Diagnosing and caring for patients with pancreatic cysts is best done through a multidisciplinary approach. At Fox Chase, a team of specialists works together to provide the best treatment for each patient.

When treating pancreatic cysts, we believe the best outcomes result from a multidisciplinary approach to care. At Fox Chase, your specialized team of surgeons, radiologists, and gastroenterologists collaborate on confirming your diagnosis and developing the best course of treatment.

Most pancreatic cysts are benign (noncancerous) and stem from conditions other than cancer. However, some cysts are considered precancerous, and a small percentage are malignant or can become cancerous. The specialists at Fox Chase will work closely with you to determine the appropriate treatment plan for your pancreatic cyst.

Imaging and Surveillance

If your pancreatic cyst contains benign cells and presents no high-risk features on imaging tests, it probably won’t have to be removed. These types of noncancerous cysts include serous cystadenomas and pseudocysts. There is no medical treatment for these cysts, but your doctor will likely recommend imaging tests, endoscopies and/or biopsies every 6–12 months to look for any changes.

Surgery

For mucin-producing cysts that are considered precancerous—including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs)—surgical removal is often recommended to avoid future occurrence of cancer.

Intraductal Papillary Mucinous Neoplasms (IPMNs)

Your pancreatic team will determine whether an IPMN is arising from the main pancreatic duct or from a side branch of the duct. Typically, an MRI will be performed as well as an endoscopy or biopsy to sample the cyst and examine its fluid to see what kind of cells it contains.

It’s difficult to predict whether an IPMN will become cancerous, but pancreatic cysts from the main duct have a significantly higher rate of malignancy. In these cases, surgical removal of the affected portion of the pancreas is considered the best primary treatment option.

For branch duct IPMN, your team will weigh the risks and benefits of pancreatic surgery vs. regular imaging and surveillance. Key factors include:

• Whether the cyst is larger than three centimeters
• The cyst’s location in the pancreas
• Any thickening of the cyst walls
• Whether symptoms are present, such as pain or jaundice
• The age and general health of the patient

Mucinous Cystic Neoplasms (MCNs)

MCNs have the potential to become cancerous because of nodules or growths on the cyst walls. This type of cyst can occur anywhere in the gland, and surgical removal is a viable option and typically used as the first line of treatment.

Types of Surgery

• Whipple Procedure: Also known as a pancreatoduodenectomy, this surgery is performed for cysts in the head of the pancreas. It removes the head of the pancreas, the gallbladder, the duodenum (first part of the small intestine), part of the bile duct, and often part of the stomach.
• Distal pancreatectomy: This procedure removes the body and tail of the pancreas (where the cyst is located) along with nearby lymph nodes and sometimes the spleen and its blood vessels.
• Total pancreatectomy: Removal of the entire organ may be recommended if the cyst has affected a large portion of the pancreas. The surgery also removes the gallbladder, duodenum, part of the bile duct and stomach, nearby lymph nodes and sometimes the spleen. It is not often recommended because it has not shown better outcomes than less aggressive surgical treatments, and it can lead to the development of diabetes that is difficult to control.

While the use of minimally invasive surgical techniques (including robotics) has changed the landscape of surgical treatment for pancreatic cysts, pancreatic surgery is still a serious procedure that carries significant risks. Your doctors will work closely with you to help guide your decision.

“The majority of pancreatic cyst patients that I see don’t need specific medical treatment beyond close monitoring. I strive to explain things clearly to my patients, and that can be all they need to have some peace of mind.”

– Sanjay S. Reddy, MD, FACS, Surgical Oncologist and Co-Leader of The Marvin and Concetta Greenberg Pancreatic Cancer Institute at Fox Chase