Its main functions are to produce digestive enzymes to break down food in the small intestine and to secrete hormones (insulin and glucagon) to control blood sugar levels. Pancreatic cysts can develop on or in this organ. These cysts are either closed sacs, lined with epithelial tissue that contains fluid, or they’re marked by nonepithelial tissue, in which case they’re called pseudocysts. Some cysts are caused by pancreatitis, which is an inflammation of the pancreas. But most pancreatic cysts don’t have a detectable cause and are discovered through imaging tests conducted for other reasons. They can sometimes — but very rarely — develop in children who experience trauma in the abdominal region from a sports or other injury. There are 20 different types of pancreatic cysts. Some are benign (noncancerous) and some are malignant (cancerous). These four are among the most common types: (1)
Pseudocysts These are often a result of pancreatitis.Serous Cystadenomas Almost all of these are benign.Intraductal Papillary Mucinous Neoplasms IPMS are the most common type of precancerous cysts.Mucinous Cystic Neoplasms (MCN) One-quarter of MCNs can be cancerous, and they develop mainly in women. (2)
What Are Pancreatic Pseudocysts?
Many pancreatic cysts are actually pseudocysts, which are always noncancerous. Unlike pancreatic cysts, which are self-contained sacs lined with a type of cell called epithelial cells, pseudocysts develop within a cavity or space in the pancreas and are surrounded by fibrous, nonepithelial tissue. Pseudocysts can develop from both acute and chronic pancreatitis, but they’re more common in chronic pancreatitis. (3) Chronic pancreatitis is most often caused by long-term, heavy alcohol use, and acute pancreatitis is usually caused by gallstones, with alcohol being the second most common cause. About 5 to 16 percent of people with acute pancreatitis develop pseudocysts, (4) and 20 to 40 percent of people with chronic pancreatitis develop pseudocysts. (3) About 30 to 50 percent of pseudocysts are expected to go away on their own, usually within four to six weeks, and may be monitored by your doctor with CT scans. (4,5) It’s often not clear what causes a pancreatic cyst to develop, but it’s sometimes associated with rare inherited disorders, including von Hippel-Lindau disease and polycystic kidney disease, both of which predispose people to cysts affecting multiple organs.
What Are the Symptoms of Pancreatic Cysts?
Pancreatic cysts, including pseudocysts, often produce no symptoms. When they do, symptoms can include:
Nausea and vomitingUpper abdominal pain, which may radiate to the back and shoulders and worsen after eating or drinking (also a symptom of pancreatitis)Abdominal bloating
Pancreatic cysts can lead to several complications, including:
Infection of the cystJaundice (yellowing of skin and eyes), which can occur when a large cyst blocks the common bile ductPortal hypertension, or high blood pressure of the portal vein system of the gastrointestinal (GI) tract
Pseudocysts may also rupture, damaging nearby blood vessels and causing hemorrhaging (bleeding). Ruptured pseudocysts may also cause peritonitis, a life-threatening infection of the membrane lining the abdominal cavity, called the peritoneum.
How Are Pancreatic Cysts Diagnosed?
Pancreatic cysts can be detected with various imaging techniques, including:
Transabdominal ultrasoundsEndoscopic ultrasounds, which are ultrasounds performed using a long, thin tube (endoscope) that’s inserted into the GI tract by way of the throatComputerized tomography (CT) scanMagnetic resonance imaging (MRI) and a special type of MRI for the liver, bile ducts, gallbladder, and pancreas, called magnetic resonance cholangiopancreatographyEndoscopic retrograde cholangiopancreatography, a procedure that uses an endoscope to help X-ray the bile and pancreatic ductsMagnetic resonance cholangiopancreatography (MRCP)
How Are Pancreatic Pseudocysts Treated?
As mentioned, pseudocysts often go away without treatment, but doctors may need to drain a pseudocyst if it causes persistent symptoms, is large, or is obstructing the pancreatic or bile duct. Pseudocysts are usually drained via an endoscope. If the cyst is infected, doctors may use a catheter and a needle guided by CT scans to drain it. Surgeons may decide to create a connection between the cyst and an adjacent organ of the intestine instead of directly draining the fluid from the cyst. This allows pancreatic juices that may later leak into the cyst to also drain out of the body. Surgeons make a connection in one of the following ways:
Between the cyst and the back wall of the stomach, a procedure called a cystogastrostomyTo the small intestine, called a cystojejunostomy or cystoduodenostomy
How Are Pancreatic Cysts Treated?
Surgery is the primary treatment for malignant cysts, large benign cysts, and benign cysts that have a high chance of becoming malignant. The exact surgical technique used depends on the location of the cyst. There are three main types of surgery used to remove cysts:
Whipple procedureDistal pancreatectomyTotal pancreatectomy
The Whipple procedure, also known as a pancreaticoduodenectomy, is used to remove cysts in the head of the pancreas by excising the head, part of the small intestine, the lower half of the bile duct, surrounding lymph nodes, the gallbladder, and if necessary some of the stomach. In a distal pancreatectomy, which is done when a cyst is located in the tail of the organ, surgeons remove the tail and in many instances the spleen. A total pancreatectomy, which is performed when cysts have affected many parts of the pancreas, is what its name implies: The whole pancreas is removed. Living without this organ means that patients will have to take enzymes and insulin for the rest of their lives, but doctors remove it because they want to eradicate the presence or possibility of cancerous cells. Additional reporting by Carlene Bauer.
