TN 20 (12-18)

DI 23022.225 Liver Cancer

COMPASSIONATE ALLOWANCE INFORMATION

LIVER CANCER

ALTERNATE NAMES

Hepatocellular (Liver) cancer; Intrahepatic Bile Duct Cancer; Liver Cancer; Hepatocellular Carcinoma

DESCRIPTION

Two of the most common forms of Liver Cancer are Hepatocellular Carcinoma and Intrahepatic Bile Duct Cancer. Hepatocellular Carcinoma is a type of adenocarcinoma that forms in the tissues of the liver. The following are possible risk factors for Hepatocellular Carcinoma: having hepatitis B or hepatitis C; having a close relative with both hepatitis and liver cancer; having alcoholic cirrhosis; hemochromatosis; and eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts that have not been stored properly). Intrahepatic Bile Duct Cancer arises within the liver bile ducts and may be multifocal.

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

Diagnostic testing: Diagnosis of Hepatocellular Carcinoma includes a clinical examination, which includes a medical history and a thorough physical examination. Many blood tests may be used to check for liver problems. For example, one blood test detects alpha-fetoprotein (AFP). High AFP levels could be a sign of liver cancer. Several tests may be performed including CT scan, ultrasound test, MRI, angiogram, and biopsy.

Physical findings: Hepatocellular Carcinoma is sometimes called a “silent disease” because in an early stage it often does not cause symptoms. But, as the cancer grows, symptoms may include:

  • Pain in the upper abdomen on the right side;

  • Pain that may extend to the back and shoulder;

  • Swollen abdomen (bloating);

  • Weight loss;

  • Loss of appetite and feelings of fullness;

  • Weakness or feeling very tired;

  • Nausea and vomiting;

  • Yellow skin and eyes, and dark urine from jaundice; and

  • Fever.

ICD-9: 155.0, 155.1, 230.8

PROGRESSION

Hepatocellular Carcinoma is rarely discovered early and often does not respond to current treatments-thus, the prognosis is often poor. For patients with advanced disease, care is focused on keeping the patient as comfortable as possible. Palliative therapy aims to improve the quality of a person's life by controlling pain and other problems caused by the disease.

TREATMENT

Hepatocellular Carcinoma can be cured only when it is found at an early stage (before it has spread) and only if the patient is healthy enough to have surgery. However, treatments other than surgery may be able to control the disease and help patients live longer and feel better. The choice of treatment depends on the condition of the liver; the number, size, and location of tumors; and whether the cancer has spread outside the liver. Options include surgery, radiation therapy, chemotherapy, percutaneous ethanol injections, and hepatic arterial infusions. For a few patients, liver transplantation may be an option.

SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
  • A pathology report stating that hepatocellular carcinoma is present in a biopsy specimen, or

  • A MRI or CT scan showing liver abnormalities compatible with hepatocellular carcinoma along with elevated alpha-feto-protein meeting the requirements under the diagnostic testing above.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.19 Prognosis is poor based on confirmed diagnosis alone
Equals
* 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/0423022225
DI 23022.225 - Liver Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018