SOP Bulletin No. 87

Decision Support Unit

8 — th Floor, 259 Queen St, Brisbane — 3 — rd Floor Blackburn House, 199 Grenfell St, Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

15 November 2004

THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 17 NOVEMBER, 2004

New SOPs	Malignant Neoplasm of Unknown Primary Site
Revocations & Replacements	Malignant Neoplasm of the Small Intestine Neoplasm of the Pituitary Gland

IMPORTANT OPERATIONAL FEATURES

Malignant Neoplasm of Unknown Primary Site

New  – 44 & 45 of '02

• These are new SOPs, which finalise the S196G investigation into malignant neoplasm of unknown primary site.  Claims for this condition can now be determined.

• The SOPs apply when there is a metastatic neoplasm for which the primary site cannot be determined after a complete history, physical examination and appropriate investigations have been carried out.  The extent of appropriate investigation would usually be decided on clinical grounds by the treating practitioners.

• These SOPs cannot be used where the site of the primary neoplasm has been identified.  Soft tissue sarcomas and malignant melanomas are excluded from the SOP definition.  These malignancies have their own SOPs.  Lymphomas do not appear as an exclusion in the SOP definition, as lymphomas can occur in multiple primary sites, and therefore, should not occur as a neoplasm of unknown primary.  Lymphomas should be considered under the Hodgkin's or non-Hodgkin's lymphoma SOPs.

• There are causal factors for smoking, atomic and therapeutic radiation, with varying dose and time requirements in both the RH and BOP SOPs.  The RH SOP also contains an alcohol causal factor.

• The appropriate label can be found in the CCPS Encoder under 'malignant neoplasm without specification of site' or ICD codes 199, 199.0 and 199.1

Malignant Neoplasm of the Small Intestine

Revocation – 40 & 41 of '02 Replaces 153 & 154 of '96, as amended by 7 & 8 of '98

• The definition has been amended to exclude carcinoid tumours.  This change is expected to appear in all Malignant Neoplasm SOPs as they are reviewed.

• The Crohn's and coeliac disease factors now apply to all malignant neoplasms covered by the SOP (previously adenocarcinomas only).

• The familial adenomatous polyposis/adenomatous polyps factor has been reworded to an adenoma of the small intestine factor, and is also no longer restricted to adenocarcinomas.  The presence of polyps in the small intestine due to familial adenomatous polyposis is still covered in this factor.

• In both the RH and BOP SOPs there is a new ileostomy/ileal pouch factor, with time requirements, for adenocarcinoma involving an ileostomy or ileal pouch only.

Neoplasm of the Pituitary Gland

Revocation – 42 & 43 of '02 Replaces 37 and 38 of '97

• The definition has been amended to exclude carcinoid tumours.

• The bilateral adrenalectomy factor for ACTH secreting pituitary adenomas is now a causal factor as well as a worsening factor in both RH and BOP.

Remember! If you are having any problems with SOPs, or SOPs in CCPS, talk to us!