TN 20 (12-18)

DI 23022.260 Ovarian Cancer

COMPASSIONATE ALLOWANCE INFORMATION

OVARIAN CANCER (excluding Germ Cell)

ALTERNATE NAMES

Ovarian Epithelial Carcinoma; Ovarian Epithelial Cancer; Ovarian Carcinoma

DESCRIPTION

Ovarian Cancer forms in tissues of the ovary. Most ovarian cancers are either ovarian epithelial carcinomas or malignant germ cell tumors is a disease in which malignant cells form in the tissue covering the ovary.

Those with a family history of Ovarian Cancer are at an increased risk of developing it. Some ovarian cancers are caused by inherited gene mutation. Hereditary ovarian cancers make up approximately 5% to 10% of all cases of Ovarian Cancer. Tests that can detect mutated genes are sometimes performed for members of families with a high risk of cancer.

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

Diagnostic testing: The following may be used to diagnose the extent of disease: blood tests, urinalysis, GI series, exploratory laparoscopy, ultrasound, abdominal CT scan, and/or MRI of the abdomen. Diagnosis requires pathological evaluation of biopsy specimen or cytology specimen.

Physical findings: Common symptoms of Ovarian Cancer include:

  • Abdominal bloating;

  • Indigestion;

  • Nausea;

  • Changes in appetite;

  • Pressure in pelvis or lower back;

  • A frequent or urgent need to urinate;

  • Constipation;

  • Changes in bowel movements;

  • Increased abdominal girth;

  • Tiredness or low energy; and

  • Changes in menstruation.

ICD-9: 233.39, 795.82

PROGRESSION

The prognosis for individuals with Ovarian Cancer is often poor. About 76% with ovarian cancer survive 1 year after diagnosis and about 45% live longer than 5 years after diagnosis.

TREATMENT

The prognosisTreatment may include surgery, radiation, and/or chemotherapy.

If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy can be utilized for palliation, but the prognosis is poor.

Suggested MER for Evaluation:
  • A pathology report and an operative report are the preferred methods for documentation.

  • Clinical note from a surgeon that the cancer is inoperable or unresectable.

  • Surgical pathology report that the cancer was not completely removed and that the surgical margins were positive for malignancy.

  • 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.
Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.23 E 1 b With metastases to or beyond the regional lymph nodes satisfies the criteria in 13.23 E 1 b.
Equals 13.23 E 1 a Ovarian Cancer that is inoperable or unresectable may equal the criteria in 13.23 E 1 a, as it has a similar prognosis to this listing.
* 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/0423022260
DI 23022.260 - Ovarian Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018