Hans Gerdes (center), Director of the Gastrointestinal Endoscopy Unit, is one of many specialists who evaluate pancreatic cysts.
When you come to Memorial Sloan Kettering with a diagnosis of a possible pancreatic cyst, we’ll start by reviewing your medical information and results from imaging tests, if you have any. We’ll also ask whether you have a family history of pancreatic or other gastrointestinal cancers such as stomach, gallbladder, or liver cancer. This can make a difference in the risk of the cyst becoming cancerous over time.
Additional tests to further evaluate the cyst may include:
These blood tests can help us determine whether your cyst is benign (noncancerous) or precancerous:
CA19-9: This test measures the level of a protein in the blood or cyst fluid that may be higher if a cyst is precancerous. The test isn’t precise, however, since the CA19-9 level can rise in response to noncancerous conditions such as pancreatitis.
Carcinoembryonic Antigen (CEA): This test measures the amount of the protein in the blood or (better) from fluid taken from a pancreatic cyst during an endoscopic ultrasound. Results may help in determining if a cyst is precancerous.
Liver (hepatic) function: This test measures the level of a waste product created in the liver called bilirubin levels of liver enzymes that can rise when a cyst or tumor blocks the bile duct.
Imaging tests that can help in evaluating a pancreatic cyst include:
Computed Tomography (CT) Angiography/Triphasic CT scan: This test can help confirm or evaluate the location and size of a pancreatic cyst without requiring a cut in the skin. An injection of a special dye before scanning creates an image of the pancreas and nearby blood vessels, reducing how much radiation is needed to complete the scan.
Magnetic Resonance Imaging (MRI)/MRCP: This test can help us learn more about a cyst’s size and structure. We may use an MRI test called an MRCP to see inside the pancreas ducts, where cysts sometimes start.
Endoscopic ultrasound (EUS): With this procedure, we put a thin tube with a light at the end, called an endoscope, into your mouth and down into your stomach while you’re under anesthesia. We can get detailed images of the pancreas by way of an ultrasound probe at the endoscope’s tip that emits sound waves.
In addition to blood tests and imaging tests, we may recommend you have a biopsy. This test involves our pathologists taking a sample of the pancreatic cyst tissue to examine carefully. A biopsy is done at the same time as an endoscopic ultrasound.
To perform this procedure, we insert a thin needle into an endoscope and use ultrasound images to guide the needle into the cyst and remove fluid and cells. The Carcinoembryonic Antigen (CEA) blood test can be done at the same time to help identify the presence of a pancreatic cyst, and the pathologist can then analyze this tissue under a microscope to see what kind of cells are there.
Experts in Diagnosing Pancreatic Cysts
In addition to providing expert imaging services, MSK pathologists are leaders in analyzing fluid in pancreatic cysts and determining if — and what type of — cancer cells might be present.
Most pancreatic cysts are benign (noncancerous) and unlikely to cause you any harm. Our multidisciplinary team of specialists will review your test results together at our weekly meeting and collaborate to develop a plan customized for you, whether you have a benign pancreatic cyst or a cyst that might benefit from treatment.