The pancreas is a solid organ. Occasionally the pancreas can develop cysts, which are fluid filled cavities within the pancreas. Most of the time these cysts are benign and do not cause symptoms. Unfortunately, there are a subset of cysts that can be cancerous or turn into cancer if not treated. Therefore, it is important that your doctor be able to correctly diagnose the type of cyst that you have in order to manage it correctly.
The most common cause of pancreatic cysts is pancreatitis. We call these pancreatic pseudocysts. There are several other types of pancreatic cystic neoplasms that can arise from various causes, most of which is unrelated to a patient’s diet or lifestyle.
Most of the time pancreatic cyst do not cause any symptoms. They may be an incidental finding on an abdominal imaging test. When symptoms do occur, they can range from abdominal pain, feeling of abdominal fullness or a persistent dull stomach ache.
Pancreatic cystic neoplasms are often diagnosed incidentally on an abdominal imaging study such as a CT scan or an MRI. Once they are found on CT scan they can be further evaluated by an endoscopic ultrasound, ERCP (endoscopic retrograde cholangio-pancreatography) or an MRCP (magnetic retrograde cholangio-pancreatography). Depending on the characteristic of the cyst, a needle biopsy may be performed during the endoscopic ultrasound. At the time of the biopsy, cyst fluid can be analyzed to determine the type of cyst that you may have.
Treatment of pancreatic cystic neoplasms depends on the type of cyst that you have and also the location of the cyst. For cysts with little or no malignant potential such as serous cystadenoma, observation with follow up imaging study may be all that is needed. However, cysts with malignant potential such as mucinous cystic neoplasms may warrant surgical removal.
When surgery is indicated, removal of the cyst and the surrounding tissue is required. The type of surgery depends on the location of the cyst. When located in the tail of the pancreas, a distal pancreatectomy is the treatment of choice. If the cyst is located in the head of the pancreas, a Whipple procedure is often necessary. A total pancreatectomy is rarely needed to treat pancreatic cystic neoplasms but depending on the location of the cyst and the size, extent and the type of surgery needed may vary.