TN 20 (12-18)

DI 23022.175 Gallbladder Cancer

COMPASSIONATE ALLOWANCE INFORMATION

GALLBLADDER CANCER

ALTERNATE NAMES

Cholangiocarcinoma; Klatskin Tumor; Biliary Duct Cancer

DESCRIPTION

Gallbladder Cancer includes cancers that are formed in tissues of the gallbladder and those originating in the bile ducts of the liver (biliary system). Gallbladder Cancer is a disease in which malignant (cancer) cells form in the innermost layer of the tissue and tissue and then spread through the outer layers. Bile Duct Cancer, also called cholangiocarcinoma, is a cancer that forms in a bile duct. Bile Duct Cancer may be found inside the liver (intrahepatic) or more commonly outside the liver (extrahepatic). Klatskin tumor is a type of cholangiocarcinoma that develops where the right and left bile ducts meet, as they exit the liver forming the common hepatic duct. Risk factors for Gallbladder Cancer are greatest for females and Native Americans.

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

Diagnostic testing: Gallbladder Cancer is diagnosed with ultrasound exam; blood tests including liver function tests, carcinoembryonic antigen (CEA) assay, and CA 19-9 assay; CT scan; chest x-ray; MRI; MRA; PTC; endoscopy; and biopsy and laparoscopy.

Physical findings: Individuals with gallbladder cancer may present with:

  • Jaundice;

  • Palpable mass in the right upper quadrant;

  • Periumbilical lymphadenopathy;

  • Left supraclavicular adenopathy, and

  • Unexplained weight loss.

Other symptoms may include:

  • Abdominal pain; Fever, nausea and vomiting;

  • Bloating;

  • Anorexia; and

  • Bloating.

ICD-9: 156.00

PROGRESSION

Cholangiocarcinoma generally causes progressive liver failure. Gallbladder Cancer can invade the liver or it can disseminate into lymph nodes or can spread as intra-peritoneal metastases.

TREATMENT

Cholangiocarcinoma and Gallbladder Cancer can be cured only if the disease is found before it has spread and it can be removed by surgery. Cholangiocarcinoma (tumor) usually cannot be completely removed by surgery and is incurable. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
  • Clinical history and examination that describes the diagnostic features of the impairment.

  • Imaging (e.g. x-ray, MRI, MRA, CT scans)

  • Results of ultrasound testing

  • Results of blood chemistry testing

  • Operative report

  • Pathology report

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.19 Cholangiocarcinoma and Gallbladder Cancer meet the criteria in 13.19.
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/0423022175
DI 23022.175 - Gallbladder Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018