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Underwriting Colon Cancer

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.

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Underwriting Colon Cancer

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  1. 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 For the education of producers/brokers. Not for use with the public.

  2. General Concepts and Terms • Cancer 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.

  3. Related GI Concerns • Ulcerative colitis (UC) - recurrent inflammation of the colorectum • Crohn’s disease (Regional Enteritis) - chronic inflammatory process which may be found in any area of GI tract from lips to anus • Familial AdenomatousPolyposis(FAP)and Gardner’s 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.

  4. Benign Colon Polyps • Hyperplastic 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.

  5. Benign Colon Polyps GUIDELINES For the education of producers/brokers. Not for use with the public.

  6. Colorectal Cancer Items of interest • Colorectal 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.

  7. Risk Factors Risk factors for developing colorectal cancer include: • family history of cancer or polyps • inherited conditions (such as familial adenomatouspolyposis and hereditary nonpolyposis) • diet and or age • inflammatory bowel disease (such as ulcerative colilitis or Crohn’s disease) • personal history of colorectal polyps For the education of producers/brokers. Not for use with the public.

  8. Factors 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 • Surveillance For the education of producers/brokers. Not for use with the public.

  9. Colorectal Cancer: Anatomy The wall of the colon consists of four layers: • mucosa(adjacent to the lumen) • Submucosa • muscularispropria • subserosa(outermost, farthest from the lumen) For the education of producers/brokers. Not for use with the public.

  10. Colorectal Cancer: Anatomy The wall of the colon consists of four layers: • mucosa (adjacent to the lumen) • Submucosa • muscularispropria • subserosa(outermost, farthest from the lumen) For the education of producers/brokers. Not for use with the public.

  11. Staging Cancer Stage 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.

  12. Staging of Colorectal Cancer TNM is preferred to the older Duke’s system. Both are provided below for reference. For the education of producers/brokers. Not for use with the public.

  13. Determining the Rating Step 1: Refer to Rx for Success for colorectal cancer rating based upon staging and age at diagnosis. For the education of producers/brokers. Not for use with the public.

  14. Determining the Rating Step 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. For the education of producers/brokers. Not for use with the public.

  15. Determining the Rating Step 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.

  16. Case Clinic # 1 • 70 Male • Smoker • Diagnosed with adenocarcinoma Stage I age 66Tentative offer: Standard Smoker For the education of producers/brokers. Not for use with the public.

  17. Case Clinic # 2 • 71 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 year’s 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.

  18. Case Clinic # 3 • 69 Female • Non-smoker • Diagnosed 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.

  19. Case Clinic # 4 • 60 Female • Non-Smoker • Diagnosed with carcinoma in situ with treatment completed 6 months prior to app Tentative offer: Non-smoker Plus For the education of producers/brokers. Not for use with the public.

  20. Resources • For Quick Quotes, send an e-mail to lifemark.quickquotes@prudential.com • To reach the RU of the Day, please call 1-888-828-4PRU (1-888-828-4778), prompt 1 and ask Account Representative for RU of the Day For the education of producers/brokers. Not for use with the public.

  21. Important information Insurance 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.

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