Frequently Asked Questions
What are pancreatic cysts?
Pancreatic cysts are fluid-filled neoplasms (i.e., abnormal growths) in the pancreas. "Pancreatic cysts" is somewhat of a misnomer. So called "pancreatic cysts" may be true cysts, false cysts or enlargements of the pancreatic ductal (i.e., pipe) system mimicking a cyst. True cysts are fluid-filled structures in the pancreas lined with cells (e.g., serous cystic neoplasms, mucinous cystic neoplasms). False cysts (i.e., pseudocysts) are fluid-filled structures in the pancreas without a cell lining. Sometimes the pancreatic ductal system can enlarge and appear cystic (e.g., intraductal papillary mucinous neoplasms).

What types of pancreatic cysts are there?
Common pancreatic cysts include pseudocysts, serous cystic neoplasms, and mucinous cysts. The most common are mucinous cysts of which there are 2 types; namely, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN).

Why are pancreatic cysts important?
Some pancreatic cysts may progress to pancreatic cancer. Mucinous pancreatic cysts are the most common pancreatic cysts and have significant potential to progress to pancreatic cancer. Since patients with mucinous cysts are at increased risk of pancreatic cancer, active screening, risk stratification and pancreatic cyst removal in select patients at highest risk promotes pancreatic cancer early detection and treatment.

How are pancreatic cysts detected?
Pancreatic cysts may be detected incidentally, i.e., when a patient undergoes testing for another indication. Many pancreatic cysts are being diagnosed in this way due to an increase in the use of high resolution cross-sectional imaging (i.e., CT and MRI scans) and recognition of their significance. Pancreatic cysts may also cause symptoms and signs and be discovered in this manner.

What signs and symptoms may develop in a patient with a pancreatic cyst?
Signs and symptoms of pancreatic cysts include**:
  1. pain
    1. abdomen (up under ribs)
    2. . back (just below the shoulder blades)
  2. pancreatitis (i.e.,inflammation of pancreas which is commonly associated with abdominal/back pain, loss of appetite, nausea and vomiting)
  3. pancreatic digestive enzyme deficiency (exocrine insufficiency) manifested by:
    1. bloating/indigestion
    2. flatulence (foul smelling)
    3. steatorrhea (i.e., frequent bowel motions which appear oily, greasy and often float on the top of toilet bowel)
    4. weight loss (unintentional)
    5. malnutrition, muscle wasting
  4. diabetes (endocrine insufficiency) especially in patients who are not obese and do not have a family history of diabetes:
    - this could be diabetes of new onset manifested by:
    1. increased thirst
    2. increased urination
    3. increased appetite

    - this could also be worsening of pre-existing diabetes manifested by:
    1. increase in the strength or number of oral hypoglycemics (i.e., diabetes pills) needed to control diabetes
    2. increase in required insulin needed to control diabetes
    3. transition from oral hypoglycemics (i.e., diabetes pills) to insulin
  5. jaundice manifested by:
    1. yellow eyes
    2. clay-colored stools
    3. tea colored urine
    4. pruritis (itchy skin)

** Importantly, these signs and symptoms may also develop in patients with pancreatic cancer.

Do all pancreatic cysts need to be surgically removed?
No. Pancreatic cysts have variable malignant potential. Mucinous pancreatic cysts are the most common pancreatic cysts and have significant potential to progress to pancreatic cancer. Despite this, most mucinous pancreatic cysts without worrisome features may be safely but carefully watched.