TN 20 (12-18)

DI 23022.335 Stomach Cancer

COMPASSIONATE ALLOWANCE INFORMATION

STOMACH CANCER

ALTERNATE NAMES

Gastric Cancer; Gastric Carcinoma; Stomach Carcinoma

DESCRIPTION

Stomach Cancer forms in tissues lining the stomach. Age, diet, and stomach diseases can affect the risk of developing stomach cancer. In the early stages, the following symptoms may occur: indigestion and stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, and/or heartburn. In more advanced stages, the following symptoms may occur: blood in the stool, vomiting, unintentional weight loss, stomach pain, jaundice, and/or trouble swallowing.

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

Diagnostic testing: The following may be used to diagnose the disease: physical exam and history, blood tests, endoscopy, fecal occult blood test (FOBT), barium swallow, biopsy, and/or CT scan.

Physical findings: Most symptoms of gastric cancer reflect advanced disease. Patients may complain of one or more of the following:

  • Indigestion;

  • Nausea;

  • Vomiting;

  • Dysphagia;

  • Postprandial fullness;

  • Loss of appetite;

  • Melena;

  • Hematemesis; and

  • Weight loss.

ICD-9: 151.9

PROGRESSION

The progression of the disease depends on the stage and extent of the cancer, as well as the patient's general health. Stomach cancer is often in an advanced stage when diagnosed and is rarely cured.

TREATMENT

Treatment may include surgery, chemotherapy, radiation, or chemo-radiation. Treatment of Stage IV Gastric Cancer may include palliative chemotherapy, endoluminal laser therapy or endoluminal stent placement, palliative surgery, and/or a clinical trial of new combinations of chemotherapy.

SUGGESTED PROGRAMMATIC ASSESSMENT*
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.

  • 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 13.16 B Stomach Cancer that is inoperable, unresectable, recurrent, or with metastases meets the criteria in 13.16 B.
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/0423022335
DI 23022.335 - Stomach Cancer - 12/13/2018
Batch run: 12/13/2018
Rev:12/13/2018