Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part II of II) - Chapter VIII 8. NEOPLASTIC DISEASE 8.1 General -

MANUAL SINGLE NATIONAL DISABILITY
(PART II OF II)

CHAPTER VIII
8. NEOPLASTIC DISEASE

8.1 General

It should be noted that with new knowledge of these pathologies, the bearer of a neoplasia or a history of having it is not synonymous with disability. It must meet the requirements and conditions specified in this chapter to consider the patient's debilitating cancer.

Determining the percentage of impairment resulting from malignant tumors based on:

• The location and size of tumor,

• The tumor invasion to neighboring organs,

• The extension to regional lymph nodes

· The Distant metastases

• The histology

• The degree of response to treatment (surgery, radiation, hormones, chemotherapy), and

• The magnitude of the consequences post-treatment.

8.2 CONSIDERATIONS FOR ASSESSMENT

In malignant diagnosis should be established based on the signs and symptoms, reports of examinations and diagnostic aid pathology, among others. You should also consider:

a) The site of the primary lesion, recurrent or metastatic disease should be documented in all cases of malignant neoplasm. If surgery was performed should include a reliable copy of the protocol and surgical pathology report of the part or biopsy. If you can not obtain these documents, the hospitalization epicrisis the physician's report should include details of the surgical findings and results of examinations (gross and microscopic) made by the pathologist.

b) If there is disease progression by the treating physician, it must send an updated medical report including recent surveys specifically aimed at determining local recurrence, lymph node, metastasis to other organs and probable sequelae after treatment.

c) For purposes of qualifying or opinion, the concept of lymph node metastases distance refers to the node tumor invasion beyond the limits of radical en bloc resection.

d) local or regional recurrence after radical surgery or anatomo-pathological evidence of incomplete excision in radical surgery is considered equal to the injury "inoperable" and for purposes of the rating should be evaluated as such, except for breast cancer.

e) The local or regional recurrence after complete removal of a tumor located, should not be considered equal to the recurrence after radical surgery.

f) The histological diagnosis of cancer is and should be documented with the original submission of the report issued by a pathologist, in case of no agreement between what was reported and the clinical, laboratory examinations, should be resorted to interconsultation pathologist requesting another shipment of plates and blocks shows that originated the diagnosis. The cytology report of either liquid or bodies shall be considered when dealing with

patients with disseminated disease, such as neoplastic cells in ascites, pleural, etc.

It is essential that the assessor also has the spread of cancer studies, such as imaging (RX, ECO, TAC, etc..) And radionuclides in asymptomatic patients. Moreover, in a patient with gastric cancer and a palpable mass at the level of right upper quadrant enough just endoscopy and histological report for finding a deficiency of 40%. In lymphomas, histological type and the compromised sites are not necessarily indicative of total disability. When the tumor involvement extends beyond the regional lymph nodes, the damage will generally be considered as severe.

8.3 Evaluation of neoplastic disease

These guidelines provide criteria to evaluate and quantify the deficiency caused by the presence of a neoplastic disease, the consequences that may arise from the treatment, or both.

a) In cases where a tumor and / or its metastases are hormone dependent, isótoposensibles, or both, or there is disappearance of the primary tumor or its metastases in a follow-up period of at least 3 years, the deficiency is determined in accordance with assessment of the damage to the corresponding organ system. Example: In a seminoma operated and treated, the deficiency is defined based on the presence or absence of sexual problems, must be cataloged in accordance with the provisions of Chapter VI.

b) When the malignancy is localized or regional lymph nodes involves only apparently were completely removed with or without radiotherapy, and is not expected metastasis or recurrence in the short term, the deficiency should be considered as described in the paragraph a), evaluating the resulting damage to the organ system involved by the tumor. The exceptions to these cases are outlined in section 8.4.

c) Effects of surgical therapy, significant postoperative sequelae must be evaluated according to the state of the organ system affected. If you made an extended gastrectomy, a colostomy or nephrectomy, gastrectomy deficiency depend on its own or its complications, such as dumping syndrome, malnutrition, etc., The colostomy should be considered with the percentage of disability resulting from an ostomy and nephrectomy the percentage given in the chapter for this disease. .

d) Effects of chemotherapy and radiation therapy: The impact caused by these types of procedures should be considered the treatment outcome and adverse response to therapy. These may vary greatly, so that each case must be studied individually. It is important to get the attending physician complete the treatment plan, including medication, dose, frequency of administration and duration. Obtain a description of complications or adverse responses to therapy, such as nausea, vomiting, diarrhea, weakness, skin disorders or reactive mental disorders and the severity of these effects in anticancer chemotherapy may change during the period of administration drug. Evaluation of patients with regard to the impact of therapy

with drugs or radiation, should be based on observation during a period sufficient to allow a proper determination of the deficiency on this ground.

e) There may be a patient with a history of being a carrier of a cancer, which at the time to evaluate it is only periodic checks and no evidence of active tumor disease. In this case, the failure rate is given by the aftermath of treatment, if any, such as total laryngectomy, nephrectomy, amputation, total gastrectomy, etc., And not by the statistical forecast.

f) When a cancer patient refused any treatment, you should inform the patient of the risk of your decision, you should rate the current state and to conduct periodic reviews in accordance with the clinical course of cancer to alter the percentage of deficiency, when be the case.

g) In the case of patients considered curative treatment, it was ruled under "Monitoring and Treatment" and will be periodic reviews in accordance with the clinical course of cancer to alter the percentage of impairment, when appropriate.

