Pancreatic Cyst: Causes, Symptoms & Treatment

Pancreatic cysts are abnormal growths in the pancreas. Such growths occur in blister form. A distinction is made between pseudocysts and true cysts. They can be removed without the need for surgery.

What is a pancreatic cyst?

True cysts are made of epithelium. Epithelium is one of the four basic types of tissue found in many different places in the body and is completely normal. Epithelium does not contain blood vessels or pancreatic enzymes such as lipase and amylase and is made up of very small, densely packed cells. True cysts occur less frequently than pseudocysts. There are three different forms of true cysts: the so-called congenital cysts are congenital, i.e. hereditary, cysts. Retention cysts tend to occur in chronic pancreatitis and form from constrictions and protrusions of pancreatic ducts. The third type, known as neoplastic cysts, consist of tumor tissue and can only be distinguished from pseudocysts by close examination and removal of tissue. They cannot be assessed by imaging techniques such as sonography.

Causes

Pseudocysts, which result from injury to the pancreas or from acute pancreatitis, are bounded by scar-like tissue. They contain pancreatic enzymes (lipase and amylase) that ensure that pancreatic tissue can digest itself. Inside them is serum or blood sometimes in association with dead tissue. Pancreatic cysts can be hereditary in some cases. True cysts are either congenital, arise from chronic pancreatitis, or form from elevations of the pancreas.

Symptoms, complaints, and signs

A pancreatic cyst is initially manifested by nonspecific symptoms such as fatigue, fever, or gastrointestinal symptoms. Affected individuals suffer increased nausea and vomiting or bloating. Often there is also vomiting of blood. This is accompanied by severe pain in the abdomen, which can radiate to the back and abdomen. Larger cysts cause abdominal pain up to cramps and colic. If the cysts have metastasized to the abdomen, this can be detected by the palpable growths. In individual cases, a pancreatic cyst runs completely symptom-free. The patient only notices the tumor in the late stages, when pressing pain, abdominal cramps and external signs such as ascites develop. An untreated pancreatic cyst can lead to sepsis. This is manifested by rising fever, severe pain and lassitude, among other symptoms. If the bile duct is squeezed off, jaundice may develop, manifested by exhaustion and fever, as well as yellowing of the skin and conjunctiva of the eyes. In addition, malignant pancreatic cancer may develop from the cyst. The symptoms of pancreatic cyst develop gradually, often over the course of weeks or months. By the time the sufferer notices the condition, the cyst is often well advanced.

Diagnosis and progression

Signs of a pancreatic cyst may include nonspecific symptoms such as general weakness, weakness of the heart, bloating, fainting, chills, fever, vomiting and nausea, vomiting blood, pain in the back to clouding of consciousness. In larger cysts, it is not uncommon for abdominal pain to occur, even colic. In some cases, pancreatic cysts develop into tumors that can also be palpated through the abdomen. In many cases, however, there are no symptoms at all. In most cases, pancreatic cysts can be detected by sonography. Sometimes computed tomography, ERCP, or angiography is necessary. In the case of injury to the pancreas, lipase and amylase can be determined by abdominal lavage, a procedure known as lavage.

Complications

If a pancreatic cyst exists in the pancreas, it can sometimes result in serious complications. The risk is considered particularly high if the pseudocyst is acute or takes on a pronounced circumference. Among the most common sequelae of the pancreatic cyst are infections. These not infrequently cause abscesses. These are encapsulated cavities filled with pus. There is also an increased risk of peritonitis.A concomitant symptom is the development of a so-called water belly, which is caused due to a massive accumulation of fluid in the abdominal cavity. In this case, doctors speak of ascites. Furthermore, the infections can lead to life-threatening blood poisoning (sepsis). Bleeding is another common complication. In the worst case, the bleeding causes a drop in hemoglobin, which in turn has acute life-threatening effects. Obstructive cholestasis is also one of the sequelae of pancreatic cysts. If compression of the bile duct occurs, a pancreatic pseudocyst located in the head of the pancreas sometimes causes jaundice (icterus). In addition, the gallbladder bulges. In medicine, a bulging gallbladder accompanied by painless jaundice is also suspected to be a pancreatic tumor (pancreatic cancer). Another worrisome complication of pancreatic cyst is the development of pancreatic cancer. Thus, the risk of pancreatic cyst malignancy increases with age.

When should you see a doctor?

