Where to Turn When the Pancreas Sprouts a Cyst
Date: April 1, 2013
In some cases, a pancreatic cyst can be completely benign. In others, it can be a precursor to cancer. The problem, says pancreatic surgeon Chris Wolfgang, is figuring out which is which.
Often, when a physician discovers a pancreatic cyst, it’s unintentional—the result, perhaps, of a CT scan or MRI ordered for unrelated reasons, such as to uncover the cause of abdominal pain. From there begins the journey to determine whether the cyst is dangerous or benign.
Enter the Multidisciplinary Pancreatic Cyst Team at The Johns Hopkins Hospital. With six surgeons, a gastroenterologist and experts in imaging and pathology, the team is among the first in the country assembled specifically to diagnose, study and treat pancreatic cysts. “In the past, pancreatic cysts were often either ignored or undertreated, or patients got an operation they didn’t need,” says Wolfgang, the team’s director as well as co-director of the Pancreatic Cancer Multidisciplinary Clinic. “But since 1996, we’ve learned a lot about the different kinds of cysts. They’re not all the same. There’s a certain category of cyst that can be a precursor to benign carcinoma.”
Called intraductal papillary mucinous neoplasms, or IPMNs, these potentially malignant cysts carry a 45 to 70 percent risk of becoming cancer. “That risk is considered unacceptable,” says Anne Marie Lennon, a gastroenterologist on the cyst team. “If we know that a patient has a precancerous cyst, we’ll try to work out exactly what kind of cyst it is, how high the risk of cancer is and whether the patient should undergo surgery.”
With advancements in CT and MRI technology, physicians have recognized that pancreatic cysts are more common than ever before realized—they were just harder to find and, thus, less frequently diagnosed. Although today’s increased awareness leads to better detection, it also leaves patients and physicians with the challenge of determining whether to wait and see what happens with the cyst or to undergo an extremely invasive operation.
Fortunately, for patients who turn to the Multidisciplinary Pancreatic Cyst Team, that decision isn’t made in a vacuum. “Our patients get the opinions of not just me, but all of my colleagues,” Lennon says. “We discuss every case together, which allows the entire group to weigh in. You have a great breadth of experience. There’s very good evidence that your care will be much better in a multidisciplinary clinic.”
Since the clinic opened in 2010, the team has treated more than 500 patients. For most patients, a visit involves meeting with a physician who gathers the medical history and conducts a physical, and undergoing high-quality CT and MRI scans. Then the team meets to discuss what the most appropriate treatment plan would be.
“It’s more convenient for them, because they’re not running around getting different tests,” Wolfgang says. “It’s also very reassuring because they’re getting the advantage of so many expert opinions. If surgery is recommended, they know they’re not getting a useless operation.”