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.
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 size and impact of the cancer and its metastases, thereby minimizing complications during surgery and improving recovery following the operation. Intraperitoneal chemotherapy, where chemotherapy is injected directly into the abdomen through a catheter, is also an option for ovarian cancer treatment.
In addition, clinical trials offering the latest treatment combinations and new therapies are available for our patients through Yale Cancer Center, a comprehensive cancer center designated by the National Cancer Institute, with the NRG Cooperative Group, and through investigator-initiated research trials.
Clinical trials for both previously untreated gynecologic malignancies, as well as for recurrent malignancies that may have initially failed to respond to chemotherapy—or other treatment modalities—are options.
New trials are available using PARP inhibitors, targeted therapies, and immunotherapies for the treatment of gynecological cancers and recurrent cancers.
Radiation oncologists with gynecologic expertise collaborate with our team to provide both brachytherapy and external beam radiation therapy for the management of cervical, vaginal, vulvar, and ovarian, and other gynecologic cancers. Our patients have access to the latest, most precise technologies, including image-guided intensity-modulated radiation therapy, and high-dose-rate brachytherapy.
The Yale Department of Radiology and Biomedical Imaging works closely with our team to provide state-of-the-art CT, MRI, and ultrasound exams to better assess gynecologic disease. Radiologists routinely consult with the physicians in the Gynecologic Oncology Program and review all available imaging to ensure proper diagnoses and optimal treatment plans can be made.
The Gynecologic Pathology team is a fundamental component in the prevention, diagnosis, and treatment of diseases of the female genital organs at Smilow Cancer Hospital. In addition to tissue diagnosis, team members participate in the real-time decision-making process for patients, including daily operative consultations, weekly tumor board conferences, and on-going clinical trial programs.
Surgery for benign disease
We routinely provide surgical management for patients with benign gynecologic conditions, particularly those that have previously had unsuccessful or complicated gynecologic surgery. Such conditions include endometriosis, extensive uterine fibroids (leiomyomas), recurrent ovarian cysts, pelvic pain, and pelvic organ prolapse.
Surgery for complications
Surgical expertise is available for patients to address complications resulting from gynecologic cancers, or for progressive disease. Procedures include small and large bowel resections, colostomies, fistula repairs, and repair of pelvic support for patients with gynecologic malignancies.
For the evaluation of women with abnormal Pap smear results, and for patients with possible recurrences of premalignant or malignant disease in the lower reproductive tract, we provide a full colposcopy program. We also offer laser, LEEP, and cold knife conizations for cervical cancer, as well as for certain vulvar and vaginal cancers.
Discovery to Cure Program
Yale physicians and scientists strive to improve the prognosis for women with reproductive cancers. Early detection, exceptional clinical care, and the development of novel treatment advances are the three cornerstones of the Discovery to Cure program.
In our early detection program, a team of physicians, sonologists, nurses, and genetic counselors collaborate to provide comprehensive, technologically advanced assessments for women at greatest risk for developing ovarian and other reproductive cancers. In addition, we provide genetic counseling and complete physical exams. Comprehensive clinical care is then provided by a multidisciplinary team of caregivers. Additionally, numerous clinical trials provide patients with access to the most advanced therapies at the forefront of care for ovarian, cervical, and uterine cancers.