Departments
Inflammatory Bowel Disease Program
In 2001, the Yale Inflammatory Bowel Disease Program was formed to address the challenges faced by patients with complex, lifelong, gastrointestinal, inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Our team-based approach employs a gastroenterologist, physician assistant, and a team of nurses and medical assistants to share the responsibilities of our patients’ medical care. Following evidence-based guidelines, the IBD team will work closely together to plan and coordinate a comprehensive plan of care personalized to each patient, who will have the opportunity to meet the IBD team members during a visit. The key to effective management of the disease is coordinated care among specially trained, internationally recognized physicians with expertise in inflammatory bowel disease. Our experienced team also includes nutritionists, surgeons, radiologists, and pathologists. Our medical and surgical specialists are available at the same visit to provide comprehensive care. Our enterostomal nurses work with families to manage ostomy care and provide support. Treatment for ulcerative colitis or Crohn’s disease usually begins with medical therapy. While surgery can be a primary therapy for certain symptoms of IBD, it is usually reserved as a supplement to medical therapy. The goal of GI surgery is to restore function, using bowel-conserving surgery, including minimally invasive surgery where appropriate. In order to properly diagnose and treat patients with IBD, doctors must perform visual examinations of the gastrointestinal tract through procedures known as endoscopies. The three most common procedures are as follows: colonoscopy, upper endoscopy, and capsule endoscopy. Each procedure visualizes a different section of the gastrointestinal tract. Colonoscopy—Sigmoidoscopy: These procedures allow doctors to evaluate the entire large intestine and the end of the small intestine called the ileum. In patients with inflammatory bowel disease, a colonoscopy is required for evaluation of the disease activity and for colon cancer screening. Some patients may undergo a sigmoidoscopy, which only views the first third of the large intestine. Upper Endoscopy (EGD): This procedure allows evaluation of the esophagus, stomach, and duodenum. In patients with inflammatory bowel disease, an upper endoscopy evaluates disease involvement in the upper region of the digestive tract. Capsule Endoscopy: The newest diagnostic procedure, it allows evaluation of the small intestine not accessible by upper endoscopy and colonoscopy. A tiny camera contained in a capsule passes naturally through the digestive tract while transmitting video images to a data recorder. Images of the small bowel are downloaded to a computer and reviewed by a physician. Chromoendoscopy: Chromoendoscopy is a technique performed during colonoscopy to enhance the detection of pre-cancerous areas in the colon. It uses a blue dye that temporarily stains the colon wall duCenter for Gastrointestinal Cancers
Each year, nearly 300,000 people in the United States are diagnosed with a type of gastrointestinal cancer. Many of these cancers are too complex or difficult to be treated with just one type of treatment. The Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center provides patients with gastrointestinal cancers a comprehensive, multidisciplinary approach to the treatment of complex disease. As experts in the treatment of cancers of the esophagus, stomach, liver, pancreas, colon, bile ducts, rectum, and anus, we collaborate with diagnostic and interventional radiologists, gastroenterologists, and pathologists to provide the most up-to-date and effective treatments available. Our advanced diagnostic imaging services, including Endoscopic Retrograde Cholangiopancreatography (ERCP), MRI/MRCP (ERCP in conjunction with MRI), high-resolution CT scans, Endoscopic ultrasound (EUS), and EUS-guided fine needle aspiration, allow for patients to be comprehensively evaluated at the onset of their diagnosis. Surgical Oncology Surgery is commonly used to effectively manage certain types of gastrointestinal cancers, including malignant and premalignant tumors in the stomach, liver, bile ducts, pancreas, small intestine, and colorectum. Our team of surgeons incorporate a variety of state-of-the-art surgical techniques into procedures when necessary. These include: Laparoscopic and robotic surgery for stomach, small bowel, and colorectal tumors, as well as for primary and metastatic liver tumors and biliary tumors Cytoreduction and heated intraperitoneal chemotherapy Pancreatectomy (Whipple procedure, distal pancreatectomy, total pancreatectomy, central pancreatectomy, pancreas preserving enucleation) Medical