Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.345 Ureter Cancer
COMPASSIONATE ALLOWANCE INFORMATION
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 and/or rubber.
Symptoms may include blood in the urine, persistent back pain, extreme fatigue, unintentional weight loss, and/or painful or frequent urination.
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
DIAGNOSTIC TESTING AND CODING
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.
If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy may be utilized for palliation, but the prognosis is poor.
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.
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:
Ureter Cancer that is inoperable, unresectable, recurrent, or with metastases meets Listing 13.21.
* 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