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Pancreatic Cyst

Introduction

Pancreatic cysts are diagnosed with increasing frequency because of the widespread use of CT and MRI scans. Pancreatic cysts may be detected in over 2 percent of patients who undergo scans for unrelated reasons. They become more common as you get older

Pancreatic cysts can either be cancerous (pancreatic cancer), pre-cancerous (e.g. IPMN) or non-cancerous, most are non-cancerous. Accurate imaging is important, since non-neoplastic cysts don’t require treatment if asymptomatic, whereas some of the pancreatic cysts have a significant risk of becoming cancerous and should be closely watched or removed.

Types of Pancreatic Cysts

Inflammatory fluid collections

  • Acute inflammatory fluid collection - These are not true pancreatic cysts and typically occur as a local complication of acute pancreatitis. Inflammatory fluid collections were previously called pancreatic pseudocysts
  • Pseudocysts are mature fluid collections that are usually outside the pancreas (though they may be in the pancreas). They typically develop at least four weeks after acute pancreatitis and have a thick wall. If very large or troublesome they may need a pancreatic drainage procedure.

It is important to remember that non-inflammatory pancreatic cysts can sometimes cause acute pancreatitis, so follow up of any pancreatic cyst is recommended.

Pancreatic Cystic Neoplasms (Tumours)

There are four subtypes of PCNs:

  • Serous cystic tumours – cancerous change is very rare and often just require a period of observation to confirm the diagnosis.
  • Mucinous cystic neoplasms (MCNs) – mainly occur in ladies over the age of 40. Due to the risk of cancerous change, surgical removal is offered to fit patients.
  • Solid pseudopapillary neoplasms (SPNs) – often are seen in young women and harbour a risk if growing large and have a small risk of cancerous change. These are usually surgically removed for these reasons
  • Intraductal papillary mucinous neoplasms (IPMNs) – By far the most common form of pancreatic cystic neoplasm. These cysts connect with the ducts of the pancreas. The risk of cancerous change depends primarily on the size, the type of connecting duct and whether it is blocked and whether there are any solid bits in the cyst. Depending on these worrisome or high risk features, close observation or surgery may be appropriate.

Cyst formation in pancreatic cancer

These cysts are treated as pancreatic cancers.

The most important factor is accurately determining the type of pancreatic cyst to

  • Avoid unnecessary surgery
  • Avoid letting a cyst become cancerous and untreatable

This is achieved by multiple imaging scans, which may need repeating at regular intervals, until your surgeon and radiologist are confident of the diagnosis. These imaging tests include, Computed topography (CT) scan, Ultrasound scan (US), Magnetic resonance imaging (MRI) scan, Endoscopic Ultrasound (EUS) or Endoscopic retrograde pancreato-cholangiogram (ERCP)