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Malignant Neoplasm of the Cervix B021

Document
Last amended 
29 June 2015
Current RMA Instruments:
Reasonable Hypothesis SOP
39 of 2012
Balance of Probabilities SOP
40 of 2012
Changes from Previous Instruments:

SOP Bulletin 159

ICD Coding:
  • ICD-9-CM Codes: 180, 233.1, 622.1
  • ICD-10-AM Codes: C53, D06, N87.2

This is a malignant neoplasm of the cervix uteri. The term ‘cervix’ is Latin for neck, and hence the correct name is cervix uteri, which means the neck of the uterus or womb.

It is the neck of the uterus which protrudes into the vagina and the external surface of the cervix uteri is covered with a different type of epithelium (stratified squamous epithelium) compared to that within the uterus.

This RMA instrument covers malignant neoplasm of the cervix and additionally covers some early carcinoma in situ lesions as well as some neoplastic precursor lesions (cervical dysplasia). The coverage of the carcinoma in situ (CIN) and precursor lesions depends upon the histology report with CIN 1, CIN2, mild cervical dysplasia, moderate cervical dysplasia excluded but CIN 3, severe dysplasia included.

Not covered by SOP – Non SOP

Covered by SOP

CIN 1

CIN II

CIN III

Carcinoma (invasive)

Mild dysplasia

Moderate dysplasia

Severe dysplasia

Carcinoma in situ

 

Note that strictly speaking, the dysplasia and the cervical intra-epithelial neoplasia are not malignant neoplasia even though they are included within this SOP.

Is specific diagnostic evidence required to apply the SOP?Yes.

This diagnosis is based on histology reports provided by a pathologist on a sample of cervix uteri tissue obtained via pap smear or via surgical excision.

Are there sub-factors that require specific information? – Yes 

The clinical screening factor is specifically defined in the other definitions area and applies to contemporary (at the time of serving) standards and not the current standards.  To apply this factor information regarding relevant contemporary screening practices will be required.

Additional diagnoses covered by SOP
  • Adenocarcinoma of the cervix
  • Cervical intraepithelial neoplasia grade 3 (CIN 3)
  • Severe cervical dysplasia
  • Squamous cell carcinoma of the cervix
Conditions excluded from SOP
  • Cervical intraepithelial neoplasm grade 1 (CIN 1), ICD-9 code 622.1
  • Cervical intraepithelial neoplasm grade 2 (CIN 2), ICD-9 code 622.1
  • Mild cervical dysplasia, ICD-9 code 622.1
  • Moderate cervical dysplasia, ICD-9 code 622.1
  • Squamous intraepithelial lesion (SIL), ICD-9 code 622.1
  • Melanoma in situ of the cervix, ICD-9 code 239.5
  • Soft tissue sarcoma of the cervix, ICD-9 code 171.8
  • Non-Hodgkin’s lymphoma of the cervix, ICD-9 code 202.8
  • Hodgkin’s lymphoma of the cervix, ICD-9 code 201.9
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.

Additional SOP word definitions:

Additional SOP word definitions:

Benign – This is a neoplasm which is well behaved (benign means good). The neoplasm grows and crushes the tissues surrounding it and does not invade the surrounding tissues.

Carcinoma – Neoplasm of cell types which cover the body or line body cavities. Epithelial means tiles upon. This is a common type of neoplasm with the sarcoma being uncommon.

Carcinoma in situ – This is an early carcinoma which has not yet invaded the underlying tissue (hasn’t penetrated the basement membrane) but is noted to be neoplastic based on histological cell features. This carcinoma in situ is also known as intra-epithelial carcinoma. In the TNM staging system, this is Tis.

Dysplasia – Dysplasia is the abnormal development of a cell or tissue (transformation) partly on its way to becoming neoplastic but not as yet being neoplastic. Dysplastic cells or tissues are said to be precursor lesions of malignant neoplasia. As such dysplastic tissue is at risk of being transformed into a neoplasm, and thus is removed or destroyed as a prophylactic measure.

Grades – A tumour grade is normally based upon the histological features of the tumour as seen under the microscope. A tumour grade is often specified as well differentiated or poorly differentiated/ anaplastic. Differentiation refers to the cell type (liver cell, lung cell, colon cell etc) being different from the original single cell which arose from the parents ovum and sperm. 

Hyperplasia – Increase in the number of cells.

Hypertrophy – Increase in the size of cells.

Malignant – This is a badly behaved neoplasm (malignant means bad). The neoplasm acts like a benign neoplasm but additionally has bad behaviour such as invading the surrounding tissue, breaking off and setting up a neoplastic colony in the local lymph nodes or in distant body spaces (Metastases).

Metastasis or secondary – This is a secondary neoplastic deposit or colony which has been set up from a distant primary neoplasm site. 

Oncogenic – This means cancer producing.

Pap smear – Short hand jargon for Papanicolaou stain of cervical uteri skin scraping. This is a multicolour staining procedure which aids the diagnosis of cervical cell abnormalities at an early stage.

Primary – Primary when used in reference to neoplasms indicates that the current site of the neoplasm is the tissue of origin. If the neoplasm has set up a neoplastic colony in a distant body location it is a secondary neoplasm or a metastasis.

Sarcoma – malignant neoplasm of connective tissue elements. Sarcos – flesh.

Secondary – This is a secondary neoplastic deposit or colony which has been set up from a distant primary neoplasm site.

Stage – This is the classification of the clinical behaviour of the malignant neoplasm and is different for the different types of neoplasm.