Management Team

Pancreatic Cyst

Overview

Pancreatic cyts are fluid-filled pouch-like structures that develop on/in the pancreas and may or may not be cancerous.

  • Serous cystadenomas:
    • Often benign (non-cancerous) fluid-filled cysts.
    • Common in older adults (especially women).
    • Typically asymptomatic.
  • Mucinous cystadenomas:
    • Can be benign but have potential to become cancerous (malignant).
    • More common in women.
    • Found in the body or tail of the pancreas.
  • Intraductal papillary mucinous neoplasms (IPMNs):
    • These are precancerous cysts that form in the pancreatic ducts.
    • Can progress to pancreatic cancer if untreated.
    • Often found in the head of the pancreas.
  • Pseudocysts:
    • Typically caused by pancreatitis (inflammation of the pancreas).
    • Contain fluid and debris from the inflammation.
    • Can be asymptomatic but may cause pain or infection.
  • Cystic neuroendocrine tumours:
    • Rare, typically slow-growing tumours that may have cystic areas.
    • May be benign or malignant.
  • Solid-pseudopapillary tumours:
    • Rare and usually benign but can turn malignant.
    • More common in young women.

  • Pancreatitis (inflammation of the pancreas): A key cause of pseudocysts.
  • Genetic mutations: Inherited conditions like Von Hippel-Lindau disease or Gardner's syndrome may increase cyst formation.
  • Chronic alcohol use: This can increase the risk of pancreatic inflammation and cyst formation.
  • Cystic fibrosis: A genetic disorder that may contribute to pancreatic cyst development.
  • Pancreatic cancer: In some cases, cysts can be an early sign of pancreatic cancer.
  • Other underlying diseases: Certain conditions, like familial pancreatitis or conditions affecting pancreatic ducts, can predispose individuals to cyst formation.

  • Age: Risk increases with age, especially over 50.
  • Gender: Some cysts, like mucinous cystadenomas, are more common in women.
  • Chronic pancreatitis: Inflammation due to alcohol use or other factors can lead to pseudocysts.
  • Genetic factors: Inherited conditions, including Von Hippel-Lindau disease or cystic fibrosis, can increase cyst risk.
  • Family history: A family history of pancreatic cysts or pancreatic cancer increases the likelihood of developing cysts.
  • Smoking: Smoking can increase the risk of pancreatic cysts, particularly those that are pre-cancerous.

  • Asymptomatic: Many pancreatic cysts do not cause symptoms, especially serous cysts or small cysts.
  • Abdominal pain: Cysts, especially large ones, can cause discomfort or pain in the upper abdomen or back.
  • Digestive issues: Nausea, vomiting, and bloating may occur if a cyst obstructs the pancreatic duct.
  • Jaundice: If a cyst compresses the bile duct, it can cause jaundice.
  • Weight loss: Unexplained weight loss can occur, especially with larger or malignant cysts.
  • Pancreatitis symptoms: Fever, chills, and abdominal pain if cysts lead to infection or pancreatitis.

  • Imaging tests:
    • CT scan (computed tomography): Helps identify the presence, size, and location of cysts.
    • MRI (magnetic resonance imaging): More detailed and can differentiate cyst types.
    • Endoscopic ultrasound: Provides clear images and allows for biopsy in some cases.
    • Endoscopic retrograde cholangiopancreatography (ERCP): Helps visualize the bile and pancreatic ducts; it may also help in draining cysts or taking biopsies.
  • Biopsy: A tissue sample may be taken through a needle biopsy or during an endoscopic procedure to analyze the cyst's cells for cancerous changes.
  • Cyst fluid analysis: Fluid obtained from the cyst may be analyzed for certain markers (like CEA or amylase) to assess the likelihood of malignancy.

  • Observation: Small, asymptomatic cysts that do not show signs of malignancy may simply be monitored over time with regular imaging tests.
  • Surgical removal: If the cyst is large, causing symptoms, or suspected to be cancerous, surgery may be recommended. Surgical options include:
    • Cyst drainage: For pseudocysts, fluid may be drained.
    • Pancreatic resection: Part of the pancreas may be removed to prevent cyst growth or cancer spread.
    • Distal pancreatectomy: Removal of the tail or body of the pancreas, often used for mucinous cysts or IPMNs.
  • Endoscopic drainage: For pseudocysts, endoscopic drainage may be used to remove fluid from the cyst using a flexible tube.
  • Medication:
    • Pain management and treatment of any underlying conditions like pancreatitis.
    • Antibiotics if the cyst becomes infected.
  • Chemotherapy or radiation: For malignant cysts or pancreatic cancer, chemotherapy, and radiation therapy may be necessary after surgical resection.
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