TN 20 (12-18)

DI 23022.290 Salivary Cancers

COMPASSIONATE ALLOWANCE INFORMATION

SALIVARY CANCERS

ALTERNATE NAMES

Salivary Glands Cancer; Anaplastic Small Cell Carcinoma of the Salivary Glands; Adenosquamous Carcinoma of the Salivary Glands; Anaplastic Small Cell Carcinoma; Adenosquamos Carcinoma

DESCRIPTION

Salivary Cancers form in tissues of salivary glands in the floor of the mouth and throughout the oropharynx, the parotid glands, and the submandibular glands. Cancer of the salivary glands commonly presents with one of several different histologies: mucoepidermoid, adenoid cystic, acinic cell, malignant mixed, squamous or adenocarcinoma. There are two rare histologies, which have much worse prognosis than the standard pathological diagnoses: Anaplastic small cell and adenosquamous carcinoma of the salivary glands.

Anaplastic Small Cell Carcinoma of the Salivary Glands is a type of cancer that displays very aggressive metastatic behavior. Microscopically, the cancer cells have oval, hyperchromatic nuclei and scant amount of cytoplasm and are organized in sheets, strands, and nests. At time of diagnosis, distant metastatic disease is almost always present.

Adenosquamous Carcinoma of the Salivary Glands is an extremely rare malignant neoplasm that simultaneously arises from surface mucosal epithelium and salivary gland ductal epithelium. The carcinoma shows histopathologic features of both squamous cell carcinoma and adenocarcinoma.

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

Diagnostic Testing: Pathologic evaluation of tissue obtained by needle biopsy or surgery is the only way to determine salivary cancer. After a salivary cancer diagnosis, the extent of disease can be evaluated by various tests, which include MRI, CT scan, PET scan, ultrasound, and endoscopy.

Physical findings: Symptoms and physical findings in individuals with Adenosquamous Carcinoma of the Salivary Gland may include:

  • Swelling;

  • Visible changes in the mucosa including erythema, ulceration, and induration;

  • Pain frequently accompanying ulceration;

  • A lump (usually painless) in the area of the ear, cheek, jaw, lip, or inside the mouth;

  • Fluid draining from the ear;

  • Trouble swallowing or opening the mouth widely;

  • Numbness or weakness in the face; and

  • Pain in the face that does not go away.

Adenosquamous Carcinoma of the Salivary Gland behaves aggressively with extensive infiltrating local disease as well as distant metastatic disease.

In Anaplastic Small Cell Carcinoma of the Salivary Glands, symptoms may include:

  • A fast-growing tumor, associated with pain in some cases;

  • Facial paralysis; and

  • Eating and chewing difficulties;

  • Tumors in the mouth that ulcerate and bleed.

ICD-9: 142

PROGRESSION

Progression can be with local recurrence or distant metastases.

Anaplastic Small Cell Carcinoma of the Salivary Glands - Neuroendocrine carcinomas are frequently found in the minor salivary glands. Individuals with this type of cancer have a better survival rate compared to those with small cell carcinomas of the lung.

Adenosquamous Carcinoma of the Salivary Gland - Limited data indicate that this is a highly aggressive neoplasm with a poor prognosis.

TREATMENT

Treatment can consist of surgery, radiation, and chemotherapy in various combinations depending on the clinical circumstances. Unfortunately, treatment for Anaplastic Small Cell Carcinoma of the Salivary Glands or Adenosquamous Carcinoma of the Salivary Gland is rarely curative.

SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
  • A pathology report on needle biopsy or surgical specimen showing Small Cell Carcinoma or Adenosquamous Carcinoma.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets
Equals 13.08 Adenosquamous Carcinoma of the Salivary Gland and Anaplastic Small Cell Carcinoma of the Salivary Gland equals the criteria in 13.08 because its poor prognosis is similar to the impairment in the listing.

Small Cell Adenosquamous Carcinoma of the Salivary Gland equals the criteria in 13.08 because its poor prognosis is similar to the impairment in the listing.

* 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/0423022290
DI 23022.290 - Salivary Cancers - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018