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Pancreatic Cysts (Fluid filled sacs): When should you be concerned?

What are Pancreatic Cysts?

Pancreatic cysts are saclike pockets of fluid on or in your pancreas, a large organ behind the stomach that produces hormones and enzymes that help digest food. With the increasing use of scans, we are detecting Pancreatic cysts at increasing frequency.

What are the types of Pancreatic Cysts?

Pancreatic cysts can be Neoplastic (cancerous or potential to be cancerous) or Non-Neoplastic (Non cancerous). Most of the pancreatic cysts are non-neoplastic. The commonest form of pancreatic cyst is formed due to pancreatitis (inflammation of pancreas) and is just a pocket of fluid lined by inflammatory scar tissue. It is called a Pseudocyst of pancreas. This is non-neoplastic.

There are four subtypes of Neoplastic cysts of Pancreas:

●Serous cystic tumors

●Mucinous cystic neoplasms (MCNs)

●Intraductal papillary mucinous neoplasms (IPMNs)

●Solid pseudopapillary neoplasms (SPNs)

What are the symptoms of Pancreatic cysts?

Most people having pancreatic cysts do not have any symptoms from it. When signs or symptoms of pancreatic cysts do occur, they typically include:

  • Persistent abdominal pain, which may radiate to your back

  • A mass you can feel in your upper abdomen

  • Nausea and vomiting

How to differentiate between Neoplastic and Non-Neoplastic Pancreatic cysts?

Individuals with Pseudocyst of the pancreas will have a history of pancreatitis which includes pain in central abdomen radiating to the back. There will also be changes of pancreatitis seen on scans like CT or MRI.

You require imaging studies like CT scan, MRI scan or Endoscopic Ultrasound (EUS) to differentiate between various forms of Neoplastic cysts. This differentiation is very important as each sub-type has different treatments in relation to it's risk profile for turning into cancer. You will need to consult a specialist dealing with Pancreatic diseases and cancer for this. The doctor may take samples from the cyst using Endoscopic ultrasound and send it for testing to determine the exact diagnosis.

Do all Pancreatic cysts need treatment? When should you be concerned?

Most Pancreatic cysts do not need any active treatment. The common type of cyst is a pseudocyst and it needs treatment only if it is causing symptoms like pain, bleeding or vomiting. The treatment of Neoplastic cysts depends on the type of the cyst, size of the cyst and other concerning features if present in imaging studies. The following are the features of Neoplastic cysts which are worrisome for cancer:

  • Cyst more than 3 cms

  • Solid component inside the cyst

  • Thick walled cysts

  • Dilated duct of pancreas

  • Symptomatic cyst

  • Enlarged lymph nodes around the cyst

In presence of any one or more of the above features, active treatment is indicated.

What are the treatment options for Pancreatic Cysts?

Treatment depends on the type of cyst you have, its size, its characteristics and whether it's causing symptoms.

  1. Watchful waiting: A benign pseudocyst, even a large one, can be left alone as long as it isn't bothering you. Serous cystadenoma rarely becomes cancerous, so it also can be left alone unless it causes symptoms or grows. But all pancreatic cysts should be monitored.

  2. Drainage: A pseudocyst that is causing bothersome symptoms or growing larger can be drained. A small flexible tube (endoscope) is passed through your mouth to your stomach and small intestine. The endoscope is equipped with an ultrasound probe (endoscopic ultrasound) and  a needle to drain the cyst. Sometimes drainage through the skin is necessary.

  3. Surgery: Surgery might be needed to remove an enlarged pseudocyst or a serous cystadenoma that's causing pain or other symptoms. Other types of pancreatic cysts generally require surgical removal because of the risk of cancer. A pseudocyst may recur if you have ongoing pancreatitis.

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