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Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Bhupinder Anand, MD

In this Article

• What is the pancreas?
• What are pancreatic cysts?
• What are the symptoms of pancreatic cysts?
• What are the causes of pancreatic cysts?
• Pseudocysts
• True cysts
• How are pancreatic cysts diagnosed?
• What is the treatment for pancreatic cysts?
• Patient Comments: Pancreatic Cysts - Diagnosis
• Find a local Gastroenterologist in your town
• Pancreatic Cysts Index

The most important aspect of management of pancreatic cysts is the determination of whether a cyst is benign (and usually needs no treatment) or if it is cancerous and must be removed.

The second most important aspect of management is to determine whether a patient with a precancerous or cancerous pancreatic cyst is a suitable surgical candidate. In medical centers experienced in performing pancreatic surgery, surgical removal of precancerous or cancerous cysts results in a high rate of cure.

Very small cysts can be followed to detect an increase in size that may indicate cancer or an increased risk of developing cancer. Not all cysts need to have EUS or be aspirated; some may have characteristics so suggestive of malignancy that surgery is recommended without EUS. Others may have characteristics so suggestive of a non-cancerous cyst that no EUS needs to be done although imaging studies (ultrasound, CT, MRI) may be repeated periodically. There are not yet standard recommendations for managing pancreatic cysts. Different medical centers have adopted different approaches to diagnosis and treatment. Management decisions must be individualized for each patient after discussions with a doctor familiar with the patient's health status. The following is one example of how a doctor might manage pancreatic cysts.

1. Pancreatic pseudocysts need treatment if they persist beyond six weeks after acute pancreatitis, especially if they reach a large size and cause symptoms such as obstruction of the stomach or common bile duct, abdominal pain, or become infected. Small pancreatic cysts (for example, cysts smaller than one cm) will have little chance of being cancerous. Nevertheless, even these small cysts can grow in size and turn cancerous in the future. Thus, these patients are monitored with yearly scans (for example, yearly ultrasound or MRI). The cysts do not have to be evaluated with EUS and fine needle aspiration. If the cysts grow in size and/or cause symptoms, the patient will be evaluated further using EUS and fine needle aspiration.
2. Pancreatic cysts larger than 2 cm in young, healthy individuals usually are treated with surgical removal, especially if the cysts produce symptoms.
3. Pancreatic cysts larger than 2 cm in elderly patients can be studied with endoscopic ultrasound and fine needle aspiration. If fluid cytology,, CEA measurements or analysis of DNA suggest cancerous or precancerous changes, the patients can be evaluated for pancreatic surgery.

REFERENCE: UptoDate. Classification of Pancreatic Cysts.