HEAD AND NECK
CANCERS - WITH DISTANT
METASTASIS OR INOPERABLE OR UNRESECTABLE
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ALTERNATE NAMES
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Squamous Cell Carcinoma of the nasal cavity, sinuses, lips, mouth, nose, tonsils,
tongue, throat, or larynx (voice box); Adenocarcinoma of the nasal cavity, sinuses,
lips, mouth, nose, tonsils, tongue, throat, or larynx (voice box); Squamous Cell Cancer
of the nasal cavity, sinuses, lips, mouth, nose, tonsils, tongue, throat, or larynx
(voice box); Metastatic Squamous Cell Neck Cancer; Metastatic Squamous Cell Neck Carcinoma;
Head and Neck Carcinomas; Small Cell or Oat Cell Carcinoma
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DESCRIPTION
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Head and Neck Cancers includes those cancers that arise in the head or neck region (e.g., nasal cavity,
sinuses, lips, mouth, tongue, throat, or larynx [voice box]).
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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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Physical exam and history;
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Laboratory tests including blood and urine analysis;
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Computed tomography (CT) scan;
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Magnetic resonance imaging (MRI); and
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Positron emission tomography (PET) scan.
Physical findings:
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Mouth sores that won't heal;
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Persistent swelling of the neck
ICD-9: 173.02
ICD-10: C30, C44.40, C80.1
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PROGRESSION
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When cancer of any of the sites is advanced, the prognosis is very poor.
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TREATMENT
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Treatment may include surgery, radiation, and/or chemotherapy. These treatments may
affect eating, speaking, or even breathing.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation: A pathology report and an operative report are the preferred methods for documentation.
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.
"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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13.02
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Head and Neck Cancer that is inoperable or unresectable, has distant metastasis, or
is a small cell (oat cell) carcinoma, meets the requirements in listing 13.02.
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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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