Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.175 Gallbladder Cancer
COMPASSIONATE ALLOWANCE INFORMATION
Gallbladder Cancers includes cancers that are formed in tissues of the gallbladder and the bile ducts in the liver (biliary system). Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. It begins in the innermost layer of tissue and spreads through the outer layers as it grows. Bile duct cancer is a cancer that forms in a bile duct. Bile duct cancer may be found inside the liver (intrahepatic) or outside the liver (extrahepatic). Klatskin tumor is a type of cholangiocarcinoma that develops where the right and left bile ducts meet. Risk factors for gallbladder cancer are greatest for females and Native Americans. Symptoms may include jaundice; pain above the stomach; fever, nausea and vomiting; bloating; and lumps in the abdomen.
Cholangiocarcinoma, Klatskin tumor, Biliary Duct cancer
DIAGNOSTIC TESTING AND CODING
Gallbladder cancer is difficult to detect (find) and diagnose early because there aren't any noticeable signs or symptoms in the early stages of the disease and the symptoms of gallbladder cancer, when present, are like the symptoms of many other illnesses. Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Individuals with gallstones rarely develop gallbladder cancer. Tests that examine the gallbladder and nearby organs are used to detect, diagnose, and stage gallbladder cancer. The following tests and procedures may be used: physical exam and history to check for lumps; ultrasound exam; liver function tests that measure the amounts of substances released into the blood by the liver; Carcinoembryonic antigen (CEA) assay; CA 19-9 assay to measures the level of CA 19-9 in the blood; CT scan; blood chemistry studies to measure the amounts of substances released into the blood by organs and tissues in the body; chest x-ray; MRI; MRA; PTC; endoscopy; and biopsy and laparoscopy to remove the tumor.
Cholangiocarcinoma and gallbladder cancer can be cured only if it is found before it has spread and it can be removed by surgery. Bile duct cancer (tumor) 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.
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.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
Suggested Listings for Evaluation:
Cholangiocarcinoma and gallbladder cancer meet Listing 13.19
* 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