Departments

The Head and Neck Cancers Program at Smilow Cancer Hospital provides total care, as well as innovative and organ-sparing treatment options to patients with cancers of the head and neck. Our team sets the tone nationally and internationally for clinical trials and state-of-the-art cancer care. By carefully balancing treatment efficacy with quality-of-life, our collaborative approach to care personalizes treatment for tumors affecting the neck, larynx (voice box), pharynx (throat), oral cavity (mouth), ear, sinuses, tonsils, and salivary glands, as well as cervical (neck) lymph nodes or neck structures. Our multidisciplinary team includes head and neck surgeons, radiation oncologists, medical oncologists, pathologists, physical therapists, speech-language pathologists, nutritionists, a smoking cessation specialist, dentists, a physical/lymphedema therapist, advanced practice nurses, and social workers. Functional outcome is an important element in deciding which treatment approach is recommended. Our program offers a promising new surgical technique, transoral robotic surgery (TORS), that can be used to remove certain throat cancers while avoiding skin and bone incisions. This approach speeds healing and shortens a patient’s hospital stay. Likewise, patients with certain laryngeal cancers, who a few years ago would have lost their vocal cords and their voices, can often be treated with less invasive surgeries. Patients who undergo these treatments maintain their ability to speak, although they may need to alter their diet or learn new swallowing techniques. At Yale, rehabilitative specialists work with patients to help them adjust to and overcome some of these swallowing impairments. In many cases, radical neck dissections have been replaced by less radical surgeries that preserve the nerves, arteries, and muscles in the neck. Patients continue to move, speak, breathe, and eat normally after less radical surgeries, without sacrificing cure rates. Additionally, in recent years, the field of reconstructive surgery has achieved many breakthroughs, yielding previously unattainable cosmetic and functional outcomes. Medical Oncology Our medical oncologists have unique expertise in head and neck cancers and dedicate their practice entirely to cancers of the head and neck. The integration of chemotherapy with radiation has become very important for patients with head and neck cancers that involve the lymph nodes or is locally extensive, and this approach can lead to organ preservation and increase the chance of cure for many patients. Breakthroughs in targeted therapy and biomarkers allow a personalized approach that can avoid the toxicities of conventional chemotherapy in some cases, and new treatments to prevent recurrence in high-risk situations are also being studied. For patients with recurrent disease, new anti-cancer drugs and immunotherapies are also available. A study led by Yale Cancer Center revealed that the checkpoint inhibitor pembroli

The Cancer-Infectious Diseases (Cancer-ID) Program is an integrated multidisciplinary clinic that will provide supportive consultative services to people with HIV and cancer. Dedicated HIV/ID specialists from Yale Medicine will work closely with the patient’s oncology care team to manage care for patients with HIV undergoing cancer treatment. A team of providers, including surgical oncologists, medical oncologists, radiation oncologists, and pathologists, will provide consultative services for people with HIV with hematologic malignancies, gastrointestinal, genitourinary, head and neck, thoracic, dermatologic, and breast cancers, as well as those with Kaposi Sarcoma, liver, gynecologic, and neuro-oncologic malignancies. Access to a wide variety of support services and clinical trials is also available. People with HIV have higher rates of cancer incidence compared to uninfected individuals. In addition, they have worse outcomes after a diagnosis of cancer. Because the majority of cancer clinical trials do not include patients with HIV among their study population, there is little evidence-based guidance with regard to cancer care for these patients. What’s more, the patient experience may additionally suffer because this patient population includes an underserved and understudied group who are often impacted by health inequities and health disparities. With the advent of immune-based therapies and personalized approaches to cancer care, the lack of data within the HIV population to guide treatment decision-making further impacts health disparities among this underserved population. The Cancer-Infectious Diseases, or Cancer-ID program, was established in July 2022 to provide consultative care to patients with HIV who are also diagnosed with cancer. Brinda Emu, MD, serves as the director of the Cancer-ID program. She and Mark Lustberg, MD, are HIV specialists with a specific interest in cancer care and will see patients on a consultative basis. The Cancer-ID program will be located within the Yale Center for Infectious Disease, which is directed by Lydia Aoun-Barakat, MD. The program additionally has the support of Yale Cancer Center leadership. It is led by Jill Lacy, MD, and a large network of consultative affiliated oncology faculty members across all oncology disease areas, who serve as liaisons and ambassadors within the Yale Cancer Center to ensure appropriate and timely care to patients with both HIV and cancer, including access to clinical care and ancillary services. There are three main goals of the Cancer-ID program: Provide consultative care to patients with both HIV and cancer to facilitate and manage both HIV infection and cancer care throughout and beyond cancer treatment Improve the patient experience while receiving cancer care Identify and engage patients in research activities and clinical trials when appropriate The program additionally hopes to build expertise in the clinical care of cancer among people with HIV, provide ou

