A 'cyst is a closed sac having a A 'cyst is a closed sac having a distinct membrane and division distinct membrane and division on the nearby tissue. It may on the nearby tissue. It may contain air, fluids, or semi-solid contain air, fluids, or semi-solid material. A collection of pus is material. A collection of pus is called an abscess, not a cyst. called an abscess, not a cyst. Once formed, a cyst could go Once formed, a cyst could go away on its own or may have away on its own or may have to be removed through to be removed through surgery.surgery.

What are pancreatic cysts?What are pancreatic cysts?Pancreatic cysts are collections Pancreatic cysts are collections of fluid with in the head, body, of fluid with in the head, body, or tail of the pancreas. Some or tail of the pancreas. Some pancreatic cysts are true cysts, pancreatic cysts are true cysts, that is, they are lined by a that is, they are lined by a special layer of cells that are special layer of cells that are responsible for secreting fluid responsible for secreting fluid into the cysts. into the cysts.

Pancreatic cysts can range Pancreatic cysts can range from several millimeters to from several millimeters to several centimeters in size. several centimeters in size. Many pancreatic cysts are Many pancreatic cysts are benign and produce no benign and produce no symptoms, but some cysts symptoms, but some cysts are cancerous or are cancerous or precancerous. precancerous. (Precancerous cysts are (Precancerous cysts are benign cysts that have the benign cysts that have the potential to become potential to become cancerous.) cancerous.)

Different types of cysts contain Different types of cysts contain different types of fluids. For different types of fluids. For example, pseudocysts that example, pseudocysts that form after an attack of acute form after an attack of acute pancreatitis contain digestive pancreatitis contain digestive enzymes such as amylase in enzymes such as amylase in high concentrations.high concentrations.

What are the symptoms of What are the symptoms of pancreatic cysts?pancreatic cysts?The symptoms of pancreatic The symptoms of pancreatic cysts depend on their size and cysts depend on their size and location. Small (less than two location. Small (less than two cm) cysts usually cause no cm) cysts usually cause no symptoms. Large pancreatic symptoms. Large pancreatic cysts can cause abdominal cysts can cause abdominal pain and back pain by putting pain and back pain by putting pressure on surrounding pressure on surrounding tissues and nerves. tissues and nerves.

Large cysts in the head of the Large cysts in the head of the pancreas also may cause pancreas also may cause jaundice (yellowing of the skin jaundice (yellowing of the skin and eyes with darkening of and eyes with darkening of urine color) due to obstruction urine color) due to obstruction of the common duct. of the common duct. Obstruction causes bile to back Obstruction causes bile to back up and forces bilirubin (the up and forces bilirubin (the chemical that produces chemical that produces jaundice) back into the jaundice) back into the bloodstream.bloodstream.

On rare occasions, acute On rare occasions, acute pancreatitis can cause the pancreatitis can cause the formation of large pseudocysts formation of large pseudocysts that can compress the that can compress the stomach or the duodenum stomach or the duodenum leading to obstruction to flow leading to obstruction to flow within the intestines, within the intestines, abdominal pain and vomiting. abdominal pain and vomiting. These cysts also may become These cysts also may become infected and lead to fever, infected and lead to fever, chills, and sepsis. chills, and sepsis.

What are the different causes What are the different causes and types of pancreatic cysts?and types of pancreatic cysts?There are two major types of There are two major types of pancreatic cysts; inflammatory pancreatic cysts; inflammatory cysts and noninflammatory cysts and noninflammatory cysts. Inflammatory cysts are cysts. Inflammatory cysts are benign, whereas benign, whereas noninflammatory cysts can be noninflammatory cysts can be benign, precancerous, or benign, precancerous, or cancerous.cancerous.

