DESCRIPTION
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Large Intestine Cancer forms in the tissues of the colon. Most colon cancers are adenocarcinomas. When Large
Intestine Cancer spreads outside the colon or rectum, cancer cells are often found
in nearby lymph nodes. If cancer cells have reached these nodes, they may also have
spread to other lymph nodes or other organs. Large Intestine Cancer cells most often
spread to the liver.
Large Intestine Cancer is more likely to occur as people age. More than 90% of diagnoses
are made after age 50 and the average age at diagnosis is 72.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
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Diagnostic testing: The following may be used to diagnose the disease:
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Fecal occult blood test (FOBT);
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Double-contrast barium enema; or
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The following tests and procedures may be used to determine if the Large Intestine
Cancer has spread:
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CT scan, lymph node biopsy;
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Carcinoembryonic antigen (CEA) assay;
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In the absence of these reports, the adjudicator may use a physician's opinion that
indicates the cancer is inoperable or unresectable based on described objective findings.
Physical findings: Some signs and symptoms of Large Intestine Cancer include:
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Changes in bowel habits, including diarrhea or constipation or a change in consistency
of stool that lasts longer than four weeks;
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Rectal bleeding or blood in stool;
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Persistent abdominal discomfort, such as cramps, gas, or pain;
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A feeling that your bowel doesn’t empty completely;
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Many people experience no symptoms in the early stages of the disease. When symptoms
appear, they will likely vary, depending on the cancer’s size and location in the
large intestine.
ICD-9: 153.9, 154.8, 230.3, 230.4, 795.81
ICD-10: C7A.029
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PROGRESSION
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Large Intestine Cancer is the second leading cause of death from cancer in the United
States. Inoperable or unresectable cancer of the Large Intestine may progress locally
and cause intestinal obstruction, uncontrolled GI bleeding, or severe pain from invasion
into the sacral nerve plexus.
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Suggested MER for Evaluation:
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A pathology report and an operative report are the preferred methods for documentation;
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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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* 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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