8.4 CHARACTERISTICS OF CANCERS WITH DEFICIENCY OF 40%

Neoplasms by histologic type, location and extent of the injury are inoperable or are out of control for other therapies, have an overall deficit of 40.0%.

8.4.1 Head and Neck

The head and neck tumors other than salivary glands, thyroid, upper and lower jaw, orbit and temporal fossa, corresponding to this classification when:

a) Inoperable

b) Not controlled by the therapy given.

c) Recurrences after surgery, radiation, or both.

d) They have distant metastases.

e) Squamous cell carcinoma of the pyriform sinus or posterior third of tongue (not included carcinoma of the tonsil).

8.4.2 Skin Sarcoma

a) Angiosarcoma with regional lymph node metastases.

b) systemic fungal infections with liver involvement or visceral.

8.4.3 Soft Tissue Sarcoma

a) Inoperable.

b) Distant metastasis.

c) recurrent cancer after radical surgery followed by radiation therapy or not.

8.4.4. Malignant Melanoma

a) recurrence after radical surgery.

b) Metastasis to the adjacent skin or other organs.

8.4.5. Lymphoma

Hodgkin's and non-Hodgkin's lymphoma with progressive disease despite treatment.

8.4.6 Lymph Nodes

a) metastatic adenopathy of unknown primary.

b) Squamous cell carcinoma of lymph node in the neck that does not respond to treatment.

8.4.7. Salivary glands

a) carcinoma or sarcoma with metastases beyond the regional lymph nodes.

b) recurrence after radical treatment.

8.4.8. Thyroid

a) Carcinoma with metastases beyond the regional lymph nodes, not controlled by treatment

made.

b) local recurrence not controlled by prescribed therapy.

8.4.9. Mama

a) Cancer inoperable.

b) Cancer inflammatory.

c) local and regional recurrence uncontrolled.

d) Distant metastasis or bilateral breast cancer.

e) Sarcoma with metastases anywhere.

04/08/1910. Bone System (excluding the mandible)

a) Primary malignant tumors with evidence of metastasis or uncontrolled therapy

prescribed.

b) bone metastases of unknown origin after an adequate search.

08/04/1911. Upper and lower jaw, orbit or temporal fossa

a) Sarcoma of any type with metastases.

b) Carcinoma of the cavity with extension into the orbit or ethmoid or sphenoid, with or without metastasis

regional.

c) orbital tumors with intracranial extension.

d) tumor of the temporal fossa with perforation of the skull or meningeal complications.

e) Adantinoma with intracranial and orbital infiltration.

f) Rathke sac tumors with infiltration of the base of the skull or metastases.

08/04/1912. Brain Tumor and Spinal Cord

a) malignant gliomas, grade III-IV astrocytomas, glioblastoma multiforme, medulloblastoma,

ependymoblastoma and primary sarcoma;

b) O, grade I-II astrocytomas, meningioma, pituitary tumors, oligodendroglioma, ependymoma

and benign tumors. These should be evaluated by the collateral damage that occur as:

epilepsy, organic brain damage or neurological deficits.

08/04/1913. Lungs

a) ineradicable.

b) Metastasis.

c) relapse after treatment.

d) incompletely excised tumor.

e) small cell carcinoma.

08/04/1914. Pleura and Mediastinum

a) Malignant mesothelioma of the pleura.

b) Malignant tumor with metastasis to the pleura.

c) primary malignant tumor of the mediastinum not controlled by prescribed therapy.

04/08/1915. Abdomen

a) peritoneal carcinomatosis.

b) retroperitoneal malignant tumor not controlled by prescribed therapy.

c) Ascites with demonstrated malignant cells.

04/08/1916. Esophagus

a) Carcinoma or sarcoma of the upper two thirds of the esophagus.

b) Carcinoma or sarcoma of the distal esophagus with regional node metastases or infiltration of neighboring structures.

08/04/1917. Stomach

a) Carcinoma of stomach with metastasis to regional lymph nodes or tumor invasion to adjacent organs.

b) Kaposi not controlled by adequate therapy.

c) Inoperable.

d) recurrence or metastasis after radical surgery.

e) lymphomas according to the progression of disease.

04/08/1918. Small Intestine

a) carcinoma, sarcoma, or carcinoid tumor with metastases beyond the regional lymph nodes.

b) Recurrence after previous excision.

c) Kaposi not controlled by the described therapy.

08/04/1919. Intestine

a) unresectable

b) metastases beyond the regional lymph nodes.

c) recurrence or metastasis after excision.

