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URETER CANCER
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ALTERNATE NAMES
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Metastatic Transitional Cell Carcinoma of the Ureter (Stage IV); Squamous Cell Cancer
of the Ureter; Squamous Cell Carcinoma of the Ureter; Adenocarcinoma of the Ureter;
Ureter Carcinoma
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DESCRIPTION
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Ureter Cancer forms in transitional cells in the lining of the bladder, ureter, or renal pelvis.
Transitional cells are cells that can change shape and stretch without breaking apart.
Misuse of certain pain medications can affect the risk of developing transitional
cell cancer of the renal pelvis or ureter.
Risk factors can include prolonged misuse of certain pain medications, smoking cigarettes,
exposure to certain dyes and chemicals used in making leather goods, textiles, plastics,
or rubber.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: The following tests may be used to diagnose the disease: physical exam and history,
urinalysis, ureteroscopy, urine cytology, intravenous pyelogram (IVP), CT scan, and/or
ultrasound.
Physical findings:
Symptoms may include:
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Unintentional weight loss; and/or
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Painful or frequent urination.
ICD-9: 189.2
ICD-10: C66
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PROGRESSION
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Ureter Cancer usually affects men more often than women and is more common in people
older than 65. The 5-year survival rate is 5% or less.
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TREATMENT
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If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy
may be utilized for palliation, but the prognosis is poor.
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| SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for Evaluation:
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A pathology report and an operative report are the preferred methods for documentation;
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Clinical note from a surgeon that the cancer is inoperable or unresectable;
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Surgical pathology report that the cancer was not completely removed and that the
surgical margins were positive for malignancy; and
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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.
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| DETERMINATION |
LISTING
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REMARKS |
| Meets |
13.21 A or B |
Ureter Cancer that is inoperable, unresectable, recurrent, or with metastases meets
13.21 A or B.
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| Equals |
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| * 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.
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