TN 23 (02-19)

DI 23022.320 Small Cell Lung Cancer

COMPASSIONATE ALLOWANCE INFORMATION

SMALL CELL LUNG CANCER

ALTERNATE NAMES

Small Cell Lung Carcinoma; Oat Cell Lung Cancer; Mixed Small Cell/Large Cell Lung Carcinoma; Combined Small Cell Lung Carcinoma

DESCRIPTION

There are two types of Lung Cancers: Small Cell and Non Small Cell. Small Cell Cancer of the Lung is an aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. Small cell lung cancer looks small and oval-shaped under a microscope.

Risk factors for small cell lung cancer include: smoking cigarettes, cigars or pipes, now or in the past, exposure to second-hand smoke and exposure to asbestos, or radon.

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

Diagnostic testing: The diagnosis of small cell lung cancer is confirmed by a pathologist using laboratory studies obtained by bronchoscopy or a CT-guided procedure (fine-needle biopsy). Specimens (stains) for chromogranin, neuron-specific enolase and synaptophysin are usually positive. Staging of the carcinoma is performed by imaging studies (CT scans, MRI, PET scans). These studies provide the information needed for staging at diagnosis, response to treatment, resectionability and metastases.

Physical findings:

• Persistent cough;

• Wheezing;

• Hoarseness;

• Hemoptysis (expectoration of blood or of blood-stained sputum);

• Dyspnea (shortness of breath);

• Chest pain;

• Fatigue;

• Decreased appetite; and

• Weight loss.

ICD-9: 162.9

PROGRESSION Although this disease is very responsive to chemotherapy, the overall survival rate is poor. Of those diagnosed with extensive small cell lung carcinoma (most patients) the 2 year survival rate is < 2%.

TREATMENT

Management of limited stage small cell lung carcinoma involves a combination of chemotherapy and thoracic radiation therapies. Treatment can involve either a single modality or a series of multiple modalities. If a complete remission is obtained, prophylactic cranial radiation is offered. At this level of treatment, the disease is potentially curable. However, most individuals are diagnosed with extensive disease and are generally considered incurable but may achieve remission with the use of a combination chemotherapy regimen.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation: A pathology report of a lung biopsy.
Suggested Listings for Evaluation:
DETERMINATION LISTINGS REMARKS
Meets

13.14 B

Small cell lung cancer currently meets the criteria in listing 13.14.
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/0423022320
DI 23022.320 - Small Cell Lung Cancer - 02/07/2019
Batch run: 02/07/2019
Rev:02/07/2019