Pancreatic cysts are small collections of fluid found in the pancreas. The pancreas is an organ that is part of your endocrine and digestive systems. As an endocrine gland, the pancreas helps regulate blood glucose levels in your body through insulin production. As a digestive organ, it helps break down carbohydrates, fats, and proteins in food after it leaves your stomach. While not the same as solid pancreatic cancer (which is typically “adenocarcinoma”), some cysts can be “precancerous” requiring surveillance or removal or even be malignant (cancerous).
Subspecialized Interventional Gastroenterologists (GI) like Neil R. Sharma MD are the types of physicians patients may be referred to at tertiary care and academic centers for consult to deal with pancreatic cysts. In fact, you can even think of gastroenterologists as digestive health doctors. Some GI specialists may pursue further subspecialty fellowship in liver )”hepatology”) or surgical endoscopic procedures (“interventional endoscopy”). Interventional endoscopists may have focus on various minimally invasive therapies, pancreaticobiliary diseases, and/or cancers.
Examining Pancreatic Cysts
There are different types of cysts in the pancreas.
These include: pseudocysts, serous cystadenomas, simple cysts, IPMN, mucinous cystadenomas, neuroendocrine tumors, and many others.
Some cysts are completeley benign. Serous cystadenomas and pseudocysts for exmaple have little to no risk of developing into cancer.
Mucinous cysts, named for the thick liquid secreted within, are one type of pancreatic cyst that requires surveillance or sometimes interventions. They may start off benign but become cancerous if not removed. Intraductal papillary mucinous neoplasms (IPMN) are the most common type of mucinous cysts that tend to affect middle-aged men that can also develop into pancreatic cancer.
Experts like Neil R. Sharma MD will often measure the size of a detected cyst to make a decision to monitor or to recommend removal by surgery.
Detecting a Problem
Pancreatic cysts don’t usually present symptoms unless they’re quite advanced in their development. Most pancreatic cysts are incidental findings. Some of the most common symptoms associated with these polyps include the following:
- Continuous abdominal pain
- Nausea and/or vomiting
- Feelings of pressure or a mass in your abdomen
- Feelings of fullness shortly after starting to eat
- Unexplained weight loss
Once a pancreatic cyst is found, it should be worked up and further categorized, Specialists in the pancreas like Neil R. Sharma MD will perform a CT scan or MRI and labs to check for pancreatic cysts. More imaging may be necessary to get a better look and even sample the cysts to discern the subtype. Utilizing additional training via fellowship in Interventional endoscopy, Dr. Sharma conducts highly specialized endoscopies (called EUS or endoscopic ultrasound). Using EUS, Dr Sharma can sample cyst fluid if needed to check for precancerous or cancer cells. He has also performed multiple clinical trials on pancreatic cysts – diagnostic and therapeutic. In addition to EUS and biopsy, one of the more novel technologies is confocal laser endomicroscopy (CLE) He also leverages the power of CLE to better tell what type of cyst a patient has, and then personalize sampling, surveillance and even discern who may require treatment. CLE which involves the use of a camera inserted into a cyst through a needle to make a diagnosis in real time.
Treating Pancreatic Cysts
Cysts in the pancreas can be very difficult to remove without surgery, which can be quite invasive. This operation usually involves the removal of the cyst or a portion of the pancreas. Fortunately most patients do not require removal of the cyst. This selection should be determined by GI specialists with expertise in the pancreas along with multidisciplinary teams to avoid unnecessary surgery and interventions on patients without cancer and low risk of progression. Science, knowledge and technology is rapidly advancing in pancreatic cysts.
As mentioned, some cysts are benign. They may require drainage only which Dr Sharma performs minimally invasively through EUS guidance internally from the stomach or bowel. Other cysts may be precancerous. Fortunately the vast majority of these cysts are found incidentally and carry very low risk of progression over a patient’s lifetime. Experts should be able to discern the subtype of cyst using their expertise combined with labs, imaging, EUS, fluid analysis and novel technologies like CLE. The surveillance and treatment strategies should then be tailored to the patient. This is very important as the risks with surgery including downstream effects on long term patient function and diabetes are high, and should be avoided unless removal is absolutely needed. With greater advances in imaging technology and continued research from gastroenterology leaders such as Neil R. Sharma MD, more patients are detecting these cysts earlier, resulting in personalized surveillance and more selective treatments.