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COMPASSIONATE ALLOWANCE INFORMATION
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OVARIAN CANCER (excluding Germ Cell)
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ALTERNATE NAMES
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Ovarian Epithelial Carcinoma; Ovarian Epithelial Cancer; Ovarian Carcinoma
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DESCRIPTION
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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.
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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 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:
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Pressure in pelvis or lower back;
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A frequent or urgent need to urinate;
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Changes in bowel movements;
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Increased abdominal girth;
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Tiredness or low energy; and
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ICD-9: 233.39, 795.82
ICD-10: C79.82
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PROGRESSION
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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.
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TREATMENT
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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.
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| SUGGESTED
PROGRAMMATIC ASSESSMENT* |
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.
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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: |
| DETERMINATION |
LISTING
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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.
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| 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.
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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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