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Pancreatic cysts are fluid-filled closed cavity that develops within the pancreas. The pancreas an organ located below the liver, between the stomach and the spine. The pancreas produces digesting enzymes and hormones that play a role in the regulation of blood glucose control. It also generates bicarbonates, which counteract stomach acids.
Most pancreatic cysts are benign. However, it can potentially develop into pancreatic cancer. The cysts can be classified into two types: nonneoplastic cysts and neoplastic cysts. There are many other types of cysts in each subtype, such as pseudocysts, serous cystadenomas, and mucinous cystic neoplasms.
Pancreatic cysts can be asymptomatic. It is often discovered through imaging tests for another condition. Most pancreatic cysts will resolve on its own. However, the doctor may advise to closely monitor the cyst for further developments that could suggest cancer. A sample of the pancreatic cyst fluid may be collected to evaluate for presence of cancerous cell.
Symptoms
The symptoms of pancreatic cysts can vary from having none to moderate or severe. Symptoms may appear days to months after a pancreatitis attack. It often includes:
- Constant stomach pain that spreads to the back
- Unexplained weight loss
- Immediate feeling of fullness after starting to eat
- Vomiting and nausea
- Abdominal bloating
If a person persistently experiences these signs and symptoms, it is recommended to consult a healthcare professional for proper diagnosis and management. Although rare, a cyst can rupture and cause infection in the abdominal cavity. Seek immediate medical care in cases where signs of infection such as fever and prolonged abdominal pain is felt.
Causes
Pancreatic cysts can be classified into many categories. However, most of it has unknown cause. A type of cyst, known as pancreatic pseudocyst, originates within a hollow or gap within the pancreas and is covered by fibrous tissue. Inflammatory pancreatic fluid, especially the digesting enzyme amylase, or semisolid debris are present in pancreatic pseudocysts. Pseudocysts can be caused by a painful condition or abdominal trauma, such as a vehicle accident. Pancreatic pseudocysts are benign.
Certain rare disorders, such as von Hippel-Lindau and polycystic kidney disease, can cause pancreatic cysts. Von Hippel-Lindau disease is a rare genetic disorder that causes tumors to grow in different parts of the body, including the pancreas.
Risk factors
Pancreatic pseudocysts are a common complication of acute or chronic pancreatitis. Pancreatitis is an inflammation of the pancreas. It is caused by excessive alcohol consumption and gallstones. Having pancreatitis generally increases one’s risk of developing pancreatic cysts. Pseudocysts can also be caused by abdominal injuries.
Diagnosis
Generally, pancreatic cysts are difficult to diagnose due to symptoms that are also common with many other diseases. However, it is now being diagnosed at a higher rate than in the past due to more advanced imaging technology. Most pancreatic cysts are discovered during abdominal imaging for unrelated conditions.
The diagnosis for this condition starts with a physical examination, assessment of symptoms and evaluation of medical history. To confirm the diagnosis and to aid with the treatment, the doctor may require several tests, such as:
- Computerized tomography (CT) scan: This test can provide extensive imaging and information about a pancreatic cyst’s size and shape. A CT scan uses X-rays to produce images of a cross-section of the body.
- Magnetic resonance imaging (MRI) scan: This is a noninvasive procedure that uses radio waves to create a detailed image of the organ. This can reveal minor characteristics about a pancreatic cyst, such as its potential to become malignant.
- Magnetic resonance cholangiopancreatography (MRCP): This test examines the pancreatic and biliary (bile duct) systems. The dye (also known as a contrast agent) aids in producing sharper images of the organs and the arteries that interconnect them. MRCP is the preferred imaging test for monitoring a pancreatic cyst.
- Endoscopic ultrasound: This is typically used as a subsequent test (after ultrasound, CT, or MRI) to further analyze a pancreatic cyst and/or differentiate a pancreatic pseudocyst from other forms of cystic lesions. The fluid from the cyst can be collected and tested in a laboratory for signs of malignancy.
Your age, gender and the location of the pancreatic cyst can often help the doctor to determine the type of cyst and the appropriate treatment.
- Pseudocysts: are likely to develop as a result of pancreatitis or pancreatic inflammation, or due to pancreas injury. Pseudocysts are benign.
- Serous cystadenomas: are mostly harmless and rarely progress to malignancy. They are more prevalent in women over the age of 60. Serous cystadenomas can expand to the size of adjacent organs, causing abdominal discomfort and a sense of fullness.
- Mucinous cystic neoplasms: are precancerous growths that can begin in the pancreas’ body or tail. Larger cysts that are left untreated or are discovered late, may already be malignant. It is more common in women than in men, particularly those in middle-aged.
- Intraductal papillary mucinous neoplasm (IPMN): has the potential to be precancerous or cancerous. It begins in the main pancreatic duct or one of its branching ducts. Surgical removal may be necessary depending on its position and other risk factors. IPMN can affect both males and women over the age of 50.
- Solid pseudopapillary neoplasms: are uncommon and, in some cases, malignant. They are most common in women under the age of 35 and are found in the body or tail of the pancreas.
- Cystic neuroendocrine tumor: is often mistaken for other pancreatic cysts and are either precancerous or cancerous. It may contain cyst-like elements, but it is generally, solid.
Treatment
The treatment plan for pancreatic cysts is determined by the symptoms experienced by the patient, the type of cyst, the size, and its characteristics. Several options include leaving it alone and simple monitoring, minimally invasive procedure, or surgery.
- Watchful waiting: Noncancerous pancreatic cysts with no symptoms may not require treatment. The doctor may suggest carefully monitoring it to see if it progresses or resolves on its own. Because serous cystadenoma rarely progresses to cancer, it can also be ignored unless it causes symptoms or expands. Even a large benign pseudocyst can be left alone as long as it is not affecting one’s daily activities.
- Drainage: Cysts that grow to be bigger than 6 cm in size and causes prolonged symptoms, requires draining. To empty the cyst, the endoscope is outfitted with an ultrasound probe (endoscopic ultrasonography) and a needle. An endoscope (small flexible tube) is passed via the mouth to the stomach and small intestine. Drainage via the skin is sometimes required. Endoscopic draining is gaining popularity since it is less invasive, has less problems than open surgery, does not require an external drain, and has a high long-term success rate.
- Surgery: An enlarged pseudocyst or a serous cystadenoma that is producing discomfort or other symptoms may necessitate surgery. However, a pseudocyst may reoccur if the patient has persistent pancreatitis. Generally, cysts that are suspected to be cancer or a precancerous condition must be surgically removed.
