Gynecologic Oncology

The Gynecologic Oncology Program at Smilow Cancer Hospital brings together a team of clinicians whose focus is to care for women with gynecologic cancers. Patient appointments are in the dedicated Women’s Center on the first floor of the hospital. Physicians are board certified in obstetrics and gynecology, with a subspecialty of gynecologic oncology, which unites surgery, chemotherapy, and radiation therapy into the oncologic management of patients.

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. 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 program is comprised of the Departments of Obstetrics, Gynecology & 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.

The expertise of the Gynecologic Oncology Program covers all of the components critical to managing the care of women with gynecological cancers: comprehensive evaluation and diagnosis, leading-edge treatment options, thorough follow-up, and psychosocial support. Women are welcome whether they are newly diagnosed or have already received extensive treatment.

Surgery for previously untreated gynecologic cancer

The Gynecologic Oncology Program offers gynecologic, gastrointestinal, and urologic surgery for the management of previously untreated gynecologic 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. Minimally invasive robotic surgery is also available for some women in need of gynecologic surgery.

Conventional laparoscopic and robotic surgery is available to women in need of surgery for uterine cancer, for removal of the uterus, tubes, and ovaries. The surgeries are also offered to women with invasive cervical cancer who require a radical hysterectomy. Laparoscopic surgery is currently under evaluation for women with ovarian cancer to determine whether optimum upfront surgical cytoreduction is possible, or if neoadjuvant chemotherapy should be used.

When possible, preservation of fertility in women with gynecologic cancers is always a priority. We have routinely preserved fertility in women with rare germ cell ovarian cancers. In addition, 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 useful 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 and therefore minimize complications during surgery and improve 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 the management of recurrent gynecologic malignancies that may have initially failed to respond to chemotherapy or other treatment modalities are options for patients. New trials are available using PARP inhibitors, targeted therapies, and immunotherapies for the treatment of gynecological cancers, and recurrent cancers.

Radiation Therapy

Radiation oncologists with gynecologic expertise collaborate with the gynecologic oncologists at Smilow Cancer Hospital to provide both brachytherapy and external beam radiation therapy for the management of a spectrum of gynecologic cancers including cervical, vaginal, vulvar, and ovarian cancer. Patients treated at Smilow have access to the latest, most precise technologies including image-guided intensitymodulated radiation therapy and high-dose-rate brachytherapy.

Radiology

The Yale Department of Radiology and Biomedical Imaging employs state-of-the- art CT, MRI, and ultrasound exams to better diagnose and stage gynecologic disease and assist with treatment decisions. They have extensive experience in imaging of gynecologic oncology and are dedicated to providing the best patient care possible. They routinely consult with the physicians in the Gynecologic Oncology Program and review all available imaging to ensure that the best diagnosis is made, which will translate to the most appropriate treatment for your disease.

Pathology

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 this highly specialized practice setting, our gynecological pathologists have extensive diagnostic experience and a passion for patient care. In the era of precision medicine, in addition to tissue diagnosis, team members actively participate in the real-time decision making process for patient management, including daily operative consultations, weekly tumor board conferences, and many on-going clinical trial programs.

Colposcopy

We offer a full service colposcopy program 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 using the colposcopic evaluation approach. We also offer laser, LEEP, and cold knife conizations for cervical cancer and have applied these techniques for vulvar and vaginal cancer in selected patients. A tumor board is held weekly under the direction of the Gynecologic Oncology Program working in concert with the Department of Therapeutic Radiology and the Department of Pathology. All patients treated have their slides reviewed in a prospective fashion at the tumor board. All therapeutic decisions are made by a multidisciplinary panel of experts in the field of gynecologic malignancy diagnosis and management.

Surgery for Complications

Surgical expertise is available for complications resulting from gynecologic cancers or for progressive disease that include small and large bowel resections, colostomies, fistula repairs, and repair of pelvic support for the management of patients with gynecologic malignancies.

Surgery for Benign Disease

The Gynecologic Oncology Program is routinely asked to provide surgical management for patients with benign gynecologic conditions, particularly those that had previously had unsuccessful or complicated gynecologic surgery. Such conditions include endometriosis, extensive uterine fibroids (leiomyomas), recurrent ovarian cysts, pelvic pain, and pelvic organ prolapse. Prophylactic surgery, including hysterectomy, bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian conservation, is also available to women looking to prevent ovarian cancer occurrence.

Sexuality, Intimacy, and Menopause Program

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 Dr. Elena Ratner, Associate Professor of Obstetrics, Gynecology & Reproductive Sciences and Co-Chief for the Section of Gynecologic Oncology, and Dr. Mary Jane Minkin, 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 relationships and personal health.

Sexuality and Intimacy Program

For men and women, sexual dysfunction after cancer is common. The Smilow Cancer Hospital Sexuality and Intimacy Program, the only clinic of its kind in the country, is designed to help them.

Dr. Elena Ratner, Associate Professor of Obstetrics, Gynecology and Reproductive Sciences and Co-Chief for the Section of Gynecologic Oncology, and Dr. Stanton Honig, Urologist and Director of the Yale Men’s Health Program, collaborate in order to provide comprehensive care to couples as well as individuals. Sex and intimacy after cancer is largely unstudied. Dr. Ratner is in the midst of a research project to learn how treatment for sexual function affects quality of life for patients and their partners and to explore whether it improves survival. In men, prostate and bladder cancer treatment are most likely to affect sexuality. Dr. Honig works with patients and their physician to help minimize these effects and reclaim their sex lives after cancer.

It is an interdisciplinary program and deals with fertility issues as well as provides counseling. Psychologist Dwain Fehon is a key team member of the Sexuality and Intimacy Program. Also part of the team is Dr. Mary Jane Minkin, a gynecologist who specializes in menopause.