TN 7 (08-12)

DI 23022.685 Carcinoma of Unknown Primary Site

COMPASSIONATE ALLOWANCE INFORMATION

CARCINOMA OF UNKNOWN PRIMARY SITE

ALTERNATE NAMES

Cancer of Unknown Primary Origin; CUP; Origin of Unknown Primary Site; Occult Primary Malignancy; Occult Primary Cancer; Malignant Neoplasms of Unknown site; Malignant Neoplasms of Unknown Origin 

DESCRIPTION

Carcinoma of Unknown Primary Site (CUP) is a condition where cancer cells are found in the body, but the place where the cells first started growing (the origin or primary site) cannot be determined. The clinical presentation of cancer of unknown primary origin is extremely variable, and depends on the extent and type of organ involvement. Most people with CUP present with multiple areas of involvement in multiple visceral sites (organs in the cavities of the body), the most common sites of involvement being lung, bone, lymph nodes, and liver. Individuals with cancer of unknown primary origin are presumed to all have stage IV disease at the time of initial presentation.

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

Diagnostic testing: Diagnostic testing for CUP includes biopsy, imaging studies, and laboratory analysis.

ICD-9: 199.1

ONSET AND PROGRESSION

The incidence of CUP increases with age, with the median age on presentation for both men and women ranging from 59-66 years. The overall prognosis of patients with cancer of unknown primary origin with multiple organ involvement and poor response to treatment is grave.

TREATMENT

The treatment for CUPS is dependent on organ involvement.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation: The adjudicator needs medical evidence from treating sources and hospitals. It should include clinical history and examination that describe the diagnostic features of the impairment, imaging tests, biopsies, pathology reports, surgical procedures, pertinent treatment records, and up-to-date progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.27

CUP meets listing 13.27 upon confirmed diagnosis, regardless of effectiveness of treatment, except squamous cell carcinoma of unknown primary site confined to the neck nodes, which we evaluate under listing 13.02.

Medical Equals

  

* 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022685
DI 23022.685 - Carcinoma of Unknown Primary Site - 08/10/2012
Batch run: 08/10/2012
Rev:08/10/2012