Cysts that grow on or within the pancreas are quite common. Most do not cause symptoms nor are they cancerous. The most common of these growths is the pseudocyst, a benign fluid-filled sac containing pancreatic enzymes. They often are discovered incidentally when patients undergo imaging tests such as a CT scan or abdominal ultrasound for other reasons. Virginia Mason gastroenterologists, surgeons, medical oncologists, interventional radiologists and others are recognized internationally for treatment of pancreatic disorders, including cysts and pseudocysts. For more information or to schedule an appointment, call (206) 223-2319.

• Symptoms of Pancreatic Cysts
• Diagnosing Pseudocysts
• Treating a Pseudocyst

Symptoms of Pancreatic Cysts

Pseudocysts often cause no symptoms but when they do your gastroenterologist will want to test it to rule out a precancerous or cancerous growth. Common symptoms include:

• Abdominal pain (from pressing on organs) that may radiate to the chest and upper back
• Nausea and vomiting
• A growth that can be felt within the upper abdomen

Serious Complications

A pseudocyst can become infected and cause intense abdominal pain, fever and a rapid pulse. A cyst also may burst and release pancreatic enzymes all at once. When this situation occurs, the enzymes can damage blood vessels and cause internal bleeding. Both infected and ruptured pseudocysts are medical emergencies that should be seen in the emergency department at once.

Diagnosing Pseudocysts

Your gastroenterologist may suspect a disorder of the biliary tract, including a growth on or within the pancreas, based on your medical history and a description of your symptoms. Common tests and procedures available to aid in the diagnosis include:

• BLOOD TESTS
  Your blood may be tested for abnormal levels of pancreatic enzymes that aid in digestion.
   
• ABDOMINAL ULTRASOUND
  This non-invasive procedure uses sound waves rather than X-rays to produce images. The images can reveal the presence of blockages within the biliary tract. During this procedure, an ultrasound probe is passed over the abdomen and images are sent to a computer monitor. Abdominal ultrasound is commonly used in women who are pregnant.
   
• ABDOMINAL CT SCAN OR MRI A CT scan or MRI of the abdomen also can identify blockages within the biliary system. Both scans are noninvasive procedures, during which the bile duct images are shown on a computer monitor.
   
• ERCP WITH ENDOSCOPIC ULTRASOUND
  Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the gallbladder, pancreas and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 30 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.
   
  Your gastroenterologist can treat a bile duct disorder at the same time it is being diagnosed by passing miniaturized instruments through the ERCP. During ERCP, patients first receive an anesthetic to numb the throat along with a mild sedative. Your gastroenterologist will then pass a flexible endoscope with a miniature TV camera inside through your mouth and into the stomach and small intestine. When your gastroenterologist sees the pancreas on a monitor, he or she will pass a thin ultrasound probe through the ERCP. Endoscopic ultrasound (EUS) uses ultrasound images in place of X-rays for better viewing of the bile and pancreatic ducts. Your gastroenterologist also may pass a thin needle through the ERCP to take a fluid sample (biopsy).
   
  Special preparations are required for this endoscopic procedure.
   
• MRCP
  Magnetic resonance cholangiopancreatography is newer technology being employed at Virginia Mason. This noninvasive diagnostic procedure is performed in Radiology using MRI technology (magnets and radio waves) to produce computer images of the gallbladder, pancreas and bile ducts. A contrast dye is injected first through the abdominal skin to enhance the images. Patients are not required to undergo endoscopy preparation and they do not undergo sedation. MRCP is being used primarily in patients who may have failed or who are not good candidates for ERCP, in those who do not want to undergo an endoscopic procedure, and in individuals considered to be at low risk of having a pancreatic duct or bile duct disorder. While ERCP allows for therapeutic options with cholangioscopy, MRCP is a diagnostic tool only.
   
  Virginia Mason also is involved in national clinical trials to determine the accuracy of MRCP in diagnosing disorders of the biliary tract.

Treating a Pseudocyst

Most pseudocysts cause no symptoms and are not treated. However, when imaging studies have determined its size and location, your gastroenterologist may request that you have regular follow-up scans performed to monitor its growth. If a pseudocyst is causing symptoms it can be drained or surgically removed.

• ERCP
  In addition to its diagnostic role, endoscopic retrograde cholangiopancreatography (ERCP) is used therapeutically to treat disorders of the biliary tract, including pseudocysts. Once the pancreas is visualized - usually with a contrast dye that produces X-ray images viewed on a monitor - miniaturized surgical instruments are passed through the ERCP. The pseudocyst is then drained or surgically removed. Pseudocyst fluid is tested for the presence of cancer cells and proteins produced by cancer cells.