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STOMACH CANCER - WITH DISTANT METASTASES OR INOPERABLE, UNRESECTABLE OR
RECURRENT
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ALTERNATE NAMES
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Gastric Cancer; Gastric Carcinoma; Stomach Carcinoma
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DESCRIPTION
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Stomach Cancer forms in tissues lining the stomach. Age, diet, and stomach diseases can affect the
risk of developing stomach cancer. In the early stages, the following symptoms may
occur: indigestion and stomach discomfort, a bloated feeling after eating, mild nausea,
loss of appetite, and/or heartburn. In more advanced stages, the following symptoms
may occur: blood in the stool, vomiting, unintentional weight loss, stomach pain,
jaundice, and/or trouble swallowing.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
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Diagnostic testing: The following may be used to diagnose the disease: physical exam and history, blood
tests, endoscopy, fecal occult blood test (FOBT), barium swallow, biopsy, and/or CT
scan.
Physical findings: Most symptoms of gastric cancer reflect advanced disease. Patients may complain of
one or more of the following:
ICD-9: 151.9
ICD-10: C16.9
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PROGRESSION
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The progression of the disease depends on the stage and extent of the cancer, as well
as the patient's general health. Stomach cancer is often in an advanced stage when
diagnosed and is rarely cured.
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TREATMENT
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Treatment may include surgery, chemotherapy, radiation, or chemo-radiation. Treatment
of Stage IV Gastric Cancer may include palliative chemotherapy, endoluminal laser
therapy or endoluminal stent placement, palliative surgery, and/or a clinical trial
of new combinations of chemotherapy.
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| SUGGESTED PROGRAMMATIC
ASSESSMENT* |
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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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| Suggested Listings for Evaluation: |
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.16 B
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Stomach Cancer that is inoperable, unresectable, recurrent, or with metastases meets
the criteria in 13.16 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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