Pancreatic Cysts – Diagnosis and Treatment
Diagnosis
Identifying Different Kinds of Pancreatic Cysts
Doctors use advanced imaging tests to find and study cysts in the pancreas. These scans often pick up cysts when checking for other conditions. Several main types of pancreatic cysts exist, each with unique traits and risks:
| Type of Pancreatic Cyst | Key Details |
|---|---|
| Pseudocyst | Not cancerous. Often linked to pancreatitis or abdominal injury. |
| Serous Cystadenoma | Often found in older women. May grow large but rarely turns cancerous. |
| Mucinous Cystic Neoplasm (MCN) | Seen more in middle-aged women. Can turn into cancer if untreated. |
| Intraductal Papillary Mucinous Neoplasm (IPMN) | Develops in main duct or side branches. Can be pre-cancer or cancer. |
| Solid Pseudopapillary Neoplasm | More common in women under 35. Rare, may sometimes be cancerous. |
| Cystic Neuroendocrine Tumor | Mostly solid but with some cyst areas. May have the potential to be cancerous. |
Knowing the type of cyst is important because it helps guide treatment. For example, pseudocysts are often harmless and caused by pancreatitis, while mucinous cysts and IPMNs may need closer watch or removal due to higher cancer risk.
Further Testing and Details
Doctors often start with a history and a physical exam. After that, they may use imaging studies to see the cyst clearly:
- CT scans show the size and exact location of the cyst.
- MRI scans can detect small details inside the cyst, such as solid parts that could mean a higher risk.
- Endoscopic ultrasound (EUS) provides detailed images and allows doctors to take a sample of fluid from the cyst (fine needle aspiration) for lab analysis, looking for signs of cancer.
- Magnetic resonance cholangiopancreatography (MRCP) gives a clear view of the pancreatic ducts and is often the first choice when doctors want to monitor a cyst.
Doctors may check cyst fluid for CEA levels, tumor markers, and possible cancer cells. Sometimes, they study the cell types (cytology) to decide if a cyst is likely to turn cancerous.
Doctors also consider the patientโs age, sex, symptoms, and family history. Certain cyst types, like main duct IPMN or large mucinous cysts, prompt close monitoring or quick treatment.
For patients without symptoms or high risk, doctors may recommend regular scans to track changes.
Ways to Manage Pancreatic Cysts
Careful Observation
Doctors may recommend careful observation for cysts that are small, not causing any problems, and are not likely to become cancer. Common examples are benign pseudocysts and serous cystadenomas.
Regular check-ups with imaging tests help spot changes early. This โwatch and waitโ approach avoids unnecessary surgery if the cyst stays the same size and does not create symptoms. Surveillance usually involves imaging every 6-12 months.
Removing Fluid
If a cyst becomes uncomfortable or starts to grow, doctors can remove the fluid inside. They often perform this procedure with an endoscope, a small tube that goes from the mouth to the stomach and intestine.
The endoscope uses an ultrasound probe and a needle to drain the fluid safely. In some cases, doctors may drain the cyst through the skin. These drainage techniques can offer relief when surgery is not needed.
Surgical Procedures
When a cyst has a higher risk of cancer or causes significant pain, surgeons may remove the affected part of the pancreas with a distal pancreatectomy, or in rare cases, remove the whole pancreas (total pancreatectomy).
Surgical removal is also an option for large or painful pseudocysts and serous cystadenomas. Surgical resection lowers the risk of future problems but can have risks such as recurrence if ongoing pancreatitis is present.
Getting Ready for Your Visit
Steps You Can Take Before Your Visit
To make the most of your appointment, organize information before seeing your care team. Start by writing down all your symptoms, noting when they began and if they have changed.
Include details about medical history, especially any injuries to your abdomen. List all medicines, vitamins, and supplements you take. Having a complete list ready for your gastroenterologist or radiologist is helpful.
Prepare a set of questions you want to ask. Some ideas:
| Topic | Example Questions |
|---|---|
| Diagnosis | What might be causing my cyst? |
| Testing | What tests will I need? |
| Cyst Type | What type do I have, and is it cancer risk? |
| Treatment | Will surgery be needed? What is the recovery time? |
| Aftercare | What kind of follow-up is important? |
Bring up any other health problems to see how they affect your current care.
What Your Care Team May Ask You
Your doctor or team of experts, such as a pathologist or radiologist, may ask you:
- When did your symptoms appear?
- How often do the symptoms occur?
- Are the symptoms severe or mild?
- Where exactly do you feel pain?
- Is anything making your symptoms better or worse?
- Have you ever had pancreatitis?
- Do you drink alcohol, and how much?
- Do you have a history of gallstones?
