TN 20 (12-18)

DI 23022.265 Pancreatic Cancer

COMPASSIONATE ALLOWANCE INFORMATION

PANCREATIC CANCER

ALTERNATE NAMES

Exocrine Cancer; Pancreatic Adenocarcinoma; Pancreatic Carcinoma

DESCRIPTION

Pancreatic Cancer occurs when cells of the pancreas grow abnormally to form a tumor. The malignant (cancer) cells form in the tissues of the pancreas. Most pancreatic cancers begin in the ducts that carry pancreatic juices. The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

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

Diagnostic testing: To determine extent of disease the following may be done: physical exam, lab tests including blood, urine, and stool samples to check for bilirubin and other substances, CT scan, MRI scan, Ultrasonography: Transabdominal ultrasound or Endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and laparoscopy. Diagnosis is made on pathological review of a biopsy specimen.

Physical findings: Symptoms of this disease may include:

  • Pain in the upper abdomen or upper back;

  • Yellow skin and eyes, and dark urine from jaundice;

  • Weakness;

  • Loss of appetite;

  • Nausea and vomiting, and

  • Weight loss.

ICD-9: 157.3, V18.11, V84.81

PROGRESSION

Although rare, Pancreatic Cancer can be cured only when it is found at an early stage, before it has spread. However, other treatments may be able to control the disease and help patients live longer and feel better.

TREATMENT

Pancreatic Cancer may have several treatment options. Depending on the type and stage, before it has spread. However, other treatments may be able to control the disease and help patients and their doctors choose palliative therapy.

SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report showing the presence of a non-islet cell adenocarcinoma in the pancreas is the only test that can definitively make the diagnosis.
Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.20 A & B Only pathology report is needed for adjudication.
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/0423022265
DI 23022.265 - Pancreatic Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018