Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.320 Small Cell Lung Cancer
COMPASSIONATE ALLOWANCE INFORMATION
SMALL CELL LUNG CANCER
There are two types of Lung Cancers: Small Cell and Non Small Cell. Small Cell Cancer of the Lung is an aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. Small cell lung cancer looks small and oval-shaped under a microscope.
Risk factors for small cell lung cancer include: smoking cigarettes, cigars or pipes, now or in the past, exposure to second-hand smoke and exposure to asbestos, or radon.
Symptoms may include persistent cough, wheezing, hoarseness, hemoptysis (expectoration of blood or of blood-stained sputum), dypsnea, chest pain, fatigue, decreased appetite and weight loss.
Small Cell Lung Carcinoma, Oat cell Lung cancer, Mixed small cell/large cell Lung carcinoma, Combined small cell Lung carcinoma
DIAGNOSTIC TESTING AND CODING
The diagnosis of small cell lung cancer is confirmed by a pathologist using laboratory studies obtained by bronchoscopy or a CT-guided procedure (fine-needle biopsy). Specimens (stains) for chromogranin, neuron-specific enolase and synaptophysin are usually positive. Staging of the carcinoma is performed by imaging studies (CT scans, MRI, PET scans). These studies provide the information needed for staging at diagnosis, response to treatment, resectionability and metastases.
Management of limited stage small cell lung carcinoma involves a combination of chemotherapy and thoracic radiation therapies. Treatment can involve either a single modality or a series of multiple modalities. If a complete remission is obtained, prophylactic cranial radiation is offered. At this level of treatment, the disease is potentially curable. However, most individuals are diagnosed with extensive disease and are generally considered incurable but may achieve remission with the use of a combination chemotherapy regimen.
Although this disease is very responsive to chemotherapy, the overall survival rate is poor. Of those diagnosed with extensive small cell lung carcinoma (most patients) the 2 year survival rate is < 2%.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report of a lung biopsy.
Suggested Listings for Evaluation:
Small cell lung carcinoma currently meets Listing 13.14
* 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
Office of Disability Programs