Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.315 Small Cell Cancer of the Uterus
COMPASSIONATE ALLOWANCE INFORMATION
SMALL CELL CANCER OF THE UTERUS
Small Cell Cancer of the Uterus, or Cervix, is an extremely aggressive tumor with a biological behavior that is similar to small cell cancer of the lung. Neuroendocrine tumors of the uterine cervix, are rare and aggressive cancers that account for approximately 1 to 2% of all cervical cancers. Small Cell Cancer of the Cervix (SCC) was first reported in 1958 and again in 1972 (Albores-Saavedra et al, 1972). Their early series included several poorly differentiated cancers that had a histological appearance similar to that of small cell or “oat cell” cancers of the lung. In subsequent years, there have been more than 40 reports of small series of patients with “small cell” or “neuroendocrine” carcinomas of the cervix. However, the inconsistent terminology used to describe endocrine cancers of the cervix has made it difficult to clearly define their incidence and behavior.
Small Cell Carcinoma of the Cervix, Neuroendocrine Carcinoma of the Cervix, Carcinoid Tumors, Argyrophil Cell Carcinomas, Oat Cell Carcinomas, Small Cell Undifferentiated Carcinoma, Uterine Cancer, Small Cell Carcinoma of the Uterus
DIAGNOSTIC TESTING AND CODING
Small Cell Cancer of the Uterus or Cervix is rarely discovered on routine pap smear. CT scan of the brain, chest, abdomen, pelvis, and bone marrow examination are done if a metastatic pattern is suspected. Imaging methods such as positron emission tomography could improve detection of para-aortic metastases that require extended regional radiation.
Conventional treatments for small cell carcinoma of the uterus include surgery, radiation, chemotherapy, and immunotherapy.
Small Cell cancer of the uterus or Cervix is a highly aggressive tumor that often metastasizes early and widely by both lymphatic and haematogenous routes and involves regional and distant lymph nodes, lung, bone and brain and liver. The disease-free interval is usually less than two years with an almost 70% rate of recurrence within 12 months of diagnosis. Long term survival is possible for individuals with cancers that are clinically localized to the cervix but individuals with more advanced stage of the disease is poor with very few long term survivors.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report of a biopsy specimen (or surgical specimen) of the uterus (and uterine cervix) showing small cell histology. There is no substitute for pathology.
Suggested Listings for Evaluation:
13.23A or B
Small cell cancer of the uterus (corpus) or uterine cervix would equal the listing with a diagnosis supported by biopsy.
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.
Last Updated: 9/10/08
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