ALTERNATE NAMES

Lung Carcinosarcoma; Pulmonary Sarcomatoid Carcinoma; Pulmonary Carcinosarcoma; Spindle-cell Carcinoma; Lung Sarcomatoid Carcinoma Stages II - IV

DESCRIPTION

Sarcomatoid Carcinoma of the Lung is an aggressive (fast-growing) cancer that is a mix of carcinoma and sarcoma cancer types. Sarcomatoid carcinomas can appear throughout the body but are most commonly observed in the lung. The tumor is usually locally advanced at the time of diagnosis, with a large proportion of pleural invasion, either vascular or parietal.

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

Diagnostic testing: The diagnosis of sarcomatoid carcinoma of the lung is made by:

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  Physical examination;

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  Computed tomography (CT) scan;

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  Positron emission tomography (PET) scan;

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  Magnetic resonance imaging (MRI);

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  Histopathology; and

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  Immunohistochemistry.

Physical findings: Symptoms of sarcomatoid carcinoma of the lung include:

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  Chest pain;

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  Breathing difficulties;

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  Fatigue;

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  Unexplained weight loss;

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  Dry cough; and

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  Bloody phlegm.

ICD-9: 199.1

ICD-10: C34.90

PROGRESSION

Sarcomatoid carcinoma that starts in the lung often spreads quickly. Tumors may spread to the lymph nodes, followed by the adrenal glands, brain, bone, liver, kidney , peritoneum (the lining of the abdomen and abdominal organs), pancreas, skin, and heart.

Sarcomatoid carcinoma is most common in people assigned male at birth and people with a history of tobacco use. The average age of diagnosis is 65. Stage I fully resected tumors have a long-term cure rate of 50% or better. Stage II-IV tumors have a much poorer prognosis, with average survival of only 2-3 years.

TREATMENT

There is no cure for advanced sarcomatoid carcinoma of the lung. The most common approach to treatment is surgery to remove the tumor followed by chemotherapy. Sarcomatoid carcinoma of the lung is highly aggressive and has a propensity for metastatic spread; and it has a low response rate to traditional treatments such as chemotherapy, radiotherapy, and neoadjuvant therapy. Because the cancer has often spread at the time of diagnosis, radiation therapy, targeted therapy, and immunotherapy may be used when the cancer is causing problems such as pain, bleeding, or difficulties with breathing.

Suggested MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment;

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  Biopsy or needle aspiration information found in operative notes, pathology reports, summaries of hospitalizations or other medical reports that include details of surgical and pathological findings; and

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  Imaging reports (e.g., chest x-rays, CT scan, PET scan, or MRI).

Suggested Listings for Evaluation:

DETERMINATION

LISTING

Meets

13.14 A

Stage II-IV tumors have a high rate of local and metastatic recurrence, and poor prognosis.

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