Tackling the Pancreatic Cyst
Date: June 28, 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.
The discovery of a pancreatic cyst is often 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.
The Multidisciplinary Pancreatic Cyst Team at The Johns Hopkins Hospital was formed to do exactly that. 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. “Since 1996, we’ve learned a lot about the different kinds of cysts,” says Wolfgang. “They’re not all the same. There’s a certain category of cyst that can be a precursor to benign carcinoma. Intraductal papillary mucinous neoplasms, or IPMNs, for example, carry a 45 to 70 percent risk of becoming cancer.”
“If we know that a patient has a precancerous cyst,” says team member and gastroenterologist Anne Marie Lennon, “we’ll try to work out exactly what kind 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. While the increased awareness leads to better detection, the next determination to be made is whether to wait and see what happens or to undergo an extremely invasive operation.
The Multidisciplinary Pancreatic Cyst Team’s goal is to ensure that the decision is made with a number of experts who can collectively help determine the best and safest course. “We discuss every case together, which allows the entire group to weigh in,” Lennon says. “The patient is offered a much greater breadth of experience than any one of us alone could offer.”
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