04/08/1920. Liver and Gallbladder

a) primary or metastatic malignant tumors.

b) invasive carcinoma of the gallbladder.

c) unresectable bile duct carcinoma or metastases.

04/08/1921. Pancreas

a) Carcinoma, except cel Cancer. islet.

b) Carcinoma of the islet cell in unresectable or physiologically active.

04/08/1922. Kidneys, adrenal or Ureters Pigeon

a) ineradicable.

b) With metastases

08/04/1923. Bladder

a) Infiltration beyond the bladder wall.

b) ineradicable.

c) Metastasis

d) Evaluate renal impairment after total cystectomy according to the criteria applied in that chapter.

08/04/1924. Prostate

Carcinoma not controlled by prescribed therapy and well run.

08/04/1925. Testicle

a) Choriocarcinoma, not controlled by adequate therapy.

b) Other primary malignant tumors with progressive disease not controlled with therapy

indicated.

08/04/1926. Uterus Carcinoma - Adenocarcinoma and Sarcoma.

a) Inoperable and not controlled with proper treatment.

b) recurrence after radical hysterectomy or radiotherapy.

c) total pelvic exenteration.

04/08/1927. Ovary

a) Ascites with demonstrated malignant cells.

b) Tumor unresectable or partially removed.

c) unresectable metastases of the abdominal cavity.

d) Distant metastasis.

04/08/1928. Fallopian tube

Carcinoma or unresectable or metastatic sarcoma.

04/08/1929. Leukemia

a) acute lymphocytic leukemia or nonlymphocytic completely unresponsive, refractory to initial treatment.

b) acute leukemia relapses during the maintenance period of therapy or treatment while outside.

c) chronic myeloid leukemia unresponsive to treatment or is in the stage of transformation or blast crisis.

d) chronic lymphocytic leukemia in advanced stage with symptoms of anemia and thrombocytopenia or unresponsive to treatment.

08/04/1930. Myeloma

Confirmed by electrophoresis of proteins in urine or serum and bone marrow examination appropriate. With:

a) radiological evidence of bone disease with intractable osteoalgias or pathologic fractures;

b) Or, evidence of kidney damage;

c) Or, Hypercalcemia with persistent serum levels of 11 mg/100 ml for at least 1 month despite prescribed therapy;

d) O, plasma cells, 100 or more cells per ml in peripheral blood.

8.5 ACQUIRED IMMUNODEFICIENCY SYNDROME

The criteria for evaluation of patients infected with HIV or AIDS patient are given in terms of the restriction, absence or functional deficiencies. Should consider three criteria to reach a diagnosis of HIV and AIDS, as follows:

1.    Epidemiological approach: The epidemiological approach is the starting point of diagnosis and includes various forms of transmission and risk history and positive contacts.

2.    Laboratory criteria: The laboratory approach based on the demonstration of the virus, its products or antibodies produced against different viral proteins. Diagnostic methods are categorized into:

a) Detection of antibodies presumptive tests (ELISA), additional evidence (Western-Blood, immunofluorescence, rapid test or immuno-blot), among others.

b) Detection of the virus or its products: Virus isolation, antigen P24 chain reaction (PCR), among others.

c) Additional laboratory tests, immune profile, blood count and erythrocyte sedimentation rate, lymphocyte population, CD4/CD8 ratio, delayed hypersensitivity immunological tests, among others.

3. Clinical criteria: The clinical criteria is given by the detection of signs and symptoms in relation to AIDS. Always keep in mind that the incubation period can last several years and that not all clinical manifestations will occur in all patients, since the same change can have different characteristics in people. HIV may directly affect the agency to significantly reduce the level of immune defenses and may trigger a series of diseases secondary to this. For the evaluation of impairment classification is used HIV / AIDS CDC/Atlanta/93, which includes consideration of a parameter for clinical evaluation and other laboratory, based on the T4 cell count or CD4 cells. The rating applies to those who already have tested positive for HIV (2 presumptive tests and an additional positive). The percentage of overall deficit generated by infection with HIV, is defined according to CDC classification for Adolescents and Adults, 1993, at three clinical categories (A, B, C) with ranges of CD4, 1, 2 and 3, as illustrated in Table No. 8. 1.

TABLE No. 8.1: CDC CLASSIFICATION FOR TEENS AND ADULTS.

CD4 range of clinical categories A B C

Symptomatic acute infection Asymptomatic lymphadenopathy no condition (A) or (C) AIDS-indicator conditions

1)> 500 / mm3 A1 B1 C1

2) A2 B2 C2 200-499/mm3

3) <200 / mm3 A3 B3 C3

For better orientation of the qualifiers, it is recommended to carefully review the criteria for the classification of CDC/Atlanta/93 for Adolescents and Adults.

TABLE No. 8.2: GLOBAL IMPAIRMENT BY INFECTION WITH HIV / AIDS

Deficiency Category Global (%)

10.0 A1

15.0 A2

A3 20.0

27.0 B1

34.0 B2

B3 40.0

C1 44.0

C2 47.0

C3 50.0