TN 1 (10-08)

DI 23022.215 Large Intestine Cancer

COMPASSIONATE ALLOWANCE INFORMATION

LARGE INTESTINE CANCER

DESCRIPTION

Large Intestine Cancer forms in the tissues of the colon. Most colon cancers are adenocarcinomas. When large intestine adenocarcinoma spreads outside the colon or rectum, cancer cells are often found in nearby lymph nodes. If cancer cells have reached these nodes, they may also have spread to other lymph nodes or other organs. Large intestine adenocarcinoma (cancer) cells most often spread to the liver.
Large intestine adenocarcinoma (cancer) is more likely to occur as people age. More than 90% of people with this disease are diagnosed after age 50 and the average age at diagnosis is 72.

ALTERNATE NAMES

Colon Cancer, Colon Carcinoma, Colorectal Cancer, Colorectal Carcinoma, Rectal Cancer, Rectal Carcinoma, Large Bowel Cancer, Large Bowel Carcinoma, Large Intestine Adenocarinoma

DIAGNOSTIC TESTING AND CODING

The following may be used to diagnose the disease: fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, double-contrast barium enema, and/or digital rectal exam.
The following tests and procedures may be used to determine if the Large intestine adenocarcinoma has spread: CT scan, lymph node biopsy, complete blood count, carcinoembryonic antigen (CEA) assay, MRI, and/or surgery.

TREATMENT

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

PROGRESSION

Large intestine adenocarcinoma (colon cancer) is the second leading cause of death from cancer in the United States. Inoperable or unresectable large intestine adenocarcinoma may progress locally and cause intestinal obstruction, uncontrolled GI bleeding, and/or severe pain from invasion into the sacral nerve plexus.

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:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.18A, 13.18B, and 13.18C

Large Intestine Cancer that is inoperable, unresectable, recurrent, or with distant metastases meets Listing 13.18A, 13.18B, and 13.18C.

Medical Equals

 

 

* 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

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http://policy.ssa.gov/poms.nsf/lnx/0423022215
DI 23022.215 - Large Intestine Cancer - 12/19/2008
Batch run: 01/27/2009
Rev:12/19/2008