Consultation: Anne Marie Lennon
Date: January 3, 2011
If you’re a specialist in pancreatic cysts, three facts currently drive your work: The number of patients with cysts has massively increased of late. The growths can vary pathologically, making diagnosis dicey. They differ in potential for malignancy. Oh, there’s another: One type of cyst—the intraductal papillary mucinous neoplasm, or IPMN—is so relatively new to the field that fine points of diagnosis and treatment are still being worked out.
“All this has convinced us of the need for a specialty clinic,” says gastroenterologist Anne Marie Lennon, “with access to the disciplines that a large academic institution can provide.” So the new Johns Hopkins Multidisciplinary Pancreatic Cyst Center pools the expertise of dedicated pancreatic endoscopists, like Lennon, pancreatic surgeons and specialists in pancreatic cyst pathology. Also included are experts in CT and in MRI imaging of the cysts.
We’ve asked Lennon to elaborate.
Most pancreatic cysts are “pseudocysts” and not so difficult to diagnose. The rest can be harder, you say:
Yes. We need to distinguish which are benign and don’t need follow-up unless they’re symptomatic, from the smaller number that have a potential to develop cancer. We’re particularly interested in IPMNs.
Several reasons. As a field, we’re still on a learning curve with IPMNs. We know they can affect the main duct of the pancreas, the branch duct or both. The location is a concern. IPMNs in the main duct have up to a 70 percent risk of adenocarcinoma and require surgery. The branch duct, however, is more of a problem because the cancer risk, while it exists, is lower. If the cyst is in the tail of the pancreas and looks suspicious, we counsel having it removed via a distal pancreatectomy, a low-risk procedure. If, however, it arises in the head of the pancreas, the required surgery is a Whipple. And though Hopkins statistics for that are superb—less than 2 percent mortality—
we know that particular surgery isn’t something you’d take on lightly, especially for the high proportion of older patients with these cysts.
What might help?
Two things. We need more information about which cysts harbor or may develop malignancy. So we’re working with a group of basic scientists here at Hopkins to find a biomarker to tell us who should go to surgery. The group includes molecular biologist Burt Vogelstein, who’s known for his work on sentinel colorectal cancer genes. Also, we’ve begun a large, prospective pancreatic cyst study (see box) that should give us answers about disease course and best imaging practices.
To learn more about the clinic, check this site: http://www.path.jhu.edu/pancreas/cyst/Whattoexpect.php