Key takeaways:
Being diagnosed with IPMNs often comes as a surprise because IPMNs are usually discovered during a screening for something unrelated to the pancreas.
The diagnosis of an IPMN may feel overwhelming, especially when research via “Dr. Google” mentions how it can relate to pancreatic cancer.
However, it’s important to remember that while pancreatic cysts associated with IPMN can turn into pancreatic cancer, the prevalence of pancreatic cancer associated with IPMN is relatively low. Also, early detection and diagnosis can lead to effective treatment that offsets the risk of malignancy.
Increased awareness of invasive IPMN has enabled pancreatectomies (surgical removal of the pancreas) to be performed at an earlier stage, similar to common pancreatic cancer.
Intraductal papillary mucinous neoplasms of the pancreas (IPMN) are cysts or fluid-filled sacs found in the pancreas.
These types of cysts are benign, which means they are not cancerous. However, in 1%-11% of patients, an IPMN can be aggressive and develop into pancreatic ductal adenocarcinoma, a lethal form of pancreatic cancer. These tumors usually become invasive cancer, move into the lymph nodes, and are difficult to treat.
Even though they’re benign, don’t ignore IPMN. Schedule and attend follow-up appointments as your medical practitioner recommends.
Your pancreas is an organ in your abdomen that is located behind your stomach and directly connected to other major organs in your digestive tract.
A key part of your digestive system, your pancreas produces hormones that regulate various bodily functions and digestive enzymes that help your body process food.
There are four main parts of the pancreas:
The pancreas has a main duct, sometimes referred to as the main pancreatic duct, which has several branches. The digestive enzymes produced by your pancreas move through the branches, into the main duct, and into the duodenum (small intestine).
As previously mentioned, the pancreas also produces essential hormones vital to many digestive and metabolic processes. Some of these hormones include insulin and glucagon. Both are important for regulating your blood sugar levels.
There are many acronyms associated with IPMN. Use this list as a handy reference whenever these terms come up during your appointments:
A cyst is a formation of cells that make a sac. The sac may be filled with fluid, air, or solid material.
There are various types of pancreatic cysts, tumors, and lesions. These include the following:
There are different types of pancreatic cysts, but the most prevalent two are serous and mucinous. These are different from IPMNs.
An IPMN is a mucinous cyst characterized by its viscous fluid. IPMNs develop inside the main pancreatic duct and its branches. Some IPMNs reach out into the pancreatic duct system or branches of the duct. These are called branch duct IPMN.
All types of pancreatic cysts are typically found when patients receive abdominal imaging for other reasons. For example, a radiologist could see a pancreatic cyst when they’re looking at a gastric ulcer.
A study done by Johns Hopkins showed that, as we age, we are more susceptible to pancreatic cysts. This same study also found that many people (2.6%) who had IPMNs were asymptomatic.
One study published by Roberto Salvia and Claudio Bassi, among others in the American Journal of Gastroenterology, looked at the environmental, personal, and hereditary risk factors associated with the occurrence of IPMN.
They found that people with a history of diabetes and insulin treatment, a family history of pancreatic ductal adenocarcinoma (PDAC), or chronic pancreatitis (CP) have an increased risk factor for IPMN.
Usually, people are unaware that they have an IPMN because there aren’t any signs or symptoms.
When an IPMN does present symptoms, they’re often similar to bile duct disorders. Sometimes, people with an IPMN will develop acute pancreatitis, and the uncomfortable symptoms may prompt them to see their medical provider.
Some symptoms could be caused by many conditions, so it might be hard to connect them to IPMNs. These include:
IPMNs are usually put into one of two categories:
IPMNs with no associated invasive cancer are placed into one of two subtypes:
Dysplasia means the cell’s state is abnormal. In some cases, this might mean that the cell is pre-cancerous.
Over time, IPMNs may progress from low-grade to high-grade dysplasia. In the case of HGD, the disease may progress to invasive cancer.
IPMNs are further evaluated and classified according to their location in the pancreas:
IPMNs need to be classified to help make decisions around treatment.
Many tests can help look for an IPMN or monitor one once it’s found.
Your medical provider might do a blood test to see if you have some of the markers of IPMN like jaundice, elevated white blood cells, abnormal levels of pancreatic and liver enzymes, or a tumor marker (CA 19-9), which is expected to show up in biliary tract disorders.
This non-intrusive screening test can reveal a narrowing within the common bile duct, which is a marker of IPMN.
A CT scan or abdominal MRI can identify narrowing within the biliary tract. Both scans are noninvasive procedures, during which the bile duct images are shown on a computer monitor.
This endoscopy procedure involves a fine, flexible tube inserted into the small intestine known as your duodenum. From there, the ultrasound transducer can create detailed pictures of your pancreas and nearby abdominal organs.
In some cases, a biopsy and endoscopy might be done to take a tissue sample. According to international guidelines in pancreatology, it is necessary for all BD-IPMNs that present specific “worrisome features” to have an endoscopic ultrasound-guided fine-needle aspiration.
An MRCP is a non-intrusive screening test that uses a strong magnetic field to look at your pancreas, liver, gallbladder, and bile ducts. This test may show if the bile ducts are obstructed, as they might be by a suspected IPMN.
Usually, observation is the only action taken for IPMNs. They are most often not considered to be at high risk for developing cancer.
Your medical provider will watch for IPMN growth by doing tests at regular intervals—every three months for larger cysts and annually for smaller branch IPMNs.
If there is a concern about invasive IPMN evolving into cancer, the only treatment is to remove part of the pancreas or, rarely, the entire pancreas. Since treatment typically involves surgery, the risks of treatment need to be weighed carefully against the possibility of cancer.
IPMNs of the main duct might be candidates for surgery more often than those found only in the branches. This is because IPMNs within the ductal branches are more difficult to treat and have been found to be less aggressive than main duct IPMNs.
There are three common types of pancreatic surgery to treat IPMNs:
This surgery removes a section from the pancreas body and from the tail of the pancreas, which is the part of the pancreas that is closest to the spleen. In some cases, your surgeon might also remove the spleen.
Usually, enough of the pancreas is left that pancreatic function (the production of enzymes and hormones) will not be affected.
Also called the Whipple procedure, this surgery removes the head of the pancreas when it contains IPMNs. Sometimes the duodenum, part of the bile duct, the gallbladder, and part of the stomach is removed as well.
This is the procedure to remove the entire pancreas. Likewise, your surgical team will also remove the spleen, part of the stomach, and a portion at the beginning of the small intestine.
This type of surgery is very rarely performed for IPMNs and only if the IPMN goes throughout the entire main duct. If the whole pancreas is removed, the stomach will need to be connected to the remaining section of the small intestine for digestion.
The pancreas is responsible for essential body functions related to our digestive and endocrine systems. An IPMN is one of several actionable conditions that could happen to your pancreas.
IPMN causes pancreatic inflammation or pancreatitis. When this occurs, the cells that line our pancreatic duct (the area responsible for shuttling digestive enzymes to the duodenum) can become premalignant. In other words, there is a chance these cells could spiral into pancreatic cancer, a notoriously brutal type of cancer.
Most often, pancreatic cysts are not cancerous and can be readily managed, preventing cancer.
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