Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Cervix


Related Terms

  • Cervical Neoplasia

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • General Surgeon
  • Gynecologist
  • Oncologist
  • Radiology Oncologist

Comorbid Conditions

  • Other sexually transmitted diseases

Factors Influencing Duration

Factors influencing the length of disability include the woman's age, the type and stage of disease at initial presentation, the presence of concurrent infection, the individual's general health, the type of treatment pursued, and any complications. Younger women with stage 0 will recover most quickly and have the highest likelihood of long-term survival. In contrast, women with invasive disease requiring radical surgery and/or chemotherapy or radiation therapy, or those in poor health at the onset of treatment, will be disabled for a longer period and are least likely to survive their disease.

Medical Codes

ICD-9-CM:
180.0 - Malignant Neoplasm of Cervix Uteri; Endocervix; Cervical Canal NOS; Endocervical Canal; Endocervical Gland
180.1 - Malignant Neoplasm of Cervix Uteri; Exocervix
180.8 - Neoplasm, Other Specified Sites of Cervix, Malignant
180.9 - Cancer, Cervix Uteri, Unspecified Site

Overview

© Reed Group
Cervical cancer refers to cancer of the narrowed entry to the uterus (cervix) and is categorized into stages 0 through IV. Stage 0 refers to cancer limited to only the cells on the surface layer of the cervix (carcinoma in situ, or pre-invasive cancer). Stage IV refers to cancer that has spread beyond the pelvis and involves the bladder, rectum, or distant organs (liver, lung, or bone).

There are two types of cervical cancer: squamous cell carcinomas (80% to 90%) and adenocarcinomas (5% to 20%) (Saksouk). If the cancer has signs of both types, it is called mixed carcinoma. Cervical cancer is often associated with a sexually transmitted human papilloma virus (HPV). Certain types of HPVs are considered high-risk, and infection by one may cause abnormal (precancerous) cells to form on the cervix. These cells may lead to cancer if not treated.

Early detection and treatment of cervical cancer is important to improve survival. The American Cancer Society and US Preventative Services Task Force recommend that all women begin having screening Pap smears 3 years after they initiate sexual activity, or no later than age 21 (Garcia). Smear tests should be done every year, or liquid tests should be done every 2 years. From age 30 on, women who have had three normal test results in a row and have no other risk factors can reduce the frequency of testing to once every 2 to 3 years. Women who have regular Pap smears rarely present with advanced cervical cancer.

Incidence and Prevalence: The American Cancer Society estimated that 12,200 cases of cervical cancer would be diagnosed in the US in 2010 (“Cervical Cancer”). Also, it was estimated that in 2009 over 50,000 cases of carcinoma in situ would be found (Garcia).

Worldwide, cancer of the cervix is the second most common malignancy in women (Garcia). More than 500,000 new cases of cervical cancer are diagnosed around the world each year (Garcia).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The most common risk factors for cervical cancer include beginning sexual intercourse at 16 years or younger; having a history of multiple sexual partners or promiscuous male partners; being diagnosed with genital HPV infections, Chlamydia infections, or other sexually transmitted disease; having sex with an uncircumcised male; and being diagnosed with a previous precancerous cervical lesion (cervical dysplasia).

Women who have had many children and those who are long-term users of oral contraceptives (5 or more years) are considered to have increased risk of cervical cancer. Women with HIV or a family history of the disease are also at higher risk. Other factors include smoking, being exposed to secondhand smoke, and being overweight. Being the daughter of a mother who was prescribed diethylstilbestrol (DES) to prevent miscarriages may also slightly increase the risk of cervical cancer.

Half the women diagnosed with cervical cancer are between the ages of 35 and 55. Slightly more than 20% of women with cervical cancer are diagnosed when they are older than 65 years ("Detailed Guide").

Cancer of the cervix is twice as common in Hispanic women as in white women; black Americans and Native American women are also at increased risk ("Detailed Guide").

Source: Medical Disability Advisor



Diagnosis

History: Early cervical cancer rarely causes symptoms. If the cancer has become invasive, some women may report a bloody discharge between menstrual periods or after sexual intercourse, pain during intercourse (dyspareunia), or a vaginal discharge with or without odor. In later stages, individuals may report lower extremity swelling (edema), constipation, difficulty with urination, or blood in the urine (hematuria).

Physical exam: Carcinoma in situ will not be seen on routine pelvic examination. Women with invasive cervical cancer may have an abnormal growth visible on the cervix, which can be detected during a routine pelvic exam. Pelvic or rectal growths from invasive cervical cancer may be palpated during bimanual and rectal examination.

Tests: The Papanicolaou test (Pap smear) is the best method to detect cervical cancer, particularly in its early stage. The Pap smear identifies all stages of cervical cancer. An abnormal Pap smear often requires a repeat test within several months, or a more detailed examination of the cervix through colposcopy, in which a magnifying instrument called a colposcope is used to examine the cervix. If suspicious tissue is seen, a piece of tissue may be removed (biopsy) and sent to the laboratory for examination. Endocervical curettage may also be performed. In this procedure, tissue is scraped from the inside of the cervix; as in a biopsy, it is sent to the laboratory for examination. A cone biopsy is the removal and examination of a larger piece of tissue, usually cone- or cylinder-shaped.

ThinPrep (liquid-based) Pap testing may be conducted on the cervical cell sample, which is placed in a special solution for examination. Computer analysis (Autopap) also may be done of cell samples. DNA analysis through polymerase chain reaction (PCR) testing may be conducted to identify the human papilloma virus (HPV).

If there is evidence that the cancer has spread, x-rays, CT, positron emission tomography (PET) scan, or MRI may be needed. Examination of the bladder or rectum may be done with an endoscopy procedure in which a thin tube with a camera is inserted into the urethra or rectum.