The Palliative Care Program at Smilow Cancer Hospital focuses on symptom management and quality of life concerns for adult patients with serious chronic progressive or terminal illnesses. We center our care on patients and families, and help them deal together with their loved ones’ physical issues such as pain, fatigue, and nausea, as well as with psycho-social issues like depression, disruption of family life, and financial concerns. Each patient consultation includes a comprehensive review of medical records and medical history, a physical examination, and a discussion of the symptoms, goals, values, social interests, and spiritual needs of the patient and his or her family. Ongoing evaluation and follow-up care are then provided as needed. Palliative care uses many approaches, depending on the individual patient’s symptoms, needs, and wishes. It might involve the following: Medications Pain management Complementary techniques, including breathing exercises, massage or Reiki, acupuncture, art or music therapy Mental health services and coping strategies Relaxation techniques Spiritual support and guidance Nutritional support Family support Discharge planning The palliative care team includes expert physicians and advanced practice providers who partner with social workers, chaplains, pharmacists, care coordinators, and other clinical staff members to offer an additional dimension of expertise. Our staff is experienced in helping patients and families manage distress in the face of serious illness, as well as at life’s end. It’s important to note that unlike hospice care, which is meant specifically for those approaching the last stages of life—usually the final six months—palliative care can complement ongoing treatment at any stage of illness. Palliative care does not mean that active treatment to cure a disorder or prolong life will end. All care will continue through any stage or time in each patient’s illness. Bereavement Service Yale New Haven Hospital Bereavement Services provides care and support to families and friends to help you learn how to live life without your loved one. Grief is a natural response to loss, but the way we grieve is unique to each person. Our experienced staff of clinical social workers can help with learning and understanding more about grief which will help with healing. Services Telephone outreach Monthly bereavement seminars Bereavement support groups Information and referral for bereavement resources Hope for the Holidays (support for coping during the holiday season) Annual Memorial Service (a formal service to remember your loved one, conducted in collaboration with Spiritual Care and Patient Relations) For more information, contact: Andrea Lucibello, LCSW Coordinator of Bereavement Services 203-688-0726 Outpatient Palliative Care The Outpatient Palliative Care Clinic at Smilow Cancer Hospital uses an interdisciplinary team approach to provide an extra layer of support for both patients and thei

The Cardio-Oncology Program at Smilow Cancer Hospital is designed to help address the cardio-toxic side effects of chemotherapy treatment, as well as the confounding problem of co-existing cardiac disease and cancer. The program also provides pre-surgical and pre-treatment cardiac evaluation for patients with cancer. The program began in response to emerging data, which indicates that newly developed drugs for cancer treatment are having unanticipated side effects. Drugs such as Herceptin, which is very effective in the treatment of breast cancer, can have cardio-toxic side effects that are just beginning to be understood and researched. The difficulty when dealing with cardio-toxic side effects, such as fatigue and shortness of breath, is that they can often mask themselves as normal effects from the cancer treatment itself. For patients with a pre-existing heart dysfunction, our team will make decisions on how to monitor these patients, and optimize cancer treatment to mitigate these side effects. If a patient is found to have cardio-toxicities during treatment with chemotherapy, our team will work together with the oncologist and the patient to decide on the best course of action. In some cases, collaboration with the oncologist will need to take place in order to change the chemotherapy to something that's less cardio-toxic. The goal of this program is to help patients through their treatment so they have the best chance to be cured of their 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

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

Unlike a mastectomy, which removes the entire breast, breast-conserving surgery removes only the affected breast tissue, allowing patients to continue to radiation therapy on an intact breast. Yale was one of the first facilities in the country to offer this effective combination of treatments. Our physicians also perform radiation following mastectomy, and radiation for treatment of metastasis, or for cancer that has spread. To deliver radiation for breast cancer , we use a variety of novel treatments, including conventional external beam radiation, intensity-modulated radiation therapy (IMRT), deep inspiration breath hold (DIBH), and partial breast irradiation. We also offer hypo-fractionated breast radiation, a new treatment that reduces the duration of rational therapy, with fewer side effects.

The Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center provides coordinated, state-of-the-art care for patients with benign and malignant diseases of the breast. For patients diagnosed with breast cancer , we offer dedicated care, innovative treatment options, and cutting-edge research. A great deal of progress in the detection and treatment of breast cancer has been made in recent years, and our physicians are on the leading edge of finding even better solutions. Women with a diagnosis of breast cancer are cared for by a multidisciplinary team of physician specialists, including radiologists, breast surgeons, medical oncologists, radiation oncologists, pathologists, and plastic surgeons. From the tranquility of the building, to our complementary therapy services, to the most sophisticated personalized therapies and equipment available, Yale is committed to tailoring treatment to our patients to ensure they have the best experiences possible during their time in our care. Breast Surgery Although many general surgeons perform breast surgery, dedicated breast surgeons have the experience and knowledge to handle difficult or unusual cases, and are generally more likely to understand the complexities of breast diagnosis and treatment. The surgeons at the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center perform breast surgery exclusively, and are nationally known as leaders in their field. Yale surgeons were among the first to perform a lumpectomy instead of a mastectomy, and were instrumental in the development of noninvasive procedures like sentinel lymph node biopsy, intraoperative guidance by ultrasound, and advanced oncoplastic procedures. Our surgeons are experienced in cutting-edge techniques, such as skin-sparing and nipple-sparing mastectomy, and often work hand-in-hand with our plastic surgeons to offer women a variety of options for breast reconstruction. Medical Oncology Many patients with breast cancer also need medical therapy, such as chemotherapy and/or endocrine therapy. Our team of experts utilizes both standard chemotherapies and novel targeted therapies to attack the cancer precisely while minimizing harm to normal tissues. Our medical oncologists are nationally recognized for their contributions to breast cancer research. For example, investigators at Yale helped to elucidate the biology of a cellular receptor called HER2. As a result, our medical oncologists have been successful in developing treatment strategies for HER2-positive breast cancer, and have extended this expertise to provide effective therapies for triple-negative/basal-like and hormone receptor-positive breast cancer. They continue to study new treatments, and patients at Smilow Cancer Hospital have the opportunity to receive such novel therapies through clinical trials, many of which are not available elsewhere in Connecticut. New and complicated patient cases are discussed weekly by the entire team so that

We recognize that anyone diagnosed with cancer is considered a survivor from the moment of their diagnosis. We provide individualized treatment summaries and survivorship care plans to support ongoing recovery and long-term survival. We are dedicated to enhancing the quality of life for individuals impacted by cancer. We value an inclusive approach and try to meet you “where you are at,” taking care of you as a whole person. Our team of experts have the highest level of oncology training in their field. We create a supportive space to hear you voice your concerns and focus on validating and empowering you to meet your goals by using practical tools. Established in 2006, our Survivorship Clinic was the first multidisciplinary resource for cancer survivors in the State of Connecticut to provide patients and their families with vital information on cancer prevention, wellness, supportive services, and the latest health research related to cancer survivorship. Our team understands that having cancer can be a life-altering experience. Survivors often have to adapt to a “new normal” that includes lifestyle changes. Because every survivor’s experience is different, each patient who visits our Survivorship Clinic receives an individualized care plan with specific recommendations and support for issues ranging from social and emotional wellness to nutrition recommendations and exercise guidance. Plan for a 2-hour visit. At the initial visit, you will meet with each provider one-on-one for 30 minutes. During this time, each provider will offer an opportunity to discuss your concerns related to their field of practice. Together, you both develop a plan to move forward living well beyond your cancer diagnosis and treatment. We see patients on average 1-3 times, depending on each patient’s needs. The Survivorship Clinic offers referrals to additional services based upon the discussion and needs identified at your visit.

