KIDNEY
CANCER - INOPERABLE OR
UNRESECTABLE
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ALTERNATE NAMES
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Clear Cell Sarcoma of the Kidney; Diffuse Hyperplastic Perilobar Nephroblastomatosis;
Hypernephroma; Kidney Carcinoma; Neuroepithelial Tumor of the Kidney; RCC; Renal Adenocarcinoma;
Renal Cell Cancer; Renal Cell Carcinoma; Renal Pelvis Carcinoma; Rhabdoid Tumor of
the Kidney; Transitional Cell Carcinoma; Urothelial Carcinoma; Wilms Tumor
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DESCRIPTION
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Kidney
cancer is cancer that forms in tissues of the kidneys (renal cells). Kidney cancer develops
most often in individuals over 40, but no one knows the exact causes of this disease.
Smoking and misuse of certain pain medicines including over-the-counter pain medicines
for a long time can affect the risk of developing renal cell cancer. Also, certain
genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal
cell carcinoma put a person at risk for this disease. These genetic variations account
for a small number of cases, approximately 5%. Clear cell sarcoma of the kidney is
a rare type of kidney cancer, in which the inside of the cells look clear when viewed
under a microscope. Clear cell sarcoma can spread from the kidney to other organs,
most commonly the bone, but also the lungs, brain, and soft tissues of the body.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
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Diagnostic
testing:
Diagnostic testing may include physical exam and history, blood chemistry studies,
urinalysis, liver function tests, intravenous pyelogram (IVP), ultrasound exam, computed
tomography (CT) scan, magnetic resonance imaging (MRI), and biopsy.
Physical findings: There may be no symptoms of kidney cancer in the early stages. Symptoms may appear
as the tumor grows. Symptoms include:
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•
Pain in the side that does not go away;
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ICD-9: 189.0;189.1; 233.9
ICD-10: C7A.093
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PROGRESSION
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Generally, if the disease is limited and surgery removes the disease, five-year survival
is good. However, when the disease is inoperable, unresectable, or metastatic, prognosis
is poor.
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TREATMENT
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Standard treatment for kidney cancer includes surgery to remove all or part of the
kidney, radiation therapy, chemotherapy, biologic therapy, and targeted therapy.
An individual can live with part of one working kidney, but if both kidneys are removed
or not working, the person will need dialysis (a procedure to clean the blood using
a machine outside of the body) or a kidney transplant (replacement with a healthy
donated kidney). A kidney transplant may be done when the disease is in the kidney
only and a donated kidney can be found.
Targeted therapy uses drugs or other substances that can find and attack specific
cancer cells without harming normal cells. Antiangiogenic agents are a type of targeted
therapy that may be used to treat advanced kidney cancer. They keep blood vessels
from forming in a tumor, causing the tumor to starve and stop growing or to shrink.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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•
Clinical note from a surgeon that the cancer is inoperable; and
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Surgical pathology report that the cancer was not completely removed and that the
surgical margins were positive for malignancy.
“Inoperable” refers to a physician's opinion that surgery would not be beneficial
based on a review of imaging studies, laboratory results, and physical examination
findings.
“Unresectable” cancer is established when the operative report indicates that the
cancer is not completely removed or the pathology report notes that the surgical specimen
has positive margins.
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Suggested
Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.21 A
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Biopsy proof of kidney cancer and clinical note stating tumor is inoperable or pathology
report or operative note indicating tumor was unresectable or had positive surgical
margin.
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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