Program Operations Manual System (POMS)
   TN 36 (09-20)
   DI 23022.305 Small Cell Cancer of the Ovary
   
   
   
   
      
         
            
            
            
         
         
            
            
               
               | COMPASSIONATE ALLOWANCES INFORMATION  | 
         
         
            
            
               
               | SMALL CELL (OAT CELL) CANCER OF THE
                        OVARY | 
            
               
               | ALTERNATE NAMES  | Cancer of the Ovary; Small Cell Carcinoma of the Ovary; SCCO | 
            
               
               | DESCRIPTION | Small Cell Cancer of the Ovary is an extremely rare type of ovarian cancer that is distinguished from other ovarian
                     epithelial and ovarian germ cell tumors. It is divided into two types, the hypercalcemic
                     and the pulmonary type, of which the latter is extremely rare. Small cell cancer of
                     the ovary tends to occur in young women (under 40 years of age).
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               | DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
                        ICD-9-CM/ICD-10-CM
                        CODING
                         | Diagnostic testing: There is no standard or routine screening test for small cell cancer of the ovary.
                     Pelvic exam, transvaginal ultrasound may detect ovarian cancer. Biopsy is the primary
                     method of diagnosis and staging of the disease.
                   Physical findings: Symptoms of small cell cancer of the ovary are often subtle. They may include:
                   
                     
                        
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                              Persistent bloating or increased abdominal size;
                        
                           • 
                              Pelvic or abdominal pain;
                        
                     
                        
                     
                        
                     
                        
                     
                        
                     
                        
                     
                        
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                              Menstrual irregularities. ICD-9: 789.51, 795.82
                  ICD-10: R97.1 | 
            
               
               | PROGRESSION  | Small Cell Cancer of the Ovary is a highly aggressive tumor. Metastatic tumor occurs
                     mostly within the pelvis and abdomen, but hematogenous spread also occurs. Only one-third
                     of patients with stage Ia disease have disease-free follow-up periods and almost all
                     patients with higher stage tumors die of disease, usually within 2 years.
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               | TREATMENT  | The primary form of treatment for Small Cell Cancer of the Ovary is surgery with chemotherapy
                     or radiotherapy, depending on the stage of the disease. Effective treatment of patients
                     with high-stage tumors or recurrent disease has not been achieved; although rare,
                     patients with high stage tumors have survived over 4 years after intensive chemotherapy,
                     radiation therapy, or both.
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               | SUGGESTED
                     PROGRAMMATIC ASSESSMENT* | 
            
               
               | Suggested MER for Evaluation: 
                     
                        
                           • 
                              A pathology report of a biopsy specimen from the ovary showing small cell cancer.
                                 There is no substitute for pathology.
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               | Suggested Listings for Evaluation: | 
            
               
               | DETERMINATION | LISTING | REMARKS | 
            
               
               | Meets | 13.23 F | Small Cell Cancer of the Ovary meets the criteria in 13.23 F with a diagnosis supported
                  by biopsy. | 
            
               
               | Equals |  |  | 
            
               
               | * 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. |