Pancreatic Cysts

The pancreas is an elongated gland that is located behind the stomach. It is actually part of the endocrine system and the digestive system and has several distinct functions within the body. The pancreas produces enzymes that assist in digestion, and it secretes insulin and glucagon that help regulate the metabolism of sugars.

Sometimes, the pancreas can develop closed sacs of fluid called pancreatic cysts. Most cysts are not cancerous and do not produce any accompanying symptoms. Pseudocysts develop as a complication of inflammation of the pancreas (pancreatitis). This type of cysts is frequently surrounded by fibrous tissue and may be lined with scar tissue or inflammatory tissue. About 75% to 80% of pancreatic cysts are pseudocysts, and they affect about 1 in every 1,000 adults per year.

If you have a pancreatic cyst that could be cancerous, your doctor may want to monitor the cyst over a period of time to evaluate any change in size or shape to determine whether it should be removed. A sample of the fluid from the cyst can also be taken to test for cancer cells.

Cause of Pancreatic Cysts
Pancreatic cysts are caused by a genetic mutation, but what initiates this mutation is mostly unknown. A rare genetic illness called von Hippel-Lindau disease can affect the pancreas and cause cyst development.

Symptoms
Many pancreatic cysts, especially pseudocysts, do not have any symptoms and are only discovered during image testing of the abdomen. When symptoms are present, they can include:

  • A feeling of a mass in your upper abdomen
  • Chronic abdominal pain which can radiate to your back
  • Nausea and vomiting

In some occasions, pancreatic cysts and pseudocysts can develop some very serious complications. Cysts can become infected and cause fever and stomach pain, so call your doctor if you are experiencing a dramatic change in your symptoms. Although it is rare, some pseudocysts will rupture. Fluid from the pseudocyst can cause bleeding, vascular damage, and infection of the abdomen called peritonitis. Untreated ruptured cysts can result in internal bleeding and shock. Some symptoms of severe complications may include:

  • Severe abdominal pain
  • Weak and rapid heartbeat
  • Fainting
  • Decreased consciousness
  • Vomiting blood

If you experience any of the symptoms above, seek medical treatment immediately.

Diagnosis
Pancreatic cysts and pseudocysts are hard to diagnose because their symptoms can be very similar to other diseases and because the pancreas is located deep within the abdomen. However, cysts and pseudocysts are diagnosed more often today than in the past because of advancements in imaging technology.

One of the first methods of diagnosis is medical history such as previous abdominal injury or pancreatitis. To help diagnose a cyst or pseudocyst, your doctor may use:

  • Transabdominal ultrasound—uses sound waves to detect a psuedocyst.
  • Abdominal CT scan—usually provides all the diagnostic information necessary and gives more detail about the structure of the cyst and the surrounding anatomy than the ultrasound.
  • MRI scan--shows minute details of a pancreatic cyst like whether it contains any solid components. This method is not used as often.
  • Endoscopic ultrasound—a secondary test to further evaluate the nature of the cyst as well as provide a method of fluid collection to test for cancer cells.
  • ERCP (endoscopic retrograde cholangiopancreatography)—allows the doctor to see the structure of the common bile duct or pancreatic duct.
  • If a cyst is discovered, the next step is to find out whether the cyst is cancerous. Your age, gender and the location of the cyst can often help your doctor determine the type of cyst that you have and the appropriate treatment.

Treatment
Most pseudocysts resolve themselves over time and do not require treatment. Sometimes, there are complications. If symptoms do not go away or the cyst grows to larger than 6 centimeters, it may be necessary to surgically remove the cyst or drain it.

There are three basic methods of drainage:

  • Endoscopic drainage—uses a flexible tube that is inserted through the mouth
  • Percutaneous catheter drainage—uses a hollow tube inserted into the body to remove fluid
  • Surgical drainage—open surgery or laparoscopic surgery

Endoscopic drainage is often a preferred option because there is low risk of complications, it is less invasive, it does not require an external drain and it has a high rate of success. Whichever method is chosen, the prognosis is very positive for people who undergo treatment for pancreatic cysts and pseuodocysts.

Prevention
There are many factors that you cannot control in whether you will develop pancreatic cysts or pseudocysts. Because pancreatitis can result in the formation of pseudocysts, there is one lifestyle change that you can make to prevent pancreatitis. Heavy alcohol use is associated with pancreatitis, so limit your alcohol or make the decision to stop drinking alcohol. If you are a heavy user of alcohol consider talking to your doctor about getting support. There are many local programs that are available to you to help discontinue drinking.

Diet can also help prevent pancreatic pseudocysts. A diet that is high in fruits, vegetables and lean proteins and low in carbohydrates and cholesterol will give you the best chance to avoid pseudocyst formation.