Cancer can have a profound impact on someone’s life. From the very beginning, most patients have many questions about the road ahead. Working in collaboration with medical and radiation oncologists at Yale Cancer Center, our world-renowned oncology surgeons are committed to providing compassionate and personalized care, offering comfort and support. We understand that the thought of undergoing surgery can be overwhelming. An integral part of our approach is to provide support, in part, through detailed answers and by thoroughly explaining treatment options and what to expect before, during, and after the surgery. Our innovative methods enable our surgeons to address even the most complex cancerous and noncancerous conditions. Our surgeons provide the most comprehensive and advanced care available, collaborating with other internationally recognized cancer care specialists at Smilow Cancer Hospital at Yale New Haven, including diagnostic and interventional radiologists, gastroenterologists, hepatologists, imaging specialists, and pathologists. Whether patients are newly diagnosed with cancer or their cancer has not responded to traditional treatment therapies, our team of surgeons and specialists will create a personalized plan based on the latest research, technologies, evidence-based medicine, and the possibility of clinical trials. During the first visit, patients will meet with a surgical oncologist, medical oncologist, and a radiation oncologist who will create a personalized treatment. Our goal is to begin treatment as soon as possible. Because our surgeons treat patients at theSmilow Cancer Hospital at Yale New Haven, patients will have access to a multitude of medical and supportive services to help improve their quality of life while living with cancer, and after. We treat the following cancers and cysts: Breast cancer Gastrointestinal cancers, including gastric bile duct, gallbladder, liver, colon, stomach, pancreas, and colorectal cancers Intra-abdominal cancers and tumors Melanoma Pancreatic cysts (noncancerous) Sarcoma Minimally invasive surgery. Our emphasis is on the most successful surgery with the least pain, scarring, and recovery time. Our highly-skilled surgeons are leaders in minimally invasive procedures, even for complex cases that would otherwise require traditional open surgery. During minimally invasive surgery, also known as laparoscopic surgery, only a few small incisions are necessary. Surgeons use small video cameras to view the affected area and use special surgical instruments to perform the surgery. Recovery time and postsurgical discomfort are significantly reduced because the incisions are smaller than with open surgery. Surgical wounds tend to heal more quickly and with less scarring. Whipple Procedure. The pancreas, which is the largest gland of the endocrine system, is difficult to treat surgically because of its position behind major organs. The Whipple procedure is an innovative approach that allows surgeons

The Psycho-Oncology Program at Smilow Cancer Hospital is available to help patients experiencing challenges such as depression, anxiety, insomnia, and decreased energy levels while undergoing cancer treatment. This program includes specialists in evidence-based psychotherapy and medication management. Our providers focus on teaching solution-focused interventions, such as problem-solving and coping strategies, to be used in daily routines to help patients improve their quality of life and better manage their cancer treatment and care. Individual psychotherapy Issues addressed include: Adjustment to diagnosis Changes in mood (depression, anxiety) Fear of cancer recurrence Managing physical symptoms of cancer or side effects of treatment, such as pain, insomnia, and “chemobrain” Stress management Transitioning back to life after cancer treatment Couples and family psychotherapy Receive support and learn tools to help manage the stress that a cancer diagnosis can have on the entire family. Group psychoeducation and support Support Groups Video archive

Cancer Screening strategies are used to identify cancers at their earliest stage, before the onset of signs and symptoms, when the disease is most easily treated or cured. Cancer Prevention strategies are used to minimize the risk of cancer occurring. The Smilow Screening & Prevention Program brings together doctors and researchers at Smilow Cancer Hospital and Yale Cancer Center who are focused on merging the best science with the best cancer prevention and screening programs. Our goal is to provide patients in Connecticut with the tools they need to stay healthy. Screening Our Program offers many different screening tests for cancer of many types. Cancer screening tests are for patients who do not have symptoms. The goal of these tests is to find cancer as early as possible, and before any symptoms appear. Some, but not all, cancer screening tests detect potential problems and allow the doctor to remove the suspicious tissue at the time of the screening. This is important as it means that patients are less likely to develop cancer later in life. Sometimes the screening test results in a finding that requires more follow-up testing. Cancer screening offers the most protection when it is done on a regular basis as recommended by physicians. Patients should consult with their primary care physicians to determine which tests they recommend based on factors including gender, age, family history, and possibly race or ethnicity. Prevention Our program offers information to help patients make choices that can maintain their health and potentially reduce their risk of cancer. It is usually not possible to know why one person develops cancer and another does not. Healthy choices help all people--whether they have a family history of cancer or not--reduce their risk of developing cancer and many other chronic diseases. Avoiding smoking or chewing tobacco, choosing a diet that is rich in fruits and vegetables, exercising regularly, avoiding sitting for long periods, limiting alcohol, protecting skin and eyes from the sun and tanning beds are all key elements of healthy living. Following physician advice on regular cancer screening is also critical to long-term health. Types of cancer screening Click on the links below for more information on these specific cancer screening tests at Smilow Cancer Hospital: Lung Cancer Colorectal Cancer Breast Cancer Prostate Cancer Cervical Cancer Skin Cancer Head & Neck Cancer