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Eileen Stedem Life Underwriting Specialist LifeMark Account Prudential. Underwriting Colon Cancer. The Prudential Insurance Company of America, Newark, NJ NR-12D35701 Ed. 3/12 Exp. 9/6/2013. General Concepts and Terms. - PowerPoint PPT Presentation

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Underwriting Colon Cancer

Underwriting Colon CancerEileen StedemLife Underwriting SpecialistLifeMark AccountPrudentialFor the education of producers/brokers. Not for use with the public.The Prudential Insurance Company of America, Newark, NJNR-12D35701 Ed. 3/12 Exp. 9/6/20131General Concepts and TermsCancer is a general term used to describe any of the multiple types of malignant tumors.

Cancer can affect any organ or tissue in the body.

Cancer is characterized by inappropriate cell growth.For the education of producers/brokers. Not for use with the public.

22Related GI ConcernsUlcerative colitis (UC) - recurrent inflammation of the colorectum

Crohns disease (Regional Enteritis) - chronic inflammatory process which may be found in any area of GI tract from lips to anus

Familial Adenomatous Polyposis (FAP)and Gardners Syndrome - characterized by hundreds to thousands of polyps in the colon

Colon Polyp - tumor of the inner lining of the colon. Adverse underwriting action is usually due to pre-malignant potential

For the education of producers/brokers. Not for use with the public.33Benign Colon PolypsHyperplastic and other non-neoplastic polyps (e.g., hamartomas, juvenile, inflammatory lymphoid aggregates) have little to no risk of progression to cancer. Adenomatous polyps (characterized histologically as tubular, tubulovillous and villous) can progress to cancer.Tubular polyps are likely to be small and benign. Villous polyps are more likely to be large and contain cancer. After one polyp is removed, there is an increased risk of developing another polyp.

For the education of producers/brokers. Not for use with the public.44Benign Colon PolypsGUIDELINES

Colon polyp present, under 1 cm in size, well followedNo ratingColon polyp present, over 1 cm in sizeDeclineColon polyp removed, benign with good follow-upNo rating with unknown follow-up, no villous elementsNo rating with unknown follow-up of dysplastic or villous polypTable BFor the education of producers/brokers. Not for use with the public.55Colorectal Cancer Items of interestColorectal cancer is the third most common cancer in men and women and the second leading cause of cancer death in the United States.

Most colorectal cancer arises slowly from an adenomatous polyp over 7 to 15 years.

Incidence and mortality rates have been decreasing due to screening for and subsequent removal of polyps via colonoscopy.

For the education of producers/brokers. Not for use with the public.66Risk FactorsRisk factors for developing colorectal cancer include:family history of cancer or polypsinherited conditions (such as familial adenomatous polyposis and hereditary nonpolyposis)diet and or age inflammatory bowel disease (such as ulcerative colilitis or Crohns disease)personal history of colorectal polypsFor the education of producers/brokers. Not for use with the public.77Factors important in assessing the risk for colon cancer:Type (i.e. adenocarcinoma, mucinous, signet ring cell)

Grade

Stage

Time since treatment has ended

Any recurrences or relapses

SurveillanceFor the education of producers/brokers. Not for use with the public.88Colorectal Cancer: AnatomyThe wall of the colon consists of four layers:

mucosa (adjacent to the lumen)

Submucosa

muscularis propria

subserosa (outermost, farthest from the lumen)

For the education of producers/brokers. Not for use with the public.99Colorectal Cancer: AnatomyThe wall of the colon consists of four layers:

mucosa (adjacent to the lumen)

Submucosa

muscularis propria

subserosa (outermost, farthest from the lumen)

For the education of producers/brokers. Not for use with the public.10Staging CancerStage represents the extent of tumor within the body. A commonly used classification for stage is the TNM system.

T indicates local tumor size and its characteristics

N indicates the spread of the tumor to the nearby lymph nodes

M indicates spread to distant parts of the body via metastasis

For the education of producers/brokers. Not for use with the public.1111Staging of Colorectal CancerTNM is preferred to the older Dukes system. Both are provided below for reference.