Oncology In addition to chemotherapy, our medical oncology experts provide innovative nonsurgical treatment options including: Targeted Therapy, in which a special type of chemotherapy targets the changes in cancer cells that help them grow, divide, and spread Immunotherapy, which uses a patient’s own immune system to find and destroy cancer cells Yale Cancer Center emphasizes the importance of clinical trials for all stages of disease. Many of these drugs are exploring new types of therapy and new combinations of therapies, and many of our studies are available as part of our network of Care Centers. We perform state-of-the-art genomic profiling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies for patients. Radiation Oncology Patients who need radiation oncology to treat their gastrointestinal cancers can feel confident that they are receiving the highest quality care from the most experienced team of radiation oncologists in Connecticut. We offer innovative therapies including: Three-dimensional Conformal Radiation: This technique may be used to target radiation to tumors by matching their particular shapes. Four-dimensional (4-D) CT simulation makes CT scans fSmilow Cancer Genetics & Prevention Program
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 vSmilow Cancer Screening & Prevention Program
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 CancerCancer-Infectious Diseases (Cancer-ID) Program
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 ouDigestive Diseases
At Yale Medicine, we specialize in a full range of digestive health care, from advanced endoscopy and colon cancer genetics to managing such conditions as inflammatory bowel disease and liver cancer. We treat complex gastrointestinal motility disorders, provide care for rare diseases, and support patients through liver transplants. Our dedicated team is committed to offering personalized and effective treatments for all aspects of gastrointestinal health. Specialized care is offered in the following areas: Advanced endoscopy: Specialized procedure using an endoscope to diagnose or treat complex issues in the digestive system. Colon cancer genetics: Study of genes that affect the risk of developing colon cancer. Gastrointestinal motility: The movement of food through the digestive tract. Inflammatory Bowel Disease (IBD): Chronic inflammation of the digestive tract. Liver cancer Liver transplant Lysosomal disease: A group of rare inherited metabolic disorders that result when lysosomes in cells cannot breakdown waste properly. Viral hepatitis: Liver inflammation caused by a virus, such as hepatitis A, B, or C, which can lead to liver damage.Colorectal Surgery
At Yale Medicine, our colorectal surgery team specializes in surgical care for conditions affecting the lower gastrointestinal tract which includes your colon, rectum, and anus. We treat a complete array of conditions that range from non-cancerous (benign) disorders to cancerous (malignant) diseases, and they can involve surgical and non-surgical treatments. Expert physicians may also perform routine screening procedures, such as colonoscopies, to detect colon and rectal abnormalities, including cancer at an early stage. They work closely with gastroenterologists, oncologists, and other specialists to provide comprehensive care for patients with diseases affecting the lower digestive tract. About Us Specialized care is offered in the following areas: Colon and Rectal Cancer: Surgical removal of tumors in the colon and rectum. Inflammatory Bowel Disease (IBD): Including ulcerative colitis and Crohn's disease, which may require surgery to remove diseased portions of the intestinal tract. Diverticulitis: Inflammation or infection of small pouches that can form in the intestinal wall, sometimes requiring surgical intervention. Hemorrhoids: Swollen blood vessels in and around the anus and lower rectum that can cause discomfort and bleeding. Anal Fissures: Small tears in the lining of the anus that can cause pain and bleeding. Anal Fistulas and Abscesses: Infections in the anal gland that can form an abscess and may lead to an abnormal channel (fistula) between the inside of the anus and the skin. Rectal Prolapse: When part of the rectum protrudes from the anus. Fecal Incontinence: Inability to control bowel movements, which may be improved with surgery. Bowel Obstruction: Blockages in the colon or rectum that may require surgery to remove the obstruction. Polyps: Abnormal growths in the colon or rectum that can be benign or precancerous and are often removed to prevent cancer. Ostomy Surgery: Procedures that create an opening (stoma) for the body to eliminate waste, such as a colostomy or ileostomy, which may be temporary or permanent. Pelvic Floor Dysfunction: Disorders affecting the coordination of pelvic floor muscles and rectum, which may involve surgical repair. Colon and Rectal Trauma: Injury to the colon or rectum that requires surgical intervention to repair. Pilonidal Disease: A chronic skin infection in the crease of the buttocks near the coccyx.Pancreatic Diseases Program
