The reassuring news is that most pancreatic cysts are not cancer, and many IPMNs can be safely monitored rather than treated with surgery. The key is determining what type of cyst is present and whether it has features suggesting a higher risk of future change.
The pancreas produces digestive juices that travel through small ducts into the bowel. An IPMN is a growth arising from the cells lining these ducts. It produces a thick fluid called mucin, which can cause a duct or one of its side branches to expand and appear cyst-like on a scan.
IPMNs are divided into three groups:
Branch-duct IPMNs are the most commonly encountered and are often low risk. Main-duct and mixed-type IPMNs generally require closer assessment because they carry a greater chance of containing significant precancerous change or cancer.
Pancreatic cysts are increasingly found because MRI and CT scans are now used so frequently. A large systematic review found pancreatic cysts on MRI in approximately 16% of people overall. Their frequency rose with age—from about 9% in people aged 50–59 to 26% in those aged 70–79. Most were small and did not have concerning features.
IPMNs are among the most common pancreatic cysts. However, their true incidence is difficult to measure because most do not cause symptoms and are discovered incidentally during a scan performed for another reason.
Routine pancreatic screening is not recommended for the general population. Most IPMNs are found unexpectedly.
Once an IPMN has been identified, however, surveillance may be recommended. This is different from screening an otherwise healthy person: surveillance means periodically checking a known cyst for changes.
People with a strong family history of pancreatic cancer or certain inherited genetic syndromes may qualify for pancreatic cancer screening program. These programs commonly use MRI and endoscopic ultrasound and should be organised through clinicians experienced in assessing inherited pancreatic cancer risk. For more information on high-risk pancreatic cancer screening, visit the APRISE (Australian Pancreatic High-Risk ScrEening (APRISE) Study) website.
MRI with magnetic resonance cholangiopancreatography, usually shortened to MRI/MRCP, is commonly used because it provides detailed images of the cyst and pancreatic ducts without radiation. A specialised pancreas-protocol CT scan may also be useful.
Endoscopic ultrasound, or EUS, involves passing a thin flexible camera through the mouth into the stomach and small bowel. An ultrasound probe on the tip provides detailed views of the pancreas. In selected cases, a small fluid sample can betaken from the cyst for laboratory testing and cell analysis.
Blood tests, including the tumour marker CA19-9 and tests for diabetes, may provide additional information. However, these blood tests cannot diagnose pancreatic cancer by themselves.
Pancreatic cyst management is rarely based on cyst size alone. The cyst’s position, connection to the pancreatic duct, growth rate, internal appearance, symptoms and the patient’s overall health all matter. Surgery can prevent cancer in carefully selected patients, but pancreatic surgery is major surgery and should not be recommended unnecessarily.
In our private practice, complex pancreatic cysts are reviewed through a specialised multidisciplinary team, involving pancreatic radiologists, pancreatic surgeons, gastroenterologists, medical oncologists and radiation oncologists. This allows the imaging, endoscopic findings and individual clinical circumstances to be considered together, with a clear recommendation for surveillance, further testing or surgery.
An IPMN deserves appropriate assessment, but it is not the same as pancreatic cancer. Most small branch-duct IPMNs remain stable and can be monitored safely. The goal is to identify the small number showing meaningful warning signs while avoiding unnecessary procedures or surgery for low-risk cysts.
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