Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.155 Esophageal Cancer
COMPASSIONATE ALLOWANCE INFORMATION
Esophageal cancer originates from the lining of the esophagus and presents as either squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) or adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). Esophageal cancer spreads extensively through the esophagus and often extends far beyond the edges of the primary tumor (distant metastases). The cancer generally presents as an obstruction to swallowing with complaints of difficulty swallowing.
Adenocarcinoma of the Esophagus, Squamous cell carcinoma of the Esophagus
DIAGNOSTIC TESTING AND CODING
The definitive test for esophageal cancer is esophagoscopy with visualization of the cancer and biopsy. Testing used to determine the causes of symptoms include a barium swallow (esophagram) generally done with a series of x-rays of the esophagus, esophagoscopy (also called endoscopy) testing that examines the inside of the esophagus using a thin lighted tube called an endoscope and a biopsy. Testing used to determine whether the cancer has spread includes a CT (CAT) scan of the chest, abdomen and pelvis, a PET scan, a bone scan and a bronchoscopy.
Historically, treatment of esophageal cancer has been surgery. Recent multimodality therapy with radiation, chemotherapy and surgery has begun to play a major role in treatment.
The prognosis for esophageal cancer is not good regardless of the treatment employed. When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report from biopsy taken during esophagoscopy (also called esophagogastroduodenoscopy or EGD). The report will address the extent to surrounding structures, recurrence and/or metastases to, or beyond, the regional lymph nodes.
Suggested Listings for Evaluation:
Esophageal Cancer meets Listing 13.16A
* 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: 9/10/08
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