StageTNMDukesDescription0Tis, N0, M0In-situ, tumor confined to mucosaIT1, N0, M0ATumor through the mucosa into submucosaIT2, N0, M0A Tumor through submucosa in muscularis propriaIIAT3, N0, M0B1Tumor through muscularis propria and into subserosa but not into neighboring tissuesIIBT4, N0, M0B2Tumor into nearby tissues or organs, but nodes remain negativeIIIAT1, N1, M0T2, N1, M0C1T1 or T2 plus 1-3 nodes positiveIIIBT3, N1, M0T4, N1, M0C2T3 or T4 plus 1-3 nodes positiveIVM1DSpread to distant sites such as liver, lung, peritoneum, ovary, etc.For the education of producers/brokers. Not for use with the public.1212Determining the RatingStep 1: Refer to Rx for Success for colorectal cancer rating based upon staging and age at diagnosis.

StageRatingAge < 65 at diagnosisRatingAge > 65 at diagnosisCarcinoma in situ, Tis No rating No rating Stage I and Stage IIA Tumor table C Tumor table D Stage IIB Tumor table B Tumor table C Stage III - Best case only with 2 positive lymph nodes and normal CEA 0-5 years 6th year 7th year 8th year 9th year 10th year thereafter Decline Table B + $10x5 Table B + $10x4 Table B + $10x3 Table B + $10x2 Table B + $10x1 Table B 0-2 years 3rd year 4th year 5th year6th year 7th year thereafter Decline Table B + $10x5 Table B + $10x4 Table B + $10x3 Table B + $10x2 Table B + $10x1 Table B Stage III (>2 lymph nodes positive) and Stage IV Decline Decline For the education of producers/brokers. Not for use with the public.1313Determining the RatingStep 2: Enter the Malignant Tumor Rating Schedule (found on Rx for Success Colorectal Cancer). Rating schedule applies only to those individuals who have had cancer which was presumably cured and who are no longer under treatment. Dating for entry into the tumor schedule starts with the date that treatment was completed, including any chemotherapy or radiation therapy.

ABCDWithin 1st year Decline Decline Decline $5x3 2nd year Decline Decline $7.50x5 $5x2 3rd year Decline $10x6 $7.50x4 $5x1 4th year $15x6 $10x5 $7.50x3 0 5th year $15x5 $10x4 $7.50x2 0 6th year $15x4 $10x3 $7.50x1 0 7th year $15x3 $10x2 0 0 8th year $15x2 $10x1 0 0 9th year $15x1 0 0 0 For the education of producers/brokers. Not for use with the public.1414Determining the RatingStep 3: Confirm:

appropriate surveillance is being performed

liver function tests are normal

CEA is normal and stable

no recurrence

no recommended tests pending

For the education of producers/brokers. Not for use with the public.1515Case Clinic # 170 Male

Smoker

Diagnosed with adenocarcinoma Stage I age 66

Tentative offer: Standard Smoker

For the education of producers/brokers. Not for use with the public.16Case Clinic # 271 Male

Diagnosed with Stage I adenocarcinoma 10/2007 with treatment ending 2/1/2008.

Serial CEA readings since diagnosis with most recent CEA increased from last years CEA but still below CEA at time of diagnosis and within normal range.

If CEA increase deemed significant, cannot consider.

For the education of producers/brokers. Not for use with the public.1717Case Clinic # 369 FemaleNon-smokerDiagnosed with Stage IIA adenocarcinoma 8/2009 with treatment ending 1/2010

Tentative offer: Standard Non-smoker with $5 extra for 1 year.For the education of producers/brokers. Not for use with the public.1818Case Clinic # 460 Female

Non-Smoker

Diagnosed with carcinoma in situ with treatment completed 6 months prior to app

Tentative offer: Non-smoker PlusFor the education of producers/brokers. Not for use with the public.19ResourcesFor Quick Quotes, send an e-mail to lifemark.quickquotes@prudential.com

To reach the RU of the Day, please call1-888-828-4PRU (1-888-828-4778), prompt 1 and ask Account Representative for RU of the Day

20For the education of producers/brokers. Not for use with the public.Important informationInsurance issued by the Prudential Insurance Company of America, Newark, NJ. Underwriting rules are subject to change at our discretion. For the education of producers/brokers. Not for use with the public.21