussion of appropriate medical management recommendations, implications for family members, and support resources Coordination of cascade testing, which is genetic testing of blood relatives of individuals with genetic pathogenic variants identified Our specific goals include the following: Clinical: Provide patient-centered care and foster collaboration among health care providers Research: Advance the field of cancer genetics, risk prediction and prevention, and related treatment options Education: Provide clinical/didactic experiences for genetic counseling students, medical students, residents, fellows, and other providers Community Outreach: Promote awareness of hereditary cancer risk and provide broad-based education about cancer prevention options Who may benefit from a hereditary cancer genetics evaluation and testing? Someone with: A personal or family history of early-onset cancer (age 50 years or younger) Several family members on the same side of the family with cancer A personal or family history of breast cancer and Jewish ancestry A personal or family history of ovarian, pancreatic, triple-negative breast cancer, or metastatic prostate cancer at any age A personal or family history of multiple colon polyps A personal or family history of multiple cancer diagnoses within the same individual A personal or family history of a rare type of cancer/tumor (breast cancer in a male, medullary thyroid cancer, sebaceous carcinoma, or adenoma) A family history of a known gene pathogenic v

Located at the Digestive Health Center at 8 Devine Street, the Gastrointestinal (GI) & Pancreatic Cancer Prevention Program is an interdisciplinary group of specialists who work together with the goal of providing patients with a personalized cancer risk assessment and taking steps to prevent the development of cancer. It includes the Lynch Syndrome and Polyposis and Hereditary Gastric Cancer Clinics, directed by Xavier Llor, MD, and the Pancreatic Cancer Early Detection Clinic (PCDC) , directed by James Farrell, MD. Our clinical team is committed to providing a comprehensive plan to help assist patients with risk assessment for gastrointestinal cancers, surveillance, surgical decision-making, and follow-up care. Patients with an identified familial or hereditary cancer risk will receive personalized recommendations for cancer risk management based on their own personal risk assessment. Individuals not suspected of having a genetic predisposition also receive personalized information on how to lower their cancer risk. These interventions can have a huge impact on a person’s life by allowing them to better manage their health and reduce their risk of ever developing cancer.

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