Source: Medical Disability Advisor



Treatment

In stage 0 (surface tissue only), carcinoma in situ, treatment may include cone biopsy (conization), laser vaporization or excision, cryosurgery, or simple hysterectomy, in which only the uterus with cervix is removed. Frequently, both diagnosis and treatment for stage 0, carcinoma in situ, can be achieved through the use of the loop electrosurgical excision procedure (LEEP).

For stage IA cancer (visible by microscope), treatment is often a simple or radical hysterectomy. For women with superficial tumor invasion who want to maintain childbearing potential, cold-knife conization treatment may be considered. Some individuals may respond to internal radiation treatment.

In stages IB and IIA (tumors that are visible and/or have penetrated surrounding tissue), treatment is often a radical hysterectomy with removal of the uterus, ovaries, upper portion of the vagina and pelvic lymph nodes. Postoperative radiation therapy may be given to decrease the risk of recurrence. Radiation therapy may also be used as the sole treatment for invasive cervical cancer or in combination with hysterectomy. In stage IIB (cancer has spread into tissue near the cervix), a combined internal and external radiation therapy may be used, usually with chemotherapy. For women with recurrent cervical cancer and those with advanced cervical cancer (stages III and IVA, in which tumor has spread into areas such as the vagina and/or organs such as the bladder), chemotherapy is the standard of care, possibly along with radiation to control pain and bleeding. Stage IVB cancer, found in areas beyond the pelvis, is considered incurable.

Source: Medical Disability Advisor



Prognosis

Overall, one-third of individuals with invasive cervical cancer will die from it (Garcia). Specific survival rates vary according to the stage. When the cancer is caught at the earliest stage of invasive cervical cancer, the 5-year survival rate is 92% (“Detailed Guide”). The overall 5-year survival rate (all stages combined) is about 71% (“Detailed Guide”). The five-year survival rate for stage I cervical cancer is greater than 90%; for stage II cancer, 60% to 80%; for stage III cancer, 50%; and for stage IV cancer, less than 30% (Garcia).

The death rate for cervical cancer in the US declines by approximately 4% each year due to the increasing use of the Pap smear (“Detailed Guide”). In many developing countries where women do not have routine Pap smears, cervical cancer is the leading cause of cancer death.

Source: Medical Disability Advisor



Complications

Untreated cervical cancer may result in massive and acute vaginal bleeding, and urethral or rectal obstruction. It also may spread to other body sites, including the bladder, rectum, lymph nodes, bone, liver, lung, and central nervous system. Death may result.

After treatment for cervical cancer, women may have problems becoming pregnant or maintaining a full-term pregnancy because the cervix has become incompetent or weakened and possibly scarred as a result of the treatments.

Psychological reactions such as depression, irritability, feelings of sexual inadequacy, and guilt can accompany this disease.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Women treated nonsurgically for stage 0 (carcinoma in situ) should not require special accommodations or work restrictions. Women treated surgically with either a simple or radical hysterectomy and those undergoing chemotherapy and/or radiation therapy may benefit from having a place at the work site where they may periodically rest. Work responsibilities for these women may need to be primarily sedentary. Return to work may start with part-time hours, with a slow transition to full-time. Women undergoing chemotherapy or radiation therapy may require leave from work to complete their treatments.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of cervical cancer confirmed?
  • Were conditions with similar symptoms ruled out?
  • Has individual experienced psychological reactions such as depression, irritability, feelings of sexual inadequacy, and guilt that can accompany this disease?

Regarding treatment:

  • What stage is the cancer?
  • With what procedure was it treated (cone biopsy, laser vaporization, excision, cryosurgery, or loop electrosurgical excision procedure)?
  • Was all the cancerous tissue removed?
  • Was a hysterectomy performed?
  • Is radiation being used as sole treatment or in combination with hysterectomy?
  • If the cancer is advanced, to what body sites has it spread?
  • Were lymph nodes removed?
  • Would individual also benefit from chemotherapy?

Regarding prognosis:

  • At what stage was cancer diagnosed?
  • Was initial treatment successful? Was additional treatment required?
  • Does individual have an underlying condition such as pregnancy that may complicate treatment or delay recovery?
  • Has individual experienced any complications as a result of the cancer or treatment for the cancer?
  • Since treatment options such as the addition of radiation or chemotherapy may extend recovery time by several months, was adequate time allotted for recovery?
  • If disability has extended past expected duration, what are the extenuating circumstances?
  • Since most women report a loss of self-esteem; decrease in or total loss of sexuality; fears about dying; general feelings of anxiety, sadness, anger, or irritability; difficulty concentrating, and changes in sleep and eating patterns, is the psychological impact of this disease being addressed? Was referral made for counseling?

Source: Medical Disability Advisor



References

Cited

"Cervical Cancer." Natonal Cancer Institute. U.S. National Institutes of Health. 21 Jul. 2009 <http://www.cancer.gov/cancertopics/types/cervical>.

"Detailed Guide: Cervical Cancer. What Are the Key Statistics About Cervical Cancer?" American Cancer Society. 26 Mar. 2008. 23 Jul. 2009 <http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_cervical_cancer_8.asp?sitearea=>.

Garcia, Agustin A. "Cervical Cancer." eMedicine. Eds. John J. Kavanagh, et al. 12 Dec. 2007. Medscape. 23 Jul. 2009 <http://emedicine.medscape.com/article/253513-overview>.

Saksouk, Faysal A. "Cervix, Cancer." eMedicine. 25 Jun. 2009. Medscape. 23 Jul. 2009 <http://emedicine.medscape.com/article/402329-overview>.

Source: Medical Disability Advisor






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