TN 33 (08-20)

DI 23022.483 Primary Peritoneal Cancer

COMPASSIONATE ALLOWANCE INFORMATION

PRIMARY PERITONEAL CANCER

ALTERNATE NAMES

Primary Peritoneal Carcinoma; Primary Peritoneal Neoplasm; Primary Peritoneal Tumor; Primary Peritoneal Sarcoma; Serous Surface Papillary Carcinoma; Serous Surface Papillary Cancer; Serous Surface Papillary Sarcoma; Serous Surface Papillary Tumor; Serous Surface Papillary Neoplasm; Extra Ovarian Serous Carcinoma; Extra Ovarian Serous Cancer; Extra Ovarian Serous Neoplasm; Extra Ovarian Serous Tumor; Extra Ovarian Serous Sarcoma; Primary Serous Papillary Carcinoma; Primary Serous Papillary Cancer; Primary Serous Papillary Sarcoma; Primary Serous Papillary Tumor; Primary Serous Papillary Neoplasm

DESCRIPTION

Primary peritoneal cancer (PPC) is cancer that originates in the peritoneum, which is a moist sheet of tissue that lines the abdominal cavity and the surface of the abdominal organs. The peritoneum protects the organs and allows them to move smoothly within the abdomen. The cells of the peritoneum develop from the same type of cells, which form the ovaries, so PPC shares characteristics with ovarian cancer, and though rare PPC can occur in men. The exact cause of PPC is not known, but may be associated with the gene BRCA1/2 (also seen in ovarian cancer).

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnosis of primary peritoneal cancer is made by:

  • History and physical exam;

  • Pelvic exam;

  • CA 125 Assay;

  • Ultrasound;

  • Computerized Tomography (CT/CAT) scan;

  • Positron Emission Tomography (PET) scan;

  • Magnetic Resonance Imaging (MRI);

  • Chest X-ray; and

  • Biopsy.

Physical findings: The signs and symptoms of primary peritoneal cancer may include:

  • Pain, swelling, or a feeling of pressure in the abdomen or pelvis;

  • Vaginal bleeding that is heavy or irregular, especially after menopause;

  • Vaginal discharge that is clear, white, or colored with blood;

  • Lump in the pelvic area; and

  • Gastrointestinal problems such as gas, bloating, or constipation

ICD-9: 158.8

ICD-10: Q91.7
PROGRESSION

The prognosis for individuals with primary peritoneal cancer is often poor. Median life expectancy is 1-2 years, with a range of 4 months to >5 years, the 5-year survival rate is about 26%.

TREATMENT

The presentation of PPC may be in the advanced stages at initial diagnosis, making curative treatment very difficult. Treatment may include surgery, radiation, and/or chemotherapy. The treatment of primary peritoneal cancer depends on the stage/grade of cancer; whether the patient has extra fluid in the abdomen that causes swelling; whether the cancer is unresectable, metastatic, or recurrent; changes in the BRACA1 or BRACA2 genes; and the patient’s age and general health.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:
  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Pathology/biopsy report of the cancer; and

  • Imaging reports such as CT scan, MRI scan; PET scan, and Ultrasound

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS

Meets

 

 

Equals

13.23 E

Primary peritoneal cancer, by definition equals 13.23E 1 a – extension to peritoneal surfaces.

* 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/0423022483
DI 23022.483 - Primary Peritoneal Cancer - 08/28/2020
Batch run: 08/28/2020
Rev:08/28/2020