Pancreatic cysts can be true cysts or pseudocysts, with the latter being the most common and almost always benign. Mucinous cysts have the potential to become cancerous, and a biopsy of the fluid inside the cyst can help determine if it is malignant. Treatment depends on the size and symptoms of the cyst, with surgery being the usual option for larger or cancerous cysts.
A pancreatic cyst is a collection of fluid that builds up inside the pancreas. When the cyst is a true cyst, the fluid pool is surrounded by a layer of fluid-secreting cells within it. In contrast, pseudocysts, which are the most common type of cyst, are not surrounded by this cell layer. Most cysts in the pancreas cause no symptoms of disease and are benign. If the cysts grow large, they can cause abdominal pain, back pain, or jaundice. In some cases, a cyst can become cancerous.
The pancreas is a small organ located behind the stomach. Its main functions are the production of enzymes that aid digestion and hormones that regulate blood sugar levels. The pancreatic duct, which runs the length of the organ, drains secretions into the small intestine for use during digestion.
There are different types of pancreatic cysts. Mucinous cysts contain mucus secreted by the cell layer surrounding the cyst and have the potential to develop into pancreatic cancer. Intraductal papillary mucinous neoplasms, which are mucinous cysts that form in the pancreatic ducts, have a higher risk of becoming cancerous than mucinous cysts located in the pancreas itself. A rare cyst called a solid pseudopapillary tumor of the pancreas can grow large; it can also become malignant.
Pseudocysts, which are almost always benign, are the most common type of cyst to develop in the pancreas. These cysts often form after a bout of acute pancreatitis. Acute pancreatitis is sudden inflammation of the pancreas, usually caused by gallstones, alcohol abuse, traumatic injury, or the use of certain prescribed medications.
When a pseudocyst develops after acute pancreatitis, it tends to contain high levels of digestive enzymes, while those that develop for other causes may contain different enzymes or other proteins. This is useful information when evaluating a cyst, because an analysis of the fluid inside it helps determine if it has the potential to become malignant. When a cyst is solid, it’s more likely to be cancerous than one filled with fluid.
Evaluation of a pancreatic cyst is done with medical imaging tests such as a CT or MRI scan and a biopsy of the fluid inside it. The biopsy is obtained by passing an instrument called an endoscope into the upper intestine through the mouth and stomach. This tool is used to take ultrasound images of the cyst and obtain a sample of the fluid inside it. Examination of the cyst and its contents is usually sufficient to make a diagnosis.
Small, asymptomatic pseudocysts rarely require treatment but may be monitored for signs of growth. Larger cysts that cause stomach pain or blockage, or that become infected, are usually removed by surgery. A cancerous or precancerous cyst is usually removed as soon as possible. When a cyst is cancerous, surgery might be followed by chemotherapy or radiation therapy as a precautionary measure.
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