Pancreatic Cysts

Fluid-filled sacs that can form within the pancreas are called pancreatic cysts. Most cysts are benign and do not require treatment, but some can be cancerous, requiring close surveillance or treatment. Cysts found in the pancreas can develop for no apparent reason and are typically detected during a CT scan or MRI performed during other procedures. Alcoholism also contributes to the risk of cysts in the pancreas. Pancreatic cysts can be benign, precancerous, or cancerous.

There are several types of pancreatic cysts. 

• Intraductal Papillary Mucinous Neoplasm (IPMN) – Intraductal Papillary Mucinous Neoplasms are cysts that typically produce large amounts of mucous and can cause enlargement of the main pancreatic duct. These cysts can occur in middle-aged men and women and, if left untreated, can become cancerous. Some IPMNs require surgical resection. 
• Mucinous Cystic Neoplasm (MCN) – Mucinous cystic neoplasms are usually large, thick-walled mucinous cysts that occur mostly in the body or tail of the pancreas. Less common than IPMN, these cysts mostly occur in middle-aged women and have the potential to be cancerous. Most patients with mucinous cystic neoplasm require surgery to remove a portion of the pancreas.
• Cystic Neuroendocrine Tumor – These tumors are located in the neck, body or tail of the pancreas. Most cystic neuroendocrine tumors are commonly found in middle-aged men and women.  
• Serous Cystic Neoplasm (SCN) – These types of cysts have little to no risk of becoming cancerous and are found mostly in women over the age of 50. Most SCNs do not require surgical resection.
• Solid Pseudopapillary Neoplasm (SPN) – These are rare tumors found on the head or tail of the pancreas. Solid pseudopapillary neoplasms are low grade cancers and are more commonly found in younger women. A complete surgical resection of these tumors is often necessary and associated with a very good prognosis.
• Pseudocyst - Pancreatic pseudocysts form when the cells of the pancreas become inflamed or are injured and pancreatic enzymes start to leak. Leaking of the enzymes harms the tissue of the pancreas. Pseudocysts are most commonly caused by acute pancreatitis.

For more pancreatic cysts, the cause is unknown. Some cysts are associated with rare illnesses or genetic disorders that can affect the pancreas. Other causes may include:

• Acute pancreatitis.
• A blockage in the pancreatic ductal system.
• Pancreas trauma.
• Pancreas infection.
• Pancreatic tumors.
• High calcium levels in your blood.
• Very high levels of blood fats (cholesterol).
• Pancreatic damage from medicines.
• Autoimmune diseases.
• Hereditary conditions.
• Heavy use of alcohol.

The following are the most common symptoms of cysts in the pancreas. However, each individual may experience symptoms differently. Symptoms may include:

• Abdominal pain.
• Nausea.
• Vomiting.
• Poor appetite.
• Weight loss.
• Diarrhea.
• Abdominal mass. The abdomen will be tender and swollen.
• Jaundice. A yellowing of the skin and eyes.
• Ascites. Fluid buildup in the abdominal cavity.

The symptoms of pancreatic cysts may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

You may have a higher risk for cysts in the pancreas if you have a health issue that can cause pancreatitis. These include gallstones. You may be able to decrease your risk by treating your health condition. Drinking less alcohol may also lower your risk.

In addition to a complete medical history and physical examination, diagnostic procedures for pseudocysts of the pancreas may include the following:

• Blood tests
• Chest x-ray - A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Computed tomography scan (CT or CAT scan) - A diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Ultrasound (also called sonography) - A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels.
• Endoscopic retrograde cholangiopancreatography (ERCP) - A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, which is a long, flexible, lighted tube. The scope is guided through the patient’s mouth and throat, then through the esophagus, stomach, and duodenum. The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray.
• Endoscopic Ultrasound – Done from the inside. 

The goal for the treatment of pancreatic cysts is to monitor growth and to treat them surgically if they grow, or if there is a risk for cancer development.

Treatments may include:

• Close monitoring by scans (to determine any change in size).
• Surgical drainage of the cyst(s).
• Surgical removal of the cysts by performing a pancreatectomy.