Pancreatic Cysts

Pancreatic Cyst
Pancreatic Cysts
By Dr. Lee Ser Yee
Pancreatic cysts are fluid-filled growths that develop in the pancreas. The pancreas is a deep gland located behind the stomach and next to the intestines. In addition to making digestive enzymes, the endocrine (islet) cells in the pancreas produce hormones, such as insulin, that control blood sugar levels in your body.

Most pancreatic cysts develop for no apparent reason and are discovered by chance during a scan done for another purpose. Advances in the imaging studies as well as the increased frequency of health screening these days have increased the number of pancreatic cysts detected.

Fortunately, most pancreatic cysts are benign (non-cancerous) and unlikely cause symptoms or harm.

But some are pre-cancerous and can develop into pancreatic cancer. The characterization and management of these cysts is a challenge as there is a significant overlap in the features of benign and pre-cancerous cyst. Thus, it is important to find out what type of cyst you have.

Types of Pancreatic Cysts

There are many types of pancreatic cysts. Common ones include:

  • Pseudocysts
    • These are mostly made of fluid and can start in or next to the pancreas.
    • A common complication of acute pancreatitis (inflammation of the pancreas)
  • Serous cystadenomas (SCAs)
    • Almost all SCAs are benign
    • They may cause pain, jaundice, or cause abdominal discomfort as they grow
  • Intraductal Papillary Mucinous Neoplasms (IPMNs)
    • These start in the ducts that connect the pancreas to the intestine
    • Most common type of pre-cancerous cyst. They produce large amounts of proteins that form mucus (mucin) in the cyst lining and fluid
    • It’s difficult to predict if and when an IPMN will become cancerous - thus these require careful evaluation and follow-up
  • Mucinous Cystic Neoplasms (MCNs)
    • These are pre-cancerous growths that are more common in the body & tail of the pancreas.
    • More common in women rather than men

Diagnosis

When you come to Surgical Associates with a diagnosis of a possible pancreatic cyst, we will review your medical history and imaging tests thoroughly together, including if there is a family history of pancreatic or other gastrointestinal cancers such as stomach, gallbladder, or liver cancer. This can make a difference in the risk of the cyst becoming cancerous over time.

Additional tests to further evaluate the cyst may include:

  • Blood Tests: Tumor markers – CA 19-9, CEA, Liver function tests
  • Imaging Studies: Computed Tomography (CT), Magnetic Resonance Imaging (MRI)/MRCP
  • Others: Endoscopic ultrasound (EUS) +/- Biopsy (if necessary) - this involves taking a sample of the pancreatic cyst tissue and/or fluid to examine the risk of cancer

Treatment

Being told you have a cyst in your pancreas can be unsettling. Usually, these cysts kind of are harmless and doesn’t need to be removed or actively treated in any way.

However, if it is deemed that the cyst has suspicious or worrisome features, in another words, it harbours cancerous cells or a risk of becoming a cancer – Surgery may be recommended to confirm the diagnosis and to treat it definitely as well.

Surveillance

It is important to monitor the cysts carefully over time, since they may to a point where it’s best to surgically remove them.

To find out more, please consult our specialist in pancreas here.

Pancreatic Cysts
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