TN 20 (12-18)

DI 23022.115 Bladder Cancer

COMPASSIONATE ALLOWANCE INFORMATION

BLADDER CANCER

ALTERNATE NAMES

Invasive Bladder Cancer; Bladder Carcinoma; Invasive Bladder Carcinoma; Transitional Cell Carcinoma of the Bladder; Urothelial Cancer; Squamous Cell Carcinoma of the Bladder; Squamous Cell Cancer of the Bladder; Adenocarcinoma of the Bladder; Urinary Cancer; Urinary Carcinoma

DESCRIPTION

Bladder Cancer is a disease in which malignant cells form in the tissues of the bladder. Most bladder cancers are transitional cell carcinomas. Other types include squamous cell carcinoma and adenocarcinoma. The cells that form carcinoma develop in the inner lining of the bladder, maybe as a result of chronic irritation and inflammation. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes. This is called Invasive Bladder Cancer.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: Bladder Cancer is diagnosed by physical exam and history; CT scan, urinalysis, intravenous pyelogram (IVP), cystoscopy (examination of urinary tract), biopsy, and/or urine cytology (microscopic study of cells). The following may also be used to determine if the cancer has spread: MRI, chest x-ray, and/or bone scan.

Physical findings: Individuals with Bladder Cancer may present with irritative bladder symptoms such as urinary frequency or urgency and hematuria. Flank pelvic or bony pain may be present.

ICD-9: 188.9

PROGRESSION

If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy can be utilized for palliation, but the prognosis is poor.

TREATMENT

Treatment may include surgery, radiation, chemotherapy, and biologic therapy. Surgical options may include transurethral resection (TUR), radical cystectomy, segmental cystectomy, or urinary diversion. Some patients may receive chemotherapy after surgery. This post-surgical treatment is referred to as adjuvant therapy.
SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • A pathology report and an operative report stating that the tumor is inoperable or unresectable are the preferred methods for documentation.

  • Clinical history and examination that describes the diagnostic features of the impairment.

  • 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.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.22 C Bladder Cancer that is inoperable, unresectable meets the criteria in 13.22 C.

13.22 D

Bladder Cancer ith metastases to or beyond the regional lymph nodes, meets the criteria in 13.22 D.
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.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022115
DI 23022.115 - Bladder Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018