Pancreatic Cysts

Diagnosis

Pancreatic cysts are being diagnosed more frequently because modern imaging tests can detect them more easily than in the past. Many cysts are discovered incidentally during abdominal scans performed for unrelated issues. After reviewing your medical history and completing a physical exam, a healthcare professional may suggest imaging tests to better understand the cyst and plan treatment.

Common diagnostic tests include:

• MRI scan to identify small details of the cyst and determine whether any features suggest a higher cancer risk

• CT scan to show the size, shape and structure of the cyst

• Endoscopic ultrasound to provide a detailed internal view and allow fluid or cell samples to be collected for laboratory analysis

• Magnetic resonance cholangiopancreatography, also called MRCP, which is often the preferred test for monitoring pancreatic cysts and evaluating the pancreatic duct

The type of pancreatic cyst can often be suspected based on its appearance, location and your age and sex.

Pseudocysts are benign and usually linked to pancreatitis, though they also can form after abdominal injury.

Serous cystadenomas are generally noncancerous but may grow large enough to press on nearby organs, causing discomfort or fullness. They occur most often in women over age 50.

Mucinous cystic neoplasms develop most commonly in the body or tail of the pancreas and almost always occur in middle-aged women. These cysts are precancerous and can become cancer if left untreated. Larger mucinous cysts may already contain cancer cells at the time of diagnosis.

Intraductal papillary mucinous neoplasms, known as IPMNs, form in the main pancreatic duct or its branches. They may be precancerous or cancerous and can affect both men and women older than 50. Depending on their size and location, IPMNs may require surgery.

Solid pseudopapillary neoplasms are rare and usually found in the body or tail of the pancreas. They occur most commonly in women under age 35 and can sometimes be cancerous.

Cystic neuroendocrine tumors are mostly solid but may contain cystlike areas. Their appearance can be mistaken for other cyst types, so additional testing is often needed.

Treatment

Treatment for pancreatic cysts varies depending on the type of cyst, its size, its features on imaging tests and whether it is causing symptoms. Some cysts require no intervention, while others need drainage or surgery.

Watchful waiting may be recommended for cysts that are benign and not causing problems. A pseudocyst that is not producing symptoms can often be monitored. Serous cystadenomas rarely become cancerous and can also be observed unless they cause discomfort or continue to grow. Several types of cysts require ongoing monitoring with imaging tests.

Drainage is an option if a pseudocyst becomes painful or increases in size. This procedure is often done using an endoscope inserted through the mouth into the stomach and small intestine. When equipped with an ultrasound probe, this tool allows the clinician to guide a needle or place a stent to drain the cyst. In some cases, drainage through the skin may be necessary.

Surgery may be recommended when a cyst carries a risk of becoming cancerous or already has worrisome features. Surgery may also be needed for large pseudocysts or serous cystadenomas that cause pain or other symptoms. A pseudocyst may return if underlying pancreatitis continues, so long-term management of pancreatitis is important.