Pancreatic cysts are fluid-filled, sac-like lesions or pockets occurring in the pancreas. Most pancreatic cysts are noncancerous and have no symptoms. They are often found during unrelated imaging tests of the stomach and abdomen
There are three types of pancreatic cysts:
Congenital: These are similar to liver or kidney cysts and are usually left alone unless they produce symptoms or malignancy becomes a concern.
Pseudocysts: The most common type of pancreatic cyst, these noncancerous pockets of fluid are lined with scar or inflammatory tissue, rather than the epithelial cell lining normally found in other cysts. Pseudocysts are often a byproduct of pancreatitis, a painful condition in which the pancreas becomes inflamed. Pseudocysts also may result from heavy alcohol use, gallstones and injury to the abdomen, such as from a car accident.
Cystic neoplasm: Although less common, these are increasingly being discovered on unrelated radiological studies of the abdomen. While fewer than 10 percent are malignant, these cystic lesions range from benign to premalignant/borderline to malignant and can be classified into four major categories:
- Solid pseudopapillary tumor: This relatively rare pancreatic tumor is slow-growing and is commonly seen in women from their late 20s to early 40s.
- Serous cystadenoma: Upon diagnosis, these relatively benign pancreatic lesions can be monitored by your physician if you have no symptoms. However, if the cysts increase in size and/or cause pain or a sense of fullness they may require treatment. Some serous cystadenomas may even obstruct the bile ducts or cause jaundice or pancreatitis.
- Mucinous cystadenoma: These precancerous lesions are usually found in the body or tail of the pancreas, commonly in middle-aged women. They have a higher risk of becoming malignant with an increase in size.
- Intraductal Papillary Mucinous Neoplasms (IPMN/IPMT): These are tumors within the pancreatic ducts which, like polyps in the colon, may progress to invasive cancer if left untreated. These can arise from the main duct or the side branches of the pancreas. Involvement of the main duct has a 60 percent chance of turning cancerous.
You may not experience any symptoms from pancreatic cysts, including pseudocysts. If you do have symptoms, they may include:
- Persistent abdominal pain radiating to your back
- Feeling a mass your upper abdomen
- Nausea and vomiting
- Difficulty eating and digesting food
Due to improved imaging technology, pancreatic cysts are more frequently diagnosed and can be treated quickly. Many are found during abdominal scans for other conditions. Arriving at a diagnosis for certain kinds of cysts, such as a cystic neoplasm, can be complex.
The biggest challenge is determining whether the cyst is precancerous. Certain procedures can help with diagnosis and developing a treatment plan:
- Medical history. A previous abdominal injury or pancreatitis may indicate a pseudocyst.
- CT scan, which will provide detailed information about the structure of a pancreatic cyst.
- MRI imaging gives even more information on the characteristics of the cyst, such as whether it has solid components.
- Endoscopic ultrasound (EUS). Along with a detailed image of the cyst, the EUS allows for diagnostic aspiration to detect possible signs of cancer. Fluid from cysts and samples of tissue also can be obtained by passing special needles through the endoscope and into the cysts. The process of obtaining tissue or fluid with a thin needle is called fine needle aspiration (FNA). Certain advanced imaging (laser endomicroscopy) techniques can be employed during EUS-FNA depending on the necessity.
Your doctor should monitor all pancreatic cysts. While some cysts may be periodically observed many cystic neoplasm will require surgical resection or removal. Smaller cysts (less than 10 millimeters) can be imaged with CT scan after one year upon being discovered, and then less frequently if they remain unchanged. Cysts larger than 10 millimeters usually require regular endoscopic ultrasound for periodic review of any changes or precancerous conditions.
Possible treatments include:
- Endoscopic drainage and cystogastrostomy (drainage of the pseudocyst into the stomach) – usually for pseudocysts.
- Surgical procedures for removal of cysts with malignant potential. Generally, the outcome is good with treatment and can also help prevent or detect cancer in early, treatable stages.
Why seek treatment at The Ohio State University Wexner Medical Center?
Recognized by U.S.News & World Report as one of the nation's highest performing hospitals in gastroenterology and GI surgery, Ohio State Wexner Medical Center takes a multidisciplinary team approach to pancreatic disease. Physicians and other healthcare professionals in gastroenterology, radiology, medical oncology and pancreatic surgery review each patient’s condition and make recommendations as to how lesions, cysts and other issues should be treated. Often more than one type of imaging may be utilized to provide the least invasive yet most effective outcome.
The specialists in the Division of Gastroenterology, Hepatology & Nutrition are dedicated to treating pancreatic diseases. Our gastroenterologists are experts in the performance of advanced endoscopic procedures. Many of them not only treat patients but also conduct research to advance care and treatment for those with pancreatic cysts.
In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis, and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.