2015-07-27 17:54:52 UTC

Pancreatic Cysts 101: Managing Pancreatic Cysts

Learn more about Pancreatic Cysts in this patient companion, based on the AGA Clinical Guideline "The Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts."

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: The Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

Contents:

What are Pancreatic Cysts?

How to Best Treat and Monitor Pancreatic Cysts

Talk With Your Doctor

 


What are Pancreatic Cysts?

  • Pancreatic cysts are small sacs of fluid that grow on or inside the pancreas. 
  • The pancreas (PAYN-kree-uss) is an organ that sits behind the stomach. It releases chemicals into the body that help digest food so you can get the energy and nutrients you need to survive. For example, the pancreas makes insulin, which is a chemical that turns the sugar from an apple or a bowl of ice cream into energy that your body can use.
  • Pancreatic cysts are surprisingly common and mostly harmless. Most people feel fine and do not even know they have them.
  • Many people only find out they have a pancreatic cyst when they go in for a scan of their belly — such as an MRI — for a different reason, such as a stomachache.
  • As more and more people get MRIs and other scans done, more people are being told they have pancreatic cysts. Luckily, the chance of these cysts being cancerous is very small. Out of every 100,000 people who find out they have pancreatic cysts on an MRI, only 25 of them will have cancerous cysts.
  • A single cyst may appear or many may grow together. Pancreatic cysts can come in different sizes and textures.
  • The chance of having pancreatic cysts grows with age. In fact, up to 25 percent of Americans over age 70 have them.
  • Less often, a cyst may call for an endoscopic test called EUS/FNA (endoscopic ultrasound–guided fine-needle aspiration) to test it for abnormal cells.
  • In a small number of cases, surgery to remove the cyst is needed.
  • Pancreatic cysts may cause symptoms, like belly pain, in some patients.
  • Very rarely, pancreatic cysts can become cancerous over time.

 

How to Best Treat and Monitor Pancreatic Cysts

Keep an Eye on Your Cysts with a Five-Year Scan Plan

If you find out you have pancreatic cysts, there is no need to panic. Remember: most cysts will never cause any problems.

  • First, your doctor should take a closer look on an MRI scan. 
  • Your doctor will want to monitor and treat your cysts based on how they look. The AGA guideline can help your doctor decide what to do based on your first MRI scan.
  • Most patients will want to follow a five-year plan. In this plan, you would have three MRI scans over a five-year period.
    • If your cysts do not change over this time, this means they have a low risk of becoming cancerous, and you should consider stopping surveillance.
    • You can talk to your doctor and adjust this plan to meet your unique needs and concerns.
  • Take a look at the flow chart to understand how your doctor will decide to treat your pancreatic cysts.

Most People with Pancreatic Cysts Do Not Need Surgery

When you first find out you have pancreatic cysts, it is normal to want to get them removed just “to be safe.” However, it is important to realize that surgery of the pancreas — like any major surgery — comes with risks.

  • Around 30 percent of patients who get part of their pancreas removed will have serious side effects, such as:
    • Bleeding, leaking or an infection inside of the body.
    • Injury to other organs, such as the spleen, stomach, colon or small intestine.
    • Diabetes.
    • Serious weight loss due to low appetite and slower digestion. 
  • For patients with cysts that are more likely to be cancerous, the risks of surgery may be outweighed by the benefit of treating symptoms or preventing cancer. However, most patients have lower-risk cysts.

Talk With Your Doctor to Understand Your Situation and Create a Plan

When you first learn you have one or more pancreatic cysts, you may be surprised, confused and unsure. Talking about your concerns and asking the right questions of your doctor can help you understand your unique situation and find a plan that works best for you.

  • What are the risk factors for pancreatic cancer? Is my risk higher than normal?
  • Am I able to safely get an MRI scan? If not, are there other options available?
  • Given my risk level, how often should I get an MRI scan or other tests?
  • If I ever need surgery, where is the closest medical center that does pancreatic operations and has the best results?

 

Reference
Vege, S.S., Ziring, B., Jain, R. et al. American Gastroenterological Association Institute guideline on the management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148: 819–822

American Gastroenterological Association. Managing Pancreatic Cysts: A Patient Guide. Gastroenterology 2015;149:498–499. Available at http://www.gastrojournal.org/article/S0016-5085(15)00901-4/fulltext

Updated March 2016

 

Created July 2015

©AGA, July 2016

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