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Understanding and Treating Pancreatic Cysts: What You Should Know

If you don’t have any issues with your pancreas, you probably don’t give this organ much thought. It’s nestled behind your stomach, and its enzymes help you digest your food and manage your blood sugar levels. 

But it’s possible to have fluid-filled sacs, called cysts, on your pancreas. There are lots of different types of pancreatic cysts that can impact your health in various ways. Taylor S. Riall, MD, PhD, a pancreatic surgeon with Banner – University Medicine, explained more about these cysts and how they may impact your health.

Types of pancreatic cysts

There are several different types of pancreatic cysts. They include the following:

Serous cysts

Serous cysts can be found anywhere in your pancreas but are more often found in the body or tail. They have a thin layer of cells and are filled with a clear, watery fluid. They can be made up of multiple small cysts (microcystic) or larger cysts (macrocytic).

Most of the time, imaging tests show that these cysts have scars between them. If your provider sees that scarring, they know you have a serous cyst, not another type of cyst.

“These cysts tend to grow slowly, are not typically cancerous and aren’t as likely to cause complications as other types of pancreatic cysts,” Dr. Riall said.

Mucinous cysts

There are two kinds of mucinous cysts of the pancreas: mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). If your provider suspects a mucinous cyst, they will probably recommend a biopsy. There are lots of different types of mucinous cysts that may need different treatment. Some could become cancerous.  

  • Mucinous cystic neoplasms (MCNs): MCNs almost always develop in women, typically between ages 30 and 50. “They are usually large and appear in the pancreatic tail but do not involve the main duct of the pancreas,” Dr. Riall said. They contain a thick, mucus-like fluid and can develop into cancer over time. 
  • Intraductal papillary mucinous neoplasms (IPMNs): IPMNs are a type of mucinous cyst that develops in the main duct or side ducts of the pancreas. They can happen to people of any age. They may cause mucus to build up, making your pancreas less healthy. It can be hard to tell the difference between IPMNs and mucinous cysts. These cysts can develop into cancer over time.
Cystic neuroendocrine tumors of the pancreas

These are cysts that develop in the pancreatic cells that make insulin and other hormones. They are less common, Dr. Riall said.

Pancreatic pseudocysts

These non-cancerous cysts can develop in people who get pancreatitis, or inflammation of the pancreas. They may clear up on their own or they may need to be drained or removed.

Symptoms of pancreatic cysts

“A lot of times, you don’t have any symptoms with pancreatic cysts. They are found on imaging tests such as CT scans and MRIs, which are done for other reasons,” Dr. Riall said.

If you have pancreatic cysts, you may have belly pain or back pain that could vary. Sometimes, it could feel like a dull ache, and other times like a sharp pain in a specific location. The pain can be a sign of where the cyst is in the pancreas.   

You may also have trouble digesting food, which can lead to symptoms such as bloating, indigestion and feeling full even after small meals. 

You could have other symptoms based on the type of cyst:

  • Serous cysts may not cause any symptoms. But you might have discomfort or pain from larger cysts or cysts that press on nearby organs.
  • MCNs and IPMNs may cause symptoms like belly pain, bloating, indigestion and changes in bowel habits. They may also cause elevated amylase levels in some cases, which can be detected in blood tests. 
  • MCNs and IPMNs can also lead to inflammation of the pancreas (called pancreatitis), which can cause severe belly pain, nausea and vomiting.
  • MCNs and IPMNs may cause jaundice, which is a yellow color to your skin and eyes that can happen if your bile ducts are blocked. You might also have unexplained weight loss.

If you have any symptoms of pancreatic cysts, talk to your health care provider. It’s important to get care quickly if you think you might have pancreatic cysts. They might not cause harm right away, but some can trigger health problems and cause complications.

“You can’t prevent pancreatic cysts,” Dr. Riall said. “If you have a strong family history of pancreatic cancer or certain syndromes, you might be more likely to get pancreatic cysts that could become cancerous.”

Diagnosing pancreatic cysts 

If your health care provider thinks you might have pancreatic cysts, they may recommend certain tests:

  • Imaging tests like magnetic resonance imaging (MRI) and computed tomography (CT) scans can show detailed images of the pancreas. With them, health care providers can see the size, location and characteristics of cysts. That information can help with diagnosis.
  • Endoscopic ultrasound (EUS) is a more specialized procedure. With it, a health care provider puts a flexible tube through your mouth and into your stomach and small intestine. 

    EUS shows close-up images of the pancreas and the area around it. EUS can help show what cysts are made of and if they look suspicious. It might be recommended when your provider needs more detailed information for diagnosing and treating your cysts. Biopsy can also be performed during EUS.

Treating pancreatic cysts  

Based on your diagnosis, your health care provider will recommend a treatment plan for pancreatic cysts. Sometimes, observing the cyst may be all you need. If you have a smaller, stable cyst that’s at low risk for complications, your provider may recommend regular check-ups and imaging tests to see if it changes and needs treatment.

If you have a large cyst, thickening, growing, changing quickly or that could become cancerous, your provider might recommend removing it surgically. Depending on the cyst, you may need a Whipple procedure (pancreaticoduodenectomy) or a pancreatectomy. You may also need your spleen removed.

“With pancreatic cysts, we often have the opportunity to remove them before invasive cancer develops,” Dr. Riall said. “Pancreatic surgery is a major operation and has many potential complications, but when done by an experienced surgeon, this operation can cure or prevent cancers from developing in pancreatic cysts.”

Depending on the type of pancreatic cyst you have, you may still need surveillance (CTs or MRIs) after it’s removed to make sure the cyst doesn’t come back.

The bottom line

If you have pancreatic cysts, you might have symptoms or your provider might spot them when you have an imaging test for another reason. Depending on the type of cyst, you may be able to watch it for changes or need it removed.

To learn more about the health of your pancreas and digestive system, reach out to an expert at Banner Health.

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