Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.225 Liver Cancer
COMPASSIONATE ALLOWANCE INFORMATION
One of the most common types of liver cancer is Hepatocellular Carcinoma. Hepatocellular Carcinoma is a type of adenocarcinoma. Hepatocellular carcinoma is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body. The following are possible risk factors for hepatocellular carcinoma: having hepatitis B and/or hepatitis C; having a close relative with both hepatitis and liver cancer; having cirrhosis; and eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts that have not been stored properly). Hepatocellular carcinoma is sometimes called a “silent disease” because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include: pain in the upper abdomen on the right side; the pain may extend to the back and shoulder; swollen abdomen (bloating); weight loss; loss of appetite and feelings of fullness; weakness or feeling very tired; nausea and vomiting; yellow skin and eyes, and dark urine from jaundice; and fever.
Hepatocellular (Liver) cancer, Intrahepatic Bile Duct Cancer, Liver Cancer, Hepatocellular Carcinoma
DIAGNOSTIC TESTING AND CODING
Diagnosis of hepatocellular carcinoma includes a clinical examination, which includes a medical history and a thorough physical examination. Many blood tests may be used to check for liver problems. For example, one blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Several tests may be performed including CT scan, Ultrasound test, MRI, Angiogram, and Biopsy.
Hepatocellular carcinoma can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have surgery. However, treatments other than surgery may be able to control the disease and help patients live longer and feel better. The choice of treatment depends on the condition of the liver; the number, size, and location of tumors; and whether the cancer has spread outside the liver. Options include radiation therapy, chemotherapy, percutaneous ethanol injections, and hepatic arterial infusions. For a few patients, liver transplantation may be an option.
Hepatocellular carcinoma is rarely discovered early and often does not respond to current treatments-thus, the prognosis is often poor. For patients with advanced disease, care is focused on keeping the patient as comfortable as possible. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: Either (1) A pathology report stating that hepatocellular carcinoma is present in a biopsy specimen, or (2) MRI or CT scan showing liver abnormalities compatible with hepatocellular carcinoma along with elevated alpha-feto-protein meeting the requirements under the diagnostic testing above.
Suggested Listings for Evaluation:
Hepatocellular Carcinoma meets Listing 13.19