Digestion Q&A by Dr. Lee
Cysts in the pancreas often are found incidentally when abdominal ultrasounds and computerized tomography (CT) scans of the abdomen are performed. Most cysts are asymptomatic, that is, they do not cause symptoms; however, symptoms (primarily pain) may occur particularly with larger and expanding cysts when they compress the tissues surrounding them. There are three common types of pancreatic cysts:
Pseudocysts: These are benign cysts that result from pancreatic inflammation (pancreatitis). They usually resolve on their own without treatment.
Serous cysts: These too are benign cysts and usually do not need treatment unless they grow large enough to cause symptoms.
Mucinous cysts: These cysts can be malignant at the time of diagnosis or may become malignant at a later time. Thus, they should be removed surgically if the patient is a good surgical candidate. Generally, larger cysts are more likely to be malignant or pre-malignant than smaller cysts.
There are characteristics of cysts on the CAT scan and ultrasound that help doctors determine a cyst's malignant potential. Sometimes, endoscopic ultrasound is necessary to adequately evaluate a cyst.
Management of pancreatic cysts is individualized. Some doctors will elect to observe small pancreatic cysts (smaller than 2 cm) without malignant characteristics every six to 12 months with scans. They will consider studying larger pancreatic cysts (more than 2 cm) and enlarging cysts with endoscopic ultrasound and at the same time may insert a needle into the cyst to obtain cyst fluid. The fluid then is examined under the microscope for cancer cells. In addition, the fluid may be analyzed for proteins produced by cancers, for example, carcinoembryonic antigen (CEA). A high level of CEA in the cyst fluid suggests a high probability that the cyst is malignant, and a low level suggests that the cyst is benign. Cysts with cancer cells or proteins should be removed surgically. Cysts without cancer cells or proteins may continue to be observed with scans.
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Last Editorial Review: 2/28/2008