In most cases, surveillance will be recommended, and our multidisciplinary team will recommend the appropriate timeline for follow-up imaging and visits.
Patients with pancreatic cysts are divided into high-risk and low-risk categories based on certain criteria, such as:
- Size of the cyst
- Family history of pancreatic cancer
- Symptoms related to the pancreas, such as an episode of pancreatitis
- Worrisome features of the cysts on a CT scan or MRI (see below)
- Analysis of the cyst fluid, which can be sampled by an advanced endoscopic procedure
Low-risk category:
- No history of pancreatitis or symptoms related to the pancreas, such as:
- Fatty, oily stools
- Yellowing of the eyes or skin
- Diabetes
- Weight loss
- No worrisome findings on imaging (see below)
- No history of significant tobacco use
- No obesity
- Cyst size < 3 cm
- No significant family history of pancreatic cancer or pancreatic cysts
- No worrisome findings on analysis of pancreatic cyst fluid
Worrisome features noted on imaging include:
- Cyst size > 3 cm
- Thickened cyst walls
- Dilation of the main pancreatic duct to 5 to 9 mm
- Rapid and/or significant increase in the size of the cyst
- An associated mass or nodule in the cyst
- Change in the diameter of the main pancreatic duct
- A cyst or mass causing blockage of the bile duct
- Concern for cystic involvement of the main pancreatic duct rather than the side branches of the pancreatic duct
- Changes in the appearance of the pancreas adjacent to the cyst
Surveillance of pancreatic cysts:
- All patients should undergo evaluation and surveillance, which includes multidisciplinary review of their individual case.
- The frequency and manner in which pancreatic cysts are monitored is based on the anticipated risk.
- Patients who fall into the low-risk category will undergo less frequent surveillance.
- Patients at high risk will have more frequent surveillance based on the recommendations of our weekly multidisciplinary consensus conference.
Testing
All patients will undergo:
- Detailed history and physical examination with a physician who specializes in managing pancreatic diseases
- Laboratory analysis
- Appropriate imaging studies (MRI/MRCP or CT)
- Review at our weekly multidisciplinary consensus conference
In addition, many patients will also undergo an endoscopic ultrasound procedure (EUS) to obtain a sample of cyst fluid for further testing.
