TN 1 (10-08)

DI 23022.245 Non-Small Cell Lung Cancer

COMPASSIONATE ALLOWANCE INFORMATION

NON-SMALL CELL LUNG CANCER

DESCRIPTION

Lung Cancer (non small cell) forms in tissues of the lung, usually in the cells lining the air passages. The two main types are Small Cell Lung Cancer and Non-Small Cell Lung Cancer. Diagnosis of the type of cancer is based on microscopic examination. About 87% of lung cancers are Non-Small Cell Lung Cancers. This type spreads more slowly than Small Cell Lung Cancer. The three types of Non-Small Cell Lung Carcinoma are Squamous Cell Carcinoma, Large Cell Carcinoma, and Adenocarcinoma.
In Stage III B It has not spread to distant sites. Stage III B has two combinations that make up this stage.
In the first combination (Any T, N3, MO) the cancer has spread to lymph nodes near the collarbone on either side, and/or has spread to hilar nodes or mediastinal lymph nodes on the side opposite the primary tumor.
In the second combination (T4, any N, MO), the tumor has grown into the space behind the chest bone and in front of the heart (the mediastinum), the heart, the large blood vessels near the heart (such as the aorta), the windpipe, the esophagus, the backbone, or the carina:

  • Two or more separate tumor nodules are present in the same lobe of a lung; or

  • There is a fluid containing cancer cells in the space around the lung (a malignant pleural effusion).

In Stage IV (Any T, Any N, M1) the tumor can be any size and may or may not have grown into nearby structures or reached nearby lymph nodes. It has spread to distant sites.
Early lung cancer often does not cause symptoms. As the cancer progresses, common symptoms may include persistent or worsening cough, breathing problems, constant chest pain, coughing up blood, a hoarse voice, frequent lung infections, fatigue, and/or unintentional weight loss.

ALTERNATE NAMES

Squamous Cell Lung Carcinoma, Squamous Cell Lung Cancer, Large Cell Lung Carcinoma, Large Cell Lung Cancer, Adenocarcinoma of the Lung, Non-Small Cell Lung Cancer, Non-Small Cell Lung Carcinoma, Lung Carcinoma

DIAGNOSTIC TESTING AND CODING

The following may be used to diagnose the disease: physical exam and history, chest x-ray, CT scan, PET scan, sputum cytology, bronchoscopy, fine needle aspiration biopsy, thorascoscopy, thoracotomy, and/or mediastinoscopy.

TREATMENT

Treatment of Stage IIIB Non-Small Cell Lung Carcinoma may include surgery, external radiation therapy, chemotherapy, or a combination of all three.
Treatment of Stage IV Non-Small Cell Lung Carcinoma may include internal radiation therapy, and/or external radiation as palliative therapy to relieve pain, symptoms, and improve quality of life.

PROGRESSION

Diagnosis in the early stages provides the greatest chance for survival; however, symptoms of lung carcinoma usually do not appear until the disease is in an advanced stage. Treatment for Stage IV will not cure the cancer, but can reduce symptoms and extend and improve the quality of life.
The 5-year survival rate for Lung Cancer is 15%. Late stage Lung Cancer has a 5-year survival rate of less than 5%. Most Lung Cancer patients die within a year of diagnosis.

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

13.14 A

Lung Cancer that is inoperable, unresectable, recurrent, or with metastases to or beyond the hilar nodes meets Listing 13.14 A.

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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DI 23022.245 - Non-Small Cell Lung Cancer - 10/24/2008
Batch run: 01/27/2009
Rev:10/24/2008