Malignant Neoplasm of the Oesophagus B033

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-10-AM Codes: C15

Brief description

Malignant neoplasm of the oesophagus is a primary cancer from the cells of the oesophagus, the muscular tube extending from the lower border of the hypopharynx to the lower bower of the oesophageal sphincter. Tumours at the gastro-oesophageal junction are included. The majority of oesophageal cancers are adenocarcinomas or squamous cell carcinomas, although other rare primary malignant subtypes may occur. 

Confirming the diagnosis

Diagnosis requires histological confirmation of a primary malignant neoplasm of the oesophagus, usually obtained by biopsy during upper gastrointestinal endoscopy. Histological classification (e.g. adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma) is essential, as some SOP factors apply only to specific tumour types. 

Diagnosis and management often involve gastroenterologists, general physicians and surgeons, and oncologists. However, general practitioners may confirm the diagnosis if the appropriate histopathology results are available. 

Additional diagnoses covered by SOP

• Adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma
• Poorly differentiated and undifferentiated carcinomas of the oesophagus
• Adenoid cystic carcinoma, oat cell carcinoma, polypoid or psuedosarcomatous carcinoma of the oesophagus;
• Barrett's adenocarcinoma
• Carcinoma of the oesophagus
• Malignant melanoma of the oesophagus (primary)

Conditions not covered by SOP

• Carcinoid tumour of the oesophagus #
• Hodgkin lymphoma of the oesophagus *
• Non-Hodgkin's lymphoma of the oesophagus *Soft tissue sarcoma of the oesophagus *
• Secondary/metastatic cancer/carcinoma involving the oesophagus (code to primary cancer site)

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

Clinical onset will usually coincide with the time of first diagnostic confirmation. Earlier symptoms such as dysphagia, odynophagia, weight loss, or reflux-like symptoms may be present but are non-specific and may reflect other gastrointestinal conditions. 

Where symptoms such as progressive difficulty swallowing or food sticking occurred prior to diagnosis- and alternative causes have been excluded- the onset may be backdated to when these more specific features first appeared. 

Clinical worsening

For malignant neoplasm of the oesophagus, the only SOP factor for worsening is inability to obtain appropriate clinical management. 

This cancer often carries a poor prognosis, and treatment options (including surgery, chemotherapy, radiation therapy, or combined modalities) can be complex, high-risk, or palliative in nature. Assessing whether worsening is attributable to a lack of appropriate clinical management- rather than the natural aggressive course of the disease- requires expert medical assessment, typically by an oncologist or upper gastrointestinal surgeon.