Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.115 Bladder Cancer
COMPASSIONATE ALLOWANCE INFORMATION
Bladder Carcinoma 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 squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder 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.
Invasive Bladder Cancer, Bladder Carcinoma, Invasive Bladder Carcinoma, Transitional Cell Carcinoma of the Bladder, Transitional Cell Cancer of the Bladder, Squamous Cell Carcinoma of the Bladder, Squamous Cell Cancer of the Bladder, Adenocarcinoma of the Bladder, Urinary Cancer, Urinary Carcinoma
DIAGNOSTIC TESTING AND CODING
The following may be used to diagnose the disease: 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.
Treatment may include surgery, radiation, chemotherapy, and biologic therapy. Surgical options may include transurethral resection (TUR), radical cystectomy, segmental cystectomy, and/or urinary diversion.
Some patients may receive chemotherapy after surgery. This post-surgical treatment is referred to as adjuvant therapy.
If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy can be utilized for palliation, but the prognosis is poor.
SUGGESTED PROGRAMMATIC ASSESSMENT*
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.
Suggested Listings for Evaluation:
Bladder Carcinoma that is inoperable, unresectable, or with metastases meets Listing 13.22 C.
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.
Last Updated: 9/30/08
Office of Disability Programs