Pancreatic cysts

What does it mean if a cyst is found in the pancreas?

Today when imaging methods are widely used, cysts in the pancreas are found in approximately 8% of imaging examinations, that is, they are a fairly common finding. It is very rare for a cyst in the pancreas to cause pain, bloating (flatulence) or other abdominal symptoms. So, in the great majority of them, the cysts are ‘accidental findings’.

Are pancreatic cysts a ‘precancerous’ lesion?

Some cysts called ‘serous cystadenomas’ never develop into cancer and do not need any follow-up. The most common type of cyst, however, is the Intraductal Papillary Mucinous Neoplasm, which is better known by its English name, IPMN. In most cases, an IFN will never develop into cancer. But this risk is not zero. It depends on many factors. Some are patient-specific, such as age, smoking, history of diabetes or family history. Some involve the cyst itself, such as its size, morphology, and the diameter of the central pancreatic duct.

What is IRMN (Intestinal Papillary Mucinous Neoplasm)?

Inside the pancreas is a network of small tubes (ducts) through which the pancreas channels its enzyme-rich secretions into the intestine. These ducts are covered by cells of the so-called ‘endoductal’ epithelium.

In IPMN, the intraductal epithelium acquires an irregular surface (‘papillary’) and produces large amounts of thick fluid (‘mucous’). The mucus builds up and creates one or more cysts, which may be detected when someone has an abdominal imaging test, such as an ultrasound, CT or MRI scan, for any reason.

What should I do if I have a cyst in my pancreas?

Because it is important to accurately characterize such a cyst, in most cases it is necessary to first perform a good Magnetic Tomography (MRI) in conjunction with Magnetic Cholangiography (MRCP). This examination is painless and harmless. Its only difficulty is that it requires our patience and cooperation.

Depending on the symptoms and findings of the MRI-MRCP, there is a possibility that a more specialized examination, the Endoscopic Ultrasound (EUS), may also be requested. EUS is done under simple anesthesia, like gastroscopy. A puncture (EUS-FNA) may also be performed during the EUS.

At the end of it all, the gastroenterologist specializing in the pancreas will be able to give us guidance for the future. In some cases, such as a serous cystadenoma, the risk may be so low that the doctor will not recommend any retesting. In most cases, as in ILMN, the best option is a follow-up with repeated tests, usually MRI-MRCP, at intervals of a few months or years. Because some cysts that started out small have grown over the years, it is important to be consistent with the recommended checkup intervals. This examination should be evaluated by a specialized gastroenterologist.

Is there a cure for PMN?

Unfortunately, there is no possibility to treat or reduce the risk with drugs or with any endoscopic method. Quitting smoking will certainly benefit anyone who has PMN and smokes.

The only real cure is surgical removal, an option that should only be recommended after careful consideration and consideration. If we operated on all the IRMNs we found by chance, we would surely cause far more problems because of the difficulties of the surgery than the IRMNs themselves will ever cause. Therefore, calmness and self-restraint are needed from the patients, the gastroenterologists, and also the surgeons.