Pancreatic Cysts and Fluid Collections
What is a Pancreatic Cyst?
Pancreatic cysts, which are sacs of fluid, don’t typically cause symptoms. Many are found incidentally on a CT scan or other imaging study that was conducted for another health problem.
Many different types of cysts can form in the pancreas, which is an organ near the stomach. Most are benign, but some types may harbor precancerous or cancerous cells. That’s why it’s important to partner with pancreatic experts in identifying the type of cyst, discussing the risk of the cyst transforming into cancer and determining an appropriate care plan.
At UChicago Medicine, our pancreas clinic is staffed by a team of experienced clinicians who work closely together to accurately diagnose and effectively treat and manage pancreatic cysts and fluid collections. Our team includes:
- Gastroenterologists (digestive health physicians) who specialize in medically treating all kinds of pancreatic diseases, including cysts.
- Interventional gastroenterologists who specialize in nonsurgical approaches to diagnosing pancreatic cysts and other problems.
- Pathologists and radiologists who are experts at diagnosing pancreatic cysts and other conditions based on tissue-based and imaging studies.
- Highly experienced pancreatic surgeons who are called on when a cyst has high-risk features that require surgery.
Treatment for Pancreatic Cysts and Fluid Collections
Few U.S. medical centers have a true multi-specialty team of clinicians devoted to pancreatic diseases and conditions, like we have at UChicago Medicine. When it comes to pancreatic cysts, this team approach is important because different types of cysts and fluid collections are managed differently, requiring the insights and skills of different clinicians:
- Surgery: When patients have a type of pancreatic cyst that carries a high risk of cancer, we typically recommend having the cyst surgically removed. Our renowned gastrointestinal surgeons perform hundreds of pancreatic surgeries a year and use the most innovative surgical approaches, including minimally invasive robotic surgery in certain cases. Research shows that patients fare better at medical centers that perform large numbers of operations, compared to smaller hospitals with lower volumes.
- Wait and watch: Patients with low-risk pancreatic cysts may not require any immediate treatment. Our medical pancreatologists typically follow these patients over their lifetimes, ordering advanced imaging tests every two years to ensure that the cysts have not grown or developed features of more aggressive cysts. If this happens, then these patients may be candidates for surgery.
- Draining: Certain types of cysts and fluid collections (such as those that follow a severe attack of acute pancreatitis) may benefit from being drained if the growth is large and causing uncomfortable symptoms, such as pain or weight loss. Drainage might be performed with a needle through the skin, or through an endoscopic or surgical procedure.
At UChicago Medicine, we recognize that every patient is different. When discussing treatment options for pancreatic cysts and fluid collections, we use shared decision making, taking each patient’s values and preferences into account, as well as his or her medical situation.
Frequently Asked Questions
Some types of pancreatic cysts have a high risk of already containing cancerous or precancerous cells when discovered. These high-risk varieties include cysts such as the following:
- Intraductal papillary mucinous neoplasms (IPMN), which grow in the main duct or side branches of the pancreas.
- Mucinous cystic neoplasms, which tend to develop in middle-age women.
- Neuroendocrine cancers of the pancreas with cystic degeneration.
In contrast, other types of pancreatic cysts have a low risk of containing cancerous or precancerous cells. Low-risk varieties include:
- Serous cystadenomas, which tend to occur in older women and can become large enough to cause symptoms (e.g., stomach pain).
- Pseudocysts, which typically result from pancreatitis and are not considered true cysts.
- Papillary solid and cystic tumors, which are very rare and primarily affect young women.
New data has shown that even patients with some lower-risk mucinous cysts (e.g., side-branch IPMN) have a 10 to 15 percent increased risk of developing cancer in their lifetimes. That’s why clinical guidelines recommend regular, long-term monitoring of these cysts to ensure they do not grow or develop cancerous features.
We can determine the type of pancreatic cyst, and whether there is a low or high risk of cancer or pre-cancer, by looking at the size, location, and appearance of the cyst. Various imaging studies, including CT scans and MRIs, may be ordered to provide details about the cyst.
