The most important aspect of management of pancreatic cysts is the determination of whether a cyst is benign (and usually needs no treatment) or is cancerous and must be removed.
The second most important aspect of management is to determine whether a patient with a precancerous or cancerous pancreatic cyst is a suitable surgical candidate. In medical centers experienced in performing pancreas surgery, surgical removal of precancerous or cancerous cysts has a high rate of cure.
There are not yet standard recommendations for managing pancreatic cysts. Different medical centers have adopted different approaches to diagnosis and treatment. Management decisions must be individualized for each patient after discussions with a doctor familiar with the patient's health status. The following is one example of how a doctor may manage pancreatic cysts.
- Pancreatic pseudocysts need treatment if they persist beyond six weeks after acute pancreatitis, especially if they become infected or are large enough to cause obstruction of the stomach or common duct or cause abdominal pain.
- Small pancreatic cysts (for example, cysts smaller than two cm) will have little chance (3.5%) of being cancerous and can be observed. Nevertheless, even these small cysts can grow and turn cancerous in the future. Thus, these patients are monitored with yearly scans (for example, yearly CT scans). These patients will be evaluated further using endoscopic ultrasound with possible fine needle aspiration if the cysts grow or cause symptoms.
- Pancreatic cysts larger than two cm in young, healthy individuals usually are treated with surgical removal, especially if the cysts produce symptoms.
- Pancreatic cysts larger than two cm in elderly patients can be studied with endoscopic ultrasound and fine needle aspiration. If fluid cytology and CEA measurements suggest cancerous or precancerous changes, the patients can be evaluated for pancreatic surgery.
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