Inflammatory cystsInflammatory cystsMost of the inflammatory cysts Most of the inflammatory cysts of the pancreas are pancreatic of the pancreas are pancreatic pseudocysts. Pseudocysts of pseudocysts. Pseudocysts of the pancreas result from the pancreas result from pancreatitis. The common pancreatitis. The common causes of pancreatitis include causes of pancreatitis include alcoholism, gallstones, trauma, alcoholism, gallstones, trauma, or surgery or surgery

The fluid inside the The fluid inside the pseudocysts represents pseudocysts represents liquefied dead pancreatic liquefied dead pancreatic tissue, cells of inflammation, tissue, cells of inflammation, and a high concentration of and a high concentration of digestive enzymes (for digestive enzymes (for example, amylase). Most example, amylase). Most pseudocysts caused by acute pseudocysts caused by acute pancreatitis resolve pancreatitis resolve spontaneously (without spontaneously (without treatment) within several treatment) within several weeks. weeks.

Pseudocysts that need Pseudocysts that need treatment are those that treatment are those that persist beyond six weeks and persist beyond six weeks and are causing symptoms such as are causing symptoms such as pain, obstruction of the pain, obstruction of the stomach or duodenum, or stomach or duodenum, or become infected. become infected.

How are pancreatic cysts How are pancreatic cysts diagnosed?diagnosed?Since the majority of Since the majority of pancreatic cysts are small and pancreatic cysts are small and produce no symptoms, they produce no symptoms, they often are discovered often are discovered incidentally when abdominal incidentally when abdominal scans (ultrasound, CT scan, or scans (ultrasound, CT scan, or MRI) are performed to MRI) are performed to investigate unrelated investigate unrelated symptoms. symptoms.

Unfortunately, ultrasound, CT, Unfortunately, ultrasound, CT, and MRI scans cannot reliably and MRI scans cannot reliably distinguish benign cysts (cysts distinguish benign cysts (cysts that usually need no that usually need no treatment) from precancerous treatment) from precancerous and cancerous cysts (cysts that and cancerous cysts (cysts that usually require surgical usually require surgical removal). removal).

Endoscopic ultrasound (EUS) is Endoscopic ultrasound (EUS) is becoming increasingly useful becoming increasingly useful in determining whether a in determining whether a pancreatic cyst is benign, pancreatic cyst is benign, precancerous, or cancerous. precancerous, or cancerous. During EUS, an endoscope with During EUS, an endoscope with a small ultrasound transducer a small ultrasound transducer on its tip is inserted through on its tip is inserted through the mouth, esophagus, and the mouth, esophagus, and stomach into the duodenum stomach into the duodenum

During EUS fluid from cysts During EUS fluid from cysts and samples of tissue also can and samples of tissue also can be obtained by passing special be obtained by passing special needles through the needles through the endoscope and into the cysts endoscope and into the cysts or tumors. The process of or tumors. The process of obtaining tissue or fluid with a obtaining tissue or fluid with a thin needle is called fine thin needle is called fine needle aspiration (FNA).needle aspiration (FNA).

What is the treatment for What is the treatment for pancreatic cysts?pancreatic cysts?The most important aspect of The most important aspect of management of pancreatic management of pancreatic cysts is the determination of cysts is the determination of whether a cyst is benign (and whether a cyst is benign (and usually needs no treatment) or usually needs no treatment) or if it is cancerous and must be if it is cancerous and must be removed.removed.The second most important The second most important aspect of management is to aspect of management is to determine whether a patient determine whether a patient with a precancerous or with a precancerous or cancerous pancreatic cyst is a cancerous pancreatic cyst is a suitable surgical candidate. suitable surgical candidate.

2. Small pancreatic cysts (for. 2. Small pancreatic cysts (for. Nevertheless, even these small Nevertheless, even these small cysts can grown in size and cysts can grown in size and turn cancerous in the future. turn cancerous in the future. Thus, these patients are Thus, these patients are monitored with yearly scans monitored with yearly scans (for example, yearly CT scans). (for example, yearly CT scans). These patients will be These patients will be evaluated further using evaluated further using endoscopic ultrasound with endoscopic ultrasound with possible fine needle aspiration possible fine needle aspiration if the cysts grow in size and/or if the cysts grow in size and/or cause symptoms.cause symptoms.

• 3. Pancreatic cysts larger than two 3. Pancreatic cysts larger than two cm in young, healthy individuals cm in young, healthy individuals usually are treated with surgical usually are treated with surgical removal, especially if the cysts removal, especially if the cysts produce symptoms.produce symptoms.