Departments

Urologic cancers include prostate, bladder, kidney, urothelial upper tract, testicular, penile, and urethral cancer. The Smilow Cancer Hospital Prostate and Urologic Cancers Program at Yale Medicine is uniquely qualified to treat these cancers. Our program utilizes the most advanced technology and techniques available to diagnose, manage, and treat urologic cancers. We are leaders in the use of MRI/US Fusion prostate biopsy (which blends MRI and ultrasound for increased accuracy), utilizing the ExactVu and Artemis systems across the region. This technology allows us to detect the cancer early and closely monitor it. When surgery is needed, our urologists provide extensive expertise in nerve-sparing laparoscopic and robotic surgery, traditional open surgery, and novel targeted or “focal“ treatments. Our patients also benefit from the expertise of a collaborative approach to cancer care, which personalizes treatment. We engage experts who specialize in medical oncology, radiation oncology, surgical oncology, pathology, and diagnostic imaging. Patients also have access to caregivers who can help with the physical, emotional, and psychological issues related to these cancers. The extended team includes health educators, social workers, dieticians, and complementary therapists. Our goal is to ensure the highest standard of care to support our patients and their families. Imaging and Interventional Radiology Our radiologists are experts in magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), and fluoroscopy, and combine their clinical expertise with advances in technology including MR-US fusion for prostate imaging, as well as positron emission tomography (PET) scans and advanced nuclear medicine scans. In addition, Blue Light™ Cystoscopy, an advanced endoscopic technology, is employed to improve bladder cancer detection and reduce risk of cancer recurrence. Surgery Our experienced urologic surgeons are committed to achieving optimal cancer outcomes, emphasizing organ preservation and the safeguarding of sexual and urinary function as much as possible. Through advanced techniques including minimally invasive and robotic surgery, our urologists are able to optimize both cancer care and surgical recovery. Cryoablation (tumor freezing) may be a good option for some patients with prostate or kidney tumors. Focal therapy is also available for appropriate patients with prostate cancer, as it is able to treat the cancer without the use of radiation or surgery, preserving the prostate, as well as urinary and sexual function. Similarly, for some patients with cancers of the ureter or upper urinary tract, a laser can be used to treat the tumor and preserve kidney function. Medical Oncology Chemotherapy is an important component of cancer care for many patients, as it can delay or prevent tumors from recurring when used before surgery. It can also help patients with advanced or metastatic disease. As a major national

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.

Fertility preservation has emerged as a crucial aspect of health care. It affords individuals facing medical treatments (such as chemotherapy or radiation therapy) that may compromise their fertility an opportunity to safeguard their ability to have biological children in the future. Fortunately, people who face a cancer diagnosis now have options to preserve their chances of one day having a baby with their own sperm or eggs. There are other circumstances in which people may pursue fertility preservation. These include conditions that may cause infertility, like endometriosis or diminished ovarian reserve , and those affected may also seek fertility preservation . People approaching their mid or late 30s may consider freezing their eggs to extend the window of time when they can conceive. Transgender individuals interested in becoming parents in the future may elect to freeze their sperm or eggs before they transition. Our Fertility Preservation Program encompasses a range of services tailored to meet one’s individual needs. At the heart of this program lies a commitment to empowering individuals with knowledge and understanding. It is designed to help people freeze their eggs, embryos, sperm, testicular tissue, or ovarian tissue for future use. This offers the chance to build a family when the time is right. The process starts with a consultation with a reproductive specialist, who will review a patient’s medical and reproductive history and provide direction, as far as testing and preservation options are concerned. Depending on the underlying motivation and the nature of the situation, options are reviewed. Options may include: Egg Freezing: This approach involves the use of hormones to stimulate the maturation of multiple eggs, which are then retrieved and frozen. This option can take a few weeks to complete. Embryo Freezing: Similar to egg freezing, hormones are used to mature multiple eggs, which are then retrieved and combined with sperm to generate embryos, which are then frozen. This can also take a few weeks to complete. Sperm Freezing: In most situations, sperm can be obtained through natural means, frozen, and stored for later use. In some situations, sperm is obtained by surgical means and then frozen. Testicular Tissue Freezing: Testicular tissue can be surgically obtained and then frozen. Sperm can be extracted from the tissue after thawing and used to fertilize eggs. Ovarian Tissue Freezing: When a medical condition leaves no time to freeze eggs, ovarian tissue can be surgically obtained. After treatment is completed and it is deemed safe to get pregnant, the tissue can be re-placed into one’s body. The reproductive specialist will work with patients and their other providers to afford them the opportunity for the most appropriate preservation option. This process can be stressful, and part of that stress may be financial. Our program is equipped to provide resources and guidance along these lines. Our coordinators rev

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