PLEURAL MESOTHELIOMA
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ALTERNATE NAMES
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Malignant Mesothelioma of the Pleura
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DESCRIPTION
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Pleural Mesothelioma is a rare type of cancer where malignant cells are found in the pleura (the thin
layer of tissue that lines the chest cavity and covers the lungs). Exposure to airborne
asbestos particles increases one's risk of developing malignant mesothelioma. Although
reported incidence rates have increased in the past 20 years, pleural mesothelioma
is still a relatively rare cancer. About 2,000 new cases of pleural mesothelioma are
diagnosed in the United States each year. Pleural mesothelioma occurs more often in
men than in women and risk increases with age, but this disease can appear in either
men or women at any age. Working with asbestos is the major risk factor for mesothelioma.
A history of asbestos exposure at work is reported in about 70% to 80% of all cases.
However, mesothelioma has been reported in some individuals without any known exposure
to asbestos.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Diagnosing Pleural Mesothelioma is often difficult, because the symptoms are similar
to those of a number of other conditions. Diagnosis begins with a review of the patient's
medical history, including any history of asbestos exposure. A complete physical examination
may be performed, including x-rays of the chest or abdomen and lung functioning tests.
A CT scan or an MRI may also be useful. A biopsy is needed to confirm a diagnosis
of pleural mesothelioma. If the cancer is in the chest, the doctor may perform a thoracoscopy.
In this procedure, the doctor makes a small cut through the chest wall and puts a
thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy
allows the doctor to look inside the chest and obtain tissue samples. If the procedure
does not yield enough tissue, more extensive diagnostic surgery may be necessary.
Physical findings: Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos.
Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura
are often symptoms of Pleural Mesothelioma.
ICD-9: 501, 511.8, 511.81
ICD-10: C45.0
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PROGRESSION
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Advanced malignant mesothelioma includes stages II, III, and IV. In stage II, cancer
is found in the lining of the chest wall and the lymph nodes on the same side of the
chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm,
or the lining of the sac that covers the heart on the same side of the chest. In stage
III, cancer has spread to any of the following areas: the chest wall, the mediastinum,
the heart, beyond the diaphragm and the peritoneum. Cancer may have also spread to
lymph nodes on the other side of the chest or outside the chest. In stage IV, cancer
has spread to distant organs or tissues. The prognosis is poor with a limited survival
time of less than 2 years.
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TREATMENT
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Treatment for Pleural Mesothelioma depends on the location of the cancer, the size
of the tumor, the amount of fluid in the chest, the stage of the disease, and the
individual's age and general health. Standard treatment options include surgery, radiation
therapy, and chemotherapy. Surgery is associated with a median survival time of 15-24
months; chemotherapy has an average response rate of 10-20%.
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SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for Evaluation:
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Pathology report confirming diagnosis.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
13.15 A |
Only pathology is required for adjudication. |
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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