HWN Suggests

Doctors aim to stop pancreatic cancer before it forms

Seeing a chance to stop one of the most deadly kinds of cancer before it forms, doctors at Johns Hopkins and at other hospitals around the nation are focusing on the common pancreatic cyst. Up to 20 percent of pancreatic cancer begins as one of these small, fluid-filled brown lesions. And left to grow unabated, pancreatic cancer kills 95 percent of sufferers within five years.

"We have a wonderful opportunity to intervene at an early stage," Dr. Anne Marie Lennon, an assistant professor and director of a new Hopkins Multidisciplinary Pancreatic Cyst Program. "We can intervene like we do for polyps in the colon. We remove them and prevent cancer."

Hopkins has long been a center…

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 Should I be worried about a pancreatic cyst?

Cysts of the pancreas — the digestive organ that lies behind the stomach — are typically discovered by accident during a CT scan performed for other reasons. Although most pancreatic cysts are benign (noncancerous), some show features that are worrisome and require further evaluation. Most cysts do not cause symptoms, but very large ones may block ducts in the pancreas and cause pain.

Articles of Interest

Awash in a Multitude of Pancreas Cysts: Can We Stop Looking?

Clinicians have sought to determine the cyst type and risk-stratify patients to pursue surveillance or surgical resection. Despite cross-sectional imaging and endoscopic ultrasound–fine-needle aspiration (EUS-FNA), diagnostic uncertainty remains in approximately one third of cases

Briefly about Pancreatic Pseudocyst

It usually occurs around 4 weeks after an acute attack of pancreatitis, where patient complains of epigastric fullness, pain, nausea and vomiting. If it's infected, there may be fever, rigors and sweating. However, pseudocyst can be also caused by chronic pancreatitis or any pancreatic trauma.

Classification and Management of Pancreatic Pseudocysts

We developed a new classification system for pancreatic pseudocysts based on the anatomical location and clinical manifestations of the pseudocyst as well as the relationship between the pseudocyst and the pancreatic duct. This classification system can guide the selection of optimal treatment for a pancreatic pseudocyst.

Cysts, Pancreatic Disease and Cancer

The link between pancreatic cancer and cysts and other early lesions in the pancreas is an evolving one and an area that is of intense clinical interest. There are many “benign” cysts or cystic lesions that can arise in the pancreas that have no malignant potential. However, there are certain lesions that may go on to become a malignancy.

Diagnosing & Treating Pancreatic Cysts

Treating a pancreatic cyst depends on the size of the cyst, the symptoms it’s causing and if it is cancerous.

Management of Patients With Pancreatic Cysts: Analysis of Possible False-Negative Cases of Malignancy

Guidelines for pancreatic cyst management have been published by several groups.11,12,14,15 The strategy for frankly malignant cysts is clearly one of resection, whereas the management of cysts in the absence of frank malignancy remains challenging.

My Patient Has a Large Pancreatic Cyst. Should I Involve a Surgeon in the Evaluation and Management of This Situation?

Historically, the majority of fluid collections associated with the pancreas have been classified as pseudocysts or inflammatory in nature. During the evaluation of a patient newly diagnosed with a pancreatic cyst, a history of acute pancreatitis is essential to exclude and therefore virtually eliminate pseudocyst from the differential diagnosis. As diagnostic techniques have expanded, many of these previously misclassified fluid collections are now being appropriately diagnosed as a pancreatic cystic neoplasm.

Pancreatic Cysts: Benign, Pre-Cancerous, or Cancerous

There are differing types of pancreatic cysts. Many are technically not cysts at all, but pockets of noncancerous fluid with inflammatory or scar tissue.

Pancreatic pseudocyst

The occurrence of pseudocyst parallels that of pancreatitis and the etiology of pseudocysts resembles the causes of pancreatitis closely, although pseudocyst formation is less common after acute compared to chronic pancreatitis, and it is more common after alcohol-induced than after non-alcohol-related pancreatitis.

Pancreatic Pseudocyst: Therapeutic Dilemma

There is no consensus regarding methods of intervention in pancreatic pseudocyst although there is no controversy with conservative treatment. Minimal intervention with maximal conservative approach remains the most widely acceptable option of therapeutic intervention in pancreatic pseudocyst.

Resources

DiagnosingPancrreaticCysts.com

While not all pancreatic cysts are cancerous, some are, and some, over time, can undergo changes that increase the risk for pancreatic cancer. If you have a pancreatic cyst, it is important to get a timely and accurate diagnosis to confirm whether or not your cyst contains cancer cells so that prompt treatment can occur.

Pancreatic Cyst and Cancer Early Detection Center

The mission of the PCC-EDC is to promote early detection and prevent pancreatic cancer through rigorous identification, tracking and treatment of patients “at risk” for pancreatic cancer through a multidisciplinary screening clinic, registry, community outreach, education and research discovery.

The National Pancreas Foundation

With increasing use of imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI), pancreatic cysts are now being detected with increasing frequency.

Buckeye Surgeon

One of my long time patients came to see me a while back with a complaint of abdominal distention, pain, and early satiety. A few years prior to this visit I had taken care of him during a prolonged bout of severe necrotizing gallstone pancreatitis.

MedicineNet

Many pancreatic cysts are small and benign and produce no symptoms, but some cysts become large and cause symptoms, and others are cancerous or precancerous (Precancerous cysts are benign cysts that have the potential to become cancerous.)

Radiopaedia

Pancreatic pseudocysts are common sequelae of acute pancreatitis or chronic pancreatitis, and the most common cystic lesion of the pancreas. They are important both in terms of management and differentiation from other cystic processes or masses in this region.