Many patients also have an endoscopic ultrasound and biopsy. Our interventional gastroenterologists thread a thin tube (endoscope) through the mouth to the pancreas. The endoscope produces sound waves, creating an image of the pancreatic cyst. At the same time, the interventional gastroenterologist use tiny instruments on the endoscope to take samples of fluid and tissue in the cyst. This allows our pathologist to diagnose the type of cyst based on the appearance of biopsied cells under a microscope.
UChicago Medicine researchers hope to further refine the diagnosis of pancreatic cysts and fluid collections by studying past cases. Our clinician-researchers are studying pre-existing samples of pancreatic cyst fluid, as well as blood, to identify molecular signatures that are associated with high-risk cysts. The results of this research could further help physicians and patients determine whether surgery or a wait-and-watch approach is warranted.
The type of pancreatic surgery will depend on the size and location of the cyst. The goal is to remove the cyst, as well as some surrounding tissue, to help ensure no precancerous or cancerous cells remain. Most patients requiring surgery undergo one of these operations:
- The Whipple procedure involves removing the head of the pancreas, along with part of the small intestine, gallbladder, and sometimes part of the stomach
- A distal pancreatectomy involves removing the tail of the pancreas and typically part of the spleen
Whenever possible, our surgeons use minimally invasive surgical approaches, removing pancreatic cysts through small incisions. This helps reduce postoperative pain and speed recovery time. By using surgical robots to assist with these operations in appropriate cases, our surgeons are able to ensure accuracy during complex surgeries.
The cause of most pancreatic cysts is unknown. People who develop severe pancreatitis or suffer an abdominal injury are at risk of developing pseudocysts, which are not considered true cysts.
In addition, some rare disorders, such as von Hippel-Lindau disease, are associated with the formation of pancreatic cysts (such as serous cystadenomas) as well.
Pancreatic cysts and fluid collections usually don’t cause any symptoms. Patients should see a doctor if they develop stomach pain, jaundice and reduced appetite and ability to tolerate food, which may be indicative of underlying pancreatic inflammation (acute pancreatitis), or an obstruction of the ducts draining the liver. These can occur when a cyst enlarges in size or becomes cancerous.
Pseudocysts, which are rare types of cysts developing after acute pancreatitis, can cause symptoms when enlarging. In addition, very rarely, some pseudocysts can rupture, causing excessive abdominal pain and internal bleeding. The likelihood of this is small. But, if it happens, patients need to seek emergency care.
Request an Appointment
You can also make an appointment with our providers by:
– Requesting an online second opinion from our specialists
To speak to someone directly, please call 1-888-824-0200. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.
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What Is the Whipple Procedure?
UChicago Medicine is one of few centers in the country that offer the Whipple procedure using both traditional open and robot-assisted techniques. An expert multi-disciplinary team of cancer doctors needs to go over every patient's case. The surgeon then discusses the risks and benefits with each patient to determine if the Whipple is right for them.
During the procedure, the surgical team removes the head of the pancreas. Then they remove the first portion of the small intestine, or duodenum, gallbladder, part of the bile duct, and nearby lymph nodes. In some cases, a small part of the stomach and portions of the nearby artery and vein may also need to be removed.
The final step is to reconnect the pancreas with the bile duct, stomach, and intestine so food can pass through the digestive system once again.
UChicago Medicine works to enhance recovery so patients can go home as soon as possible. Depending on the type and stage of the tumor, patients may undergo outpatient chemotherapy before or after surgery, or both. Because the Whipple surgery is a complex procedure, it's important to be treated by a highly experienced surgical team.
The American Cancer Society recommends patients have the Whipple operation at a hospital that does at least 15 to 20 of these surgeries per year. Surgeons at UChicago Medicine perform up to five times that many Whipple procedures annually. Want more information about pancreatic cancer and the Whipple procedure? UChicago Medicine is here to help.