Current RMA Instruments
| Reasonable Hypothesis SOP | 85 of 2016 |
| Balance of Probabilities SOP | 86 of 2016 |
Changes from previous Instruments
ICD Coding:
- ICD-9-CM Codes: 191
- ICD-10-AM Codes: C71
Brief description
This SOP covers cancers arising in the brain tissue itself, but not neoplasms of adjacent structures (e.g. meninges, pituitary gland), nor brain tumours of lymph or connective tissue (lymphomas and sarcomas), nor secondary brain tumours originating from other sites. There are more than 100 types of tumours that can affect the brain and the terminology can be confusing. The distinction between benign and malignant brain tumours is also less clear cut than for tumours arising at other sites.
Confirming the diagnosis
Histological confirmation is required for diagnosis.
The relevant medical specialist is a neurosurgeon, neurologist, or oncologist.
Diagnoses covered by SOP
Common
- astrocytoma of any grade or type
- glioblastoma (multiforme)
Uncommon
- astroblastoma
- choroid plexus carcinoma
- choriocarcinoma of the brain (primary)
- embryonal carcinoma of the brain (primary)
- ependymoblastoma
- ependymoma
- ganglioglyoma
- germinoma of the brain (primary)
- gliomatosis cerebri
- medulloblastoma
- medulloepithelioma
- neuroblastoma
- oligoastrocytoma
- oligodendroglioma
- pineoblastoma
- pineocytoma
- polar spongioblastoma
- teratoma of the brain (primary)
Conditions excluded from SOP
- acoustic neuroma*
- choroid plexus papilloma,# ICD code 225.0
- craniopharyngioma,# ICD code 237.0
- dysembryoplastic neuroepithelial tumour,# ICD code 225.0
- gangliocytoma,# (usually benign) ICD code 215.8
- haemangioblastoma,# - soft tissue sarcoma
- haemangiopericytoma,# - soft tissue sarcoma
- Hodgkin's lymphoma of the brain*
- meningioma*
- neurilemmoma* - acoustic neuroma
- neurofibroma,# ICD code 215.8
- non-Hodgkin's lymphoma of the brain*
- pituitary adenoma*
- schwannoma* - acoustic neuroma
- secondary/metastatic cancer involving the brain (code to primary cancer site)
- soft tissue sarcoma of the brain*
* another SOP applies
# non-SOP condition
Clinical onset
The clinical presentation is highly variable. Initial symptoms may include headaches, seizures, focal neurological symptoms or cognitive dysfunction. Once the diagnosis has been confirmed, clinical onset can be backdated to the time of onset of the first symptoms that are clinically consistent with the location, size or other features of the tumour.
Clinical worsening
The only worsening factor is for inability to obtain appropriate clinical management. Appropriate treatment varies with the type and stage of the tumour and other factors. The natural history for most brain cancers is for disease progression.