ASGE Adult and Pediatric Gastroenterology and Endoscopy Board Preparatory and Review Course | 2022-Anna T_Pancreatic cystic neoplasms and adenocarcinoma

Anna T_Pancreatic cystic neoplasms and adenocarcinoma

Pdf Summary

Pancreatic Cystic Neoplasms and Pancreatic Adenocarcinoma<br /><br />Pancreatic cysts are commonly detected during imaging for non-pancreatic indications, with a prevalence of 2.4-13% in asymptomatic individuals. Most cysts do not progress to cancer, but some are precursors of pancreatic adenocarcinoma. The cancer risk for different types of cysts varies. The risk of cancer conversion per year is 0.24% for all pancreatic cysts, 0.72% for intraductal papillary mucinous neoplasms (IPMNs) only, 7.7% at 10 years for low-risk IPMNs, and 24.6% at 10 years for high-risk IPMNs.<br /><br />Mucinous cystic neoplasms include IPMNs and mucinous cystadenomas. Side-branch IPMNs are the most common incidentally found cysts and are often not associated with an increased risk of malignancy. Main duct IPMNs have a higher risk of cancer and are characterized by patulous/fish mouth papilla. IPMNs with worrisome features, such as cyst size ≥ 3 cm or thickened enhanced cyst walls, require further evaluation. High-risk IPMNs with features like obstructive jaundice or a main pancreatic duct size ≥ 10 mm may warrant surgical resection.<br /><br />Mucinous cystadenomas are characterized by ovarian stroma, and the risk of cancer is lower than previously thought. Surveillance, EUS-FNA, and surgical resection may be recommended based on guidelines for IPMNs.<br /><br />Pancreatic adenocarcinoma, with a low 5-year survival rate of 10%, presents with symptoms such as obstructive jaundice, abdominal pain, weight loss, and fatigue. EUS-FNA is a sensitive and accurate method for diagnosing pancreatic cancer. Treatment options for obstructive jaundice caused by pancreatic cancer include ERCP with self-expanding metal stent (SEMs) placement, which has better outcomes than plastic stents. Neoadjuvant chemotherapy is now recommended for resectable pancreatic cancer.<br /><br />In summary, the management of pancreatic cystic neoplasms and pancreatic adenocarcinoma involves surveillance, EUS, surgical resection, and multidisciplinary approaches to improve patient outcomes.

Keywords

Pancreatic Cystic Neoplasms

Pancreatic Adenocarcinoma

Pancreatic cysts

Cancer risk

Intraductal papillary mucinous neoplasms

Mucinous cystic neoplasms

IPMNs

Mucinous cystadenomas

Obstructive jaundice

EUS-FNA