Program Operations Manual System (POMS)
TN 36 (09-20)
COMPASSIONATE ALLOWANCES INFORMATION
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SMALL CELL LUNG CANCER
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ALTERNATE NAMES |
Small Cell Lung Carcinoma; Oat Cell Lung Cancer; Mixed Small Cell/Large Cell Lung
Carcinoma; Combined Small Cell Lung Carcinoma
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DESCRIPTION
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There are two types of Lung Cancers: Small Cell and Non Small Cell. Small Cell Cancer of the Lung is an aggressive (fast-growing) cancer that forms in tissues of the lung and can spread
to other parts of the body. Small cell lung cancer looks small and oval-shaped under
a microscope.
Risk factors for small cell lung cancer include: smoking cigarettes, cigars or pipes,
now or in the past, exposure to second-hand smoke and exposure to asbestos, or radon.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: The diagnosis of small cell lung cancer is confirmed by a pathologist using laboratory
studies obtained by bronchoscopy or a CT-guided procedure (fine-needle biopsy). Specimens
(stains) for chromogranin, neuron-specific enolase and synaptophysin are usually positive.
Staging of the carcinoma is performed by imaging studies (CT scans, MRI, PET scans).
These studies provide the information needed for staging at diagnosis, response to
treatment, resectionability and metastases.
Physical
findings:
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Hemoptysis (expectoration of blood or of blood-stained sputum);
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Dyspnea (shortness of breath);
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ICD-9: 162.9
ICD-10: C34.90
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PROGRESSION |
Although this disease is very responsive to chemotherapy, the overall survival rate
is poor. Of those diagnosed with extensive small cell lung carcinoma (most patients)
the 2 year survival rate is < 2%.
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TREATMENT
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Management of limited stage small cell lung carcinoma involves a combination of chemotherapy
and thoracic radiation therapies. Treatment can involve either a single modality or
a series of multiple modalities. If a complete remission is obtained, prophylactic
cranial radiation is offered. At this level of treatment, the disease is potentially
curable. However, most individuals are diagnosed with extensive disease and are generally
considered incurable but may achieve remission with the use of a combination chemotherapy
regimen.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for
Evaluation: A pathology report of a lung biopsy.
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Suggested Listings for Evaluation: |
DETERMINATION |
LISTINGS |
REMARKS |
Meets |
13.14 B
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Small cell lung cancer currently meets the criteria in listing 13.14. |
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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