Recurrent colic, swelling in the upper abdomen, and pain indicate a pancreatic cyst. A visit to the doctor is advised if symptoms do not resolve on their own within a week. If the symptoms become more severe or additional symptoms develop, it is best to call the doctor immediately. The same applies to serious complications such as fever or attacks of pain. Then the family doctor should be called in immediately. Bleeding, abscesses and signs of icterus are also serious warning signs that should be clarified immediately by a doctor. It is best for those affected to call the emergency services so that treatment can be initiated as quickly as possible. People who eat an unhealthy diet or generally lead an unhealthy lifestyle with an unbalanced diet and little physical activity are particularly at risk of developing a pancreatic cyst. People with previous illnesses such as pancreatic cancer or necrosis in the area of the pancreas are also at risk and should have the symptoms mentioned clarified by a doctor immediately. A pancreatic cyst is treated by a primary care physician or a gastroenterologist. Nutritionists as well as physiotherapists may be consulted during treatment. Follow-up care is provided by the gastroenterologist and later by the primary care physician. In case of unusual symptoms, the responsible physician must be informed. In severe disease, treatment at a pancreatic center is indicated.

Treatment and therapy

If cysts develop as a result of pancreatitis, close observation of the unwanted growth is initially indicated. In many cases, the cysts regress on their own and disappear after some time without causing further discomfort. If the patient complains of discomfort due to the cyst, drainage can be performed. In this case, a hole is cut through the duodenum or stomach through which a gastroscope can be inserted. Such a hole is kept open by a stent, a special plastic tube, and the fluid inside the cyst can then gradually drain away. Usually it takes no more than three months for the cyst to empty, for the outer walls of the cyst to stick together and for it to disappear. Only after this process the plastic tube can be removed. In rare cases where a cyst is filled with pus, it must be drained using an endoscope. This also allows removal of dead tissue that may be inside the cyst. Thanks to the procedure using the stent or a gastroscope, it is not necessary to remove a cyst by surgery. However, the treatment of pancreatic cysts can lead to complications such as unwanted bleeding or the formation of abscesses. It is also possible to have obstruction of the duodenum or jaundice. Full recovery of the patient after treatment of a pancreatic cyst is reported to have about a 60 percent chance of success.

Outlook and prognosis

With the use of medical care, the prognosis for a pancreatic cyst is favorable. The cyst can be completely removed in surgery or by other less risky techniques. Immediately after wound healing, the affected person can be discharged from treatment as cured. The challenge is to diagnose the disease.Often the cyst remains unnoticed for a longer period of time, as it usually causes no or only a few diffuse symptoms. However, as soon as the diagnosis is established, removal of the unwanted tissue should be performed. Otherwise, an unfavorable course of the disease may lead to the development of a life-threatening situation. Bleeding in the area of the pancreas is possible, which can lead to complications and severe health changes. In addition, there is a risk that mutation of the tissue may take place. In these patients, the otherwise favorable prognosis is significantly worsened. In fact, the expected lifespan may be shortened. Therefore, if medical care is refused, the outlook of the affected person changes considerably. The earlier the diagnosis is made, the better the further course. Despite an achieved recovery and freedom from symptoms, a new formation of the cyst can occur at any time over the lifespan. The prognosis remains unchanged even in these cases.

Prevention

There are no direct preventive measures against pancreatic cysts. Doctors solely recommend a healthy lifestyle through a high-fiber diet and plenty of exercise and physical activity.

Follow-up

The person affected by a pancreatic cyst should see a doctor early on to avoid other complications or further worsening of symptoms. The sooner a doctor is contacted, the better is usually also the further course of the disease, since a self-healing in this disease usually can not occur. At the same time, the measures and the possibilities of direct aftercare for a pancreatic cyst are also relatively limited. The complaint itself can be relatively well alleviated by a minor surgical intervention. In most cases, this does not lead to further complications or to other complaints. The affected person should take care of his stomach and intestines after such an operation and avoid fatty food. Only after some time can the diet be adjusted again. As a rule, regular checks and examinations by an internist are still very important after the operation in order to detect and treat further complaints at an early stage.

What you can do yourself

Sufferers of a pancreatic cyst are often in a state of great concern and excitement. For a cyst that measures less than 2 cm, the patient helps himself or herself most by remaining calm. If the diagnosis arose from an incidental finding and no other symptoms are present due to their presence of the cyst, there is usually little cause for concern. Stress, internal excitement and hectic activity should be avoided. They reduce well-being and lead to psychological problems. It can be helpful to use various relaxation techniques to achieve inner balance. A cyst can mutate into a malignant tumor at any time. Nevertheless, the probability is very low with a small pancreatic cyst. Since there is a possibility that a small cyst may detach on its own in the further course and be carried away by the organism, further observation should take place for the time being. Regular MRI checks and good self-awareness are important in these situations. If the affected person notices changes or has a feeling of illness, he or she should initiate a check-up visit with a physician. Comprehensive information about the disease is important so that the patient can make good and correct decisions for himself in the further course. In addition, the organism should be strengthened and supported by a balanced diet and sufficient exercise.