Professor Anubhav Mittal

Introduction

 

Due to the increased and prevalent use of imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI), pancreatic cysts are now being detected more commonly.   Most of the incidentally discovered cysts are usually do not represent pancreatic cancer.  Unfortunately, much of the scientific literature is filled with a confusing array of terms like serous cystadenoma, intraductal papillary mucinous neoplasia or mucinous cystic neoplasm. Dr Mittal will help explain these terms to you and enroll you in a cyst surveillance program or recommend resection based on your individual case.

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Where to begin?

 

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In general, there are two main varieties of pancreatic cysts based on the type of fluid they contain.  The most common cysts are either serous (containing a thin type of fluid) or mucinous (containing a thicker, more viscous fluid).  For the most part, serous cysts tend to be benign (non-cancerous).  Most of the mucinous cysts are benign as well although there are a few subtypes that can be more concerning.  These include the mucinous cystic neoplasm (MCN) that contain ovarian tissue and are almost exclusively found in women as well as main-duct intrapapillary mucinous neoplasm (IPMN), a type of mucinous cyst that contains many tiny fingerlike projections that involves the main pancreatic duct.

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In many cases, Dr Mittal may be able to get a sense of what type of cyst you have based on the already available imaging tests.  Otherwise, MRI can be especially useful for further characterization.  If potentially concerning features are detected on imaging studies or if there remains significant uncertainty related to the nature of the cyst, additional information can be gained by an endoscopic ultrasound and fine needle aspiration of the cyst fluid.  This test is similar to a regular ultrasound (as in pregnancy) except that we use a probe connected to a gastroscope.   Once the endoscope is passed into the stomach, close images of the pancreas and a sample of the cyst fluid can be obtained.  If you have never had upper endoscopy, the procedure is relatively brief and uses sedation similar to that used for colonoscopy.  The fluid from the cyst can provide further diagnostic information.

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What treatment is available?

 

For cysts that are potentially non-cancerous, only follow-up is required with repeat imaging.  For potentially cancerous cysts,  the only curative treatment is surgery.  As any surgery on the pancreas is a major undertaking,  it is best to reserve resection for cases in which there is a significant concern for cancer.  This represents a minority of cases.  In the vast majority of cases, surveillance with periodic imaging tests is all that is needed.