Pancreatic cyst

A pancreatic cyst is a pocket of fluid that forms in a saclike structure on the pancreas, which is the organ responsible for hormones and enzymes that digest food. While most pancreatic cysts aren't cancerous, they may prevent normal bodily functions and are typically removed to prevent further complications. Most pancreatic cysts are discovered while imaging for other problems.

Definition & Facts

A cyst is a collection of fluid that forms inside the tail, head or body of the pancreas. Most pancreatic cysts are benign. Benign cysts are not cancerous, and they may not produce any symptoms. Even large cysts may be benign, but the patient and doctor may elect to remove the cysts for health reasons.

There are several different kinds of pancreatic cysts. Pancreatic pseudocysts are fluid-filled structures that don't have a cell wall. They are surrounded by fibrous tissue. Pseudocysts can contain inflammatory cells and dead pancreatic tissue.

Pancreatic cysts may be serous, which means that they contain a clear liquid. Serous cystadenomas are mostly small cysts that are harmless and occur mostly in middle-aged women, but they may cause some abdominal pain. They are the most common type of benign pancreatic neoplasm.

Pancreatic cysts may also be mucinous (which means that the cysts contain mucus). Mucinous cystadenomas compromise approximately 30 percent of all cysts. These cysts may contain cancerous cells and are regarded as precancerous. Intraductal papillary mucinous neoplasm (IPMN) is a subtype of a mucinous cyst and it has a 40 to 50 percent chance of being cancerous. Mucinous cystic neoplasms are often found among women and contain ovarian tissue.

Rarely, pancreatic cysts can be malignant in which case they are considered cancerous and require immediate medical attention. Solid pseudopapillary tumour of the pancreas is a type of rare tumor that may become large and malignant. It is also known as a Frantz tumor.

Symptoms & Complaints 

The smaller a cyst is, the less likely it is to cause problems and symptoms. Large cysts can cause abdominal pain and back pain. This is thought to be caused by extra pressure from the cyst that may press on nerves and tissue in the body. If a pancreatic cyst is obstructing the bile duct, it may cause a yellowing of the skin known as jaundice. An individual with jaundice will also have dark urine.

In more severe instances, a cyst may become infected, causing fever, chills, and possible blood poisoning. A cyst can also rupture and bleed, both of which are medical emergencies. While rare, a large cyst can also press on the stomach or other internal organs. This can lead to a blockage in the intestines, which would cause the patient to experience abdominal pain and vomiting. Malignant cysts may start to invade surrounding tissues. This can lead to a constant dull pain in the back and upper abdomen.

Causes

The biggest risk factors for pseudocysts are alcoholism, trauma, gallstones, and surgery that leads to pancreatitis, which is the inflammation of the pancreas. Fluid accumulates inside of a pseudocyst, and the fluid usually includes dead pancreatic tissue, inflamed cells and a large number of digestive enzymes. Cysts that are formed as the result of pancreatitis often resolve themselves without treatment. If the pseudocyst remains after six weeks, then it will require treatment.

Diagnosis & Tests

Most patients don't discover that they have a pancreatic cyst since they are relatively asymptomatic, and the majority of cysts tend to be small. Because of this, most cysts are discovered only when scanning for other issues. Abdominal scans, ultrasounds, computerized tomography (CT) scans, and magnetic resonance imaging (MRI) scans are typically used to identify issues within the body.

Both CT and MRI scans can detect the presence of a cyst, but it's not possible to conclusively determine whether or not the cyst is harmful without a fluid sample from the cyst. The procedure used to obtain the fluid or tissue sample (biopsy) is known as fine-needle aspiration (FNA) and involves using a needle.

An endoscopic ultrasound may be performed simultaneously as the biopsy. This diagnostic procedure involves a small device being inserted through the esophagus and down into the duodenum. The benefit of this method is that more accurate pictures can be taken, which can give the doctor a good idea of the condition of the liver, pancreas, and gallbladder. In some cases, the nature of the cyst can't be determined with relatively non-invasive means and surgery is recommended.

Treatment & Therapy

The first goal of treatment is to identify what type of cyst the patient is dealing with. Once an accurate diagnosis is given, treatment options can be considered. When a cyst is benign, there is usually no treatment needed. Most benign cysts won't become cancerous, and they generally don't create any undesirable symptoms. A pancreatic pseudocyst doesn't need to be treated unless the symptoms persist beyond six weeks. Small cysts that are less than a centimeter are not generally considered a risk to the patient.

For precancerous cysts, a doctor may recommend watchful waiting and monitoring to make certain the cyst doesn't grow in size. Pancreatic cysts that grow larger than a couple centimeters will generally be removed surgically if the patient is healthy enough to undergo surgery. If the patient is elderly or if surgery would put the patient at risk, then the doctor may opt to perform additional procedures to confirm the nature of the cyst before taking further action. 

Prevention & Prophylaxis

Drainage can help relieve some of the symptoms of the cyst, and a cyst that is not considered malignant can be monitored without taking further action. The best way to avoid a pancreatic cyst is to avoid alcohol and talk with your doctor about any changes in your health.