Pancreatic cysts

Diagnosis

Generally, pancreatic cysts are difficult to diagnose due to symptoms that are also common with many other diseases. However, it is now being diagnosed at a higher rate than in the past due to more advanced imaging technology. Most pancreatic cysts are discovered during abdominal imaging for unrelated conditions.

The diagnosis for this condition starts with a physical examination, assessment of symptoms and evaluation of medical history. To confirm the diagnosis and to aid with the treatment, the doctor may require several tests, such as:

• Computerized tomography (CT) scan: This test can provide extensive imaging and information about a pancreatic cyst’s size and shape. A CT scan uses X-rays to produce images of a cross-section of the body.
• Magnetic resonance imaging (MRI) scan: This is a noninvasive procedure that uses radio waves to create a detailed image of the organ. This can reveal minor characteristics about a pancreatic cyst, such as its potential to become malignant.
• Magnetic resonance cholangiopancreatography (MRCP): This test examines the pancreatic and biliary (bile duct) systems. The dye (also known as a contrast agent) aids in producing sharper images of the organs and the arteries that interconnect them. MRCP is the preferred imaging test for monitoring a pancreatic cyst.
• Endoscopic ultrasound: This is typically used as a subsequent test (after ultrasound, CT, or MRI) to further analyze a pancreatic cyst and/or differentiate a pancreatic pseudocyst from other forms of cystic lesions. The fluid from the cyst can be collected and tested in a laboratory for signs of malignancy.

Your age, gender and the location of the pancreatic cyst can often help the doctor to determine the type of cyst and the appropriate treatment.

• Pseudocysts: are likely to develop as a result of pancreatitis or pancreatic inflammation, or due to pancreas injury. Pseudocysts are benign.
• Serous cystadenomas: are mostly harmless and rarely progress to malignancy. They are more prevalent in women over the age of 60. Serous cystadenomas can expand to the size of adjacent organs, causing abdominal discomfort and a sense of fullness.
• Mucinous cystic neoplasms: are precancerous growths that can begin in the pancreas’ body or tail. Larger cysts that are left untreated or are discovered late, may already be malignant. It is more common in women than in men, particularly those in middle-aged.
• Intraductal papillary mucinous neoplasm (IPMN): has the potential to be precancerous or cancerous. It begins in the main pancreatic duct or one of its branching ducts. Surgical removal may be necessary depending on its position and other risk factors. IPMN can affect both males and women over the age of 50.
• Solid pseudopapillary neoplasms: are uncommon and, in some cases, malignant. They are most common in women under the age of 35 and are found in the body or tail of the pancreas.
• Cystic neuroendocrine tumor: is often mistaken for other pancreatic cysts and are either precancerous or cancerous. It may contain cyst-like elements, but it is generally, solid.

Treatment

The treatment plan for pancreatic cysts is determined by the symptoms experienced by the patient, the type of cyst, the size, and its characteristics. Several options include leaving it alone and simple monitoring, minimally invasive procedure, or surgery.

• Watchful waiting: Noncancerous pancreatic cysts with no symptoms may not require treatment. The doctor may suggest carefully monitoring it to see if it progresses or resolves on its own. Because serous cystadenoma rarely progresses to cancer, it can also be ignored unless it causes symptoms or expands. Even a large benign pseudocyst can be left alone as long as it is not affecting one’s daily activities.
• Drainage: Cysts that grow to be bigger than 6 cm in size and causes prolonged symptoms, requires draining. To empty the cyst, the endoscope is outfitted with an ultrasound probe (endoscopic ultrasonography) and a needle. An endoscope (small flexible tube) is passed via the mouth to the stomach and small intestine. Drainage via the skin is sometimes required. Endoscopic draining is gaining popularity since it is less invasive, has less problems than open surgery, does not require an external drain, and has a high long-term success rate.
• Surgery: An enlarged pseudocyst or a serous cystadenoma that is producing discomfort or other symptoms may necessitate surgery. However, a pseudocyst may reoccur if the patient has persistent pancreatitis.  Generally, cysts that are suspected to be cancer or a precancerous condition must be surgically removed.