7627 - Malignant neoplasms of gynecological system

DBQ: Link to Index of DBQ/Exams by Disability for DC 7627 

Definition

A malignant neoplasm is a tumor that gains access to tissue and spreads to other areas. It often recurs after attempts at surgical removal, and is referred to as cancer. In this case, the malignant tumors are located in the breast, and the organs associated with childbearing, which include the uterus, ovaries and fallopian tubes.

Etiology

Cancer is caused by genetic or chromosomal changes in cells. The direct cause of these changes is unknown. Cancer has been linked to a high-fat dietary intake, obesity, and environmental, chemical, heredity, virus such as human papillomavirus (HPV), and immunological factors.

Endometrial cancer is the most common gynecologic malignancy, followed by ovarian and cervical cancer.

Signs & Symptoms

Signs and symptoms may depend on the site of the disease. Manifestations related to the gynecological system may include: abnormal uterine bleeding; pink, watery, or foul-smelling vaginal discharge; abdominal discomfort and indigestion; swollen abdomen and low abdominal pain; abdominal mass; back pain; leg swelling; or obstruction of the urinary tract system.

Tests

Physical, pelvic and breast examinations, papanicolaou (PAP) smear, tissue biopsy, tumor staging, blood studies, ultrasound, x-ray, electrocardiogram (EKG), bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI), or hormone receptor assay may be indicated.

Treatment

The surgical procedure relates to the site of the cancer and its invasiveness. It may include removal of all of the gynecologic organs, omentum, and lymph nodes. In addition, radiation therapy, chemotherapy, antiestrogen or other hormone therapies, bone marrow transplant, or a combination of these measures may be used to treat the disease. Pain management and nutrition therapy may be initiated.

Residuals

There is potential for recurrence or metastasis postoperatively which can appear at any time after primary therapy, and may depend on the stage and amount of residual disease as well as the patient's genetic and biologic factors. Development of osteoporosis may occur. Long-term hormone therapy may be indicated. The potential for infection exists. Scarring and skin disfigurement may not resolve. Social isolation and feelings of altered sexual identity may develop. Counseling, psychotherapy, and support groups may be indicated to assist the patient in dealing with the diagnosis. A hospice program may eventually be needed in advanced stages of the disease.

Special Considerations

  • Consider service connection on a presumptive basis as a chronic condition (38 CFR 3.307; 3.309(a)).
  • Consider service connection on a presumptive basis as a condition associated with ionizing radiation exposure (38 CFR 3.307; 3.309(d); 3.311).

Notes

  • A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e) . Rate chronic residuals to include scars, lymphedema, disfigurement, and/or other impairment of function under the appropriate diagnostic code(s) within the appropriate body system
  • Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
  • When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation. 
  • May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).