Our program was formed in 2013 to address the clinical issues and concerns faced by patients and their families with pancreatic disease, such as pancreatic cancer, pancreatic cysts, and pancreatitis. We provide the latest treatments in collaboration with other Yale programs such as the Yale Cancer Center. Our team comprises doctors from several fields to provide patients with the most comprehensive care, including advanced endoscopy, gastroenterology, surgery, medical oncology, radiation oncology, pathology, and genetics. Our nurses and advanced practice nurses are also highly experienced in pancreatic diseases. It is important to us that we educate our patients about pancreatic disease and its related procedures and treatments. We believe this empowers patients and family members to take an active role in their health care decisions, which can lead to an improved quality of life. We specialize in treating the following conditions: Pancreatic cancer Pancreatic cysts Chronic pancreatitis Acute pancreatitis We also offer the following services: Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography Medical oncology Radiation oncology Pancreas surgeryCenter for Thoracic Cancers
The Center for Thoracic Cancers at Smilow Cancer Hospital consists of a multidisciplinary team of experts dedicated to providing evaluation of and treatment for patients with a thoracic malignancy, including lung cancer, esophageal cancer, thymoma, or chest wall tumors. Patients in Connecticut and beyond have access to nationally recognized expert clinicians, who provide an organized, collaborative approach to cancer care, as well as the latest technologies and treatments. Our team consists of a collaboration of specialty physicians, including medical oncology, radiation oncology, thoracic surgery, pulmonary medicine, digestive diseases, pathology, diagnostic imaging, and nursing. In addition to our expert clinicians, patients also receive comprehensive care to help with the physical, emotional, and psychological issues that are part of confronting cancer. Patients also benefit from the attention of the team's care coordinators, who make management of even the most detailed multidisciplinary treatment plan less complicated. Our team is active in clinical research, and focuses on developing advances to care in areas of thoracic oncology where the standard treatment needs improvement and where the optimal treatment approach remains unclear. To provide the best care, most of our patients are enrolled in a clinical trial where they can receive innovative therapy for their advanced disease, including immunotherapy, which was first used in clinical trials at Smilow Cancer Hospital. The Center for Thoracic Cancers offers second opinions that are easy, convenient, and all done remotely. Call (203) 200-LUNG for more information and learn how to schedule a second opinion appointment with one of our providers. Medical Oncology Our medical oncologists are nationally recognized for their leadership and expertise in lung cancer treatment and research, and are dedicated to offering personalized treatment options. Biomarker testing is often performed on the tumor to look for specific mutations that can be targeted by medication. There are currently FDA-approved lung cancer treatments for tumors showing abnormalities in EGFR, KRAS, ALK, ROS1, BRAF V600E, MET, RET , and NTRK genes. Recent studies conducted at Yale have led to FDA approval of drugs for the treatment of lung cancer, such as the immunotherapy drug Tecentriq (atezolizumab), which has been proven to improve patient survival for newly diagnosed NSCLC. This drug is designed to block PD-L1, a protein that was discovered by scientists at Yale and that has been instrumental in improving survival for lung cancer patients. Another FDA-approved drug, osimertinib, which stemmed from Yale Cancer Center and Smilow Cancer Hospital researchers, was approved for the treatment of adults with early-stage NSCLC with EGFR gene mutations. Surgery Many patients in need of surgery are referred for a minimally invasive surgery known as a video-assisted thoracoscopiGynecologic Oncology Program
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 sOvarian Cancer Early Detection Program
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.Gastrointestinal (GI) & Pancreatic Cancer Prevention Program
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.