TN 22 (12-18)

DI 23022.685 Carcinoma of Unknown Primary Site

COMPASSIONATE ALLOWANCE INFORMATION

CARCINOMA OF UNKNOWN PRIMARY SITE

ALTERNATE NAMES

Cancer of Unknown Primary Origin; CUP; Origin of Unknown Primary Site; Occult Primary Malignancy; Occult Primary Cancer; Malignant Neoplasms of Unknown site; Malignant Neoplasms of Unknown Origin

DESCRIPTION

Carcinoma of Unknown Primary Site (CUP) is a condition where cancer cells are found in the body, but the place where the cells first started growing (the origin or primary site) cannot be determined. The clinical presentation of cancer of unknown primary origin is extremely variable, and depends on the extent and type of organ involvement.

Most people with CUP present with multiple areas of involvement in multiple visceral sites (organs in the cavities of the body), the most common sites of involvement being lung, bone, lymph nodes, and liver. Individuals with CUP are presumed to all have stage IV disease at the time of initial presentation.

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

Diagnostic testing: Diagnostic testing for CUP includes biopsy, imaging studies, and laboratory analysis.

Physical findings: Individuals with CUP may have:

  • Long-lasting pain in a specific area of the body;

  • Loss of appetite;

  • Unexplained weight loss;

  • A cough or hoarseness that doesn’t go away;

  • Thickening or lump in any part of the body;

  • Changes in bowel or bladder habits;

  • Unusual bleeding or discharge; and

  • Recurring fever or night sweats.

ICD-9: 199.1

PROGRESSION

The incidence of CUP increases with age, with the median age on presentation for both men and women ranging from 59-66 years. The overall prognosis of patients with cancer of unknown primary origin with multiple organ involvement and poor response to treatment is grave.

TREATMENT

The treatment for CUP is dependent on organ involvement.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

• Clinical history and examination that describes the diagnostic features of the impairment;

• Imaging tests;

• Pathology/biopsy report of the cancer; and

• Treatment records including surgical procedures, and up-to-date progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.27

CUP meets the criteria in listing 13.27 upon confirmed diagnosis, regardless of effectiveness of treatment, except squamous cell carcinoma of unknown primary site confined to the neck nodes, which we evaluate under listing 13.02.

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.

 


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http://policy.ssa.gov/poms.nsf/lnx/0423022685
DI 23022.685 - Carcinoma of Unknown Primary Site - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018