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Tests and diagnosis
By Mayo Clinic staffPancreatic cysts are diagnosed more often now than in the past, but not because more people have them. Instead, improved imaging technology has made pancreatic cysts easier to find. In fact, many pancreatic cysts are found during abdominal scans for other problems.
The biggest challenge of the diagnostic process is determining whether the pancreatic cyst is cancerous or not. The following tests are often used to help with diagnosis and to help plan treatment:
- Medical history. A previous history of pancreatitis or abdominal injury typically is an indication of a pseudocyst.
- CT scan. A CT scan of your pancreas combines a series of X-rays from different angles to give your doctor detailed information about the structure of a pancreatic cyst. It can sometimes help differentiate cancerous cysts from noncancerous ones.
- MRI scan. An MRI scan, which uses a magnetic field and radio waves to create images, can highlight subtle details of a pancreatic cyst structure, including whether there are any solid components to the cyst.
- Endoscopic ultrasound. Your doctor may also order an endoscopic ultrasound to visualize the cyst and to obtain fluid from the cyst for analysis. In this study, a thin flexible tube (endoscope) is passed through your mouth and into your stomach and upper small intestine. The endoscope is equipped with a small ultrasound probe used to obtain images of the cyst, and with a needle to obtain fluid from the cyst.
- Cyst fluid evaluation. Fluid taken from a cyst is examined in a laboratory for possible signs of cancer. One such sign, or marker, is a substance called carcinoembryonic antigen (CEA). Elevated levels of CEA in the fluid sample are suggestive of cancer.
In some cases, the characteristics and location of the cyst in your pancreas — along with your age and sex — can help doctors pinpoint what type of cyst you have.
- Serous cystadenoma. This growth can become large enough to displace nearby organs, causing such symptoms as abdominal pain and a feeling of fullness. Serous cystadenomas occur most frequently in middle-aged women and become cancerous only rarely.
- Mucinous cystadenoma. This type of cyst is usually located in the body or tail of the pancreas and occurs most often in middle-aged women. It's precancerous and may already be cancerous when discovered. Larger cysts are more likely to be cancerous.
- Mucinous duct ectasia. More common in men, this type of cyst consists of dilated ductal segments, usually within the head of the pancreas. Also known as an intraductal papillary mucinous tumor, this type of growth is usually precancerous or cancerous.
- Papillary cystic tumor. A papillary cystic tumor — also known as a papillary cystic neoplasm, or solid and pseudopapillary neoplasm — occurs most often in young women and is usually located in the body or tail of the pancreas. It's usually cancerous.
- Cystic islet cell tumor. This type of pancreatic tumor is mostly solid but can have cyst-like components. It may be confused with other pancreatic cysts.
- Scheiman JM. Management of cystic lesions of the pancreas. Journal of Gastrointestinal Surgery. 2008;12:405.
- Pitman MB, et al. Pancreatic cysts: Preoperative diagnosis and clinical management. Cancer Cytopathology. 2010;118:1.
- Steer ML. Cystic lesions of the pancreas. http://www.uptodate.com. Accessed May 14, 2010.
- Pancreatic cysts. National Pancreas Foundation. http://pancreasfoundation.org/2010/04/pancreatic-cysts/. Accessed May 16, 2010.
- Garcea G, et al. Cystic lesions of the pancreas: A diagnostic and management dilemma. Pancreatology. 2008;8:236.
- Habashi S, et al. Pancreatic pseudocyst. World Journal of Gastroenterology. 2009;15:38.
- Khalid A, et al. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. American Journal of Gastroenterology. 2007;102:2339.
- Jacobson BC, et al. ASGE guideline: The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointestinal Endoscopy. 2005;61:363.
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