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Most pancreatic cysts never become cancer, so doctors watch them and operate only when warning signs appear. The strongest signs, the high-risk stigmata, are jaundice from a cyst in the head of the pancreas, a solid lump inside the cyst that lights up with dye, or a main duct widened to a centimetre or more. Lesser signs, the worrisome features, prompt a closer look with endoscopic ultrasound.
NICE NG85 asks that people with pancreatic cysts have a pancreatic protocol CT or MRI with MRCP (1.1.7), the other test if more information is needed (1.1.8), and referral for resection with any of three high-risk features: obstructive jaundice with a cystic lesion in the head of the pancreas, an enhancing solid component in the cyst, or a main pancreatic duct of 10 mm diameter or larger (1.1.9); endoscopic ultrasound follows CT and MRI when the likelihood of malignancy or the need for surgery is unclear (1.1.10), with fine-needle aspiration and a CEA assay on the fluid alongside cytology when there is enough sample (1.1.11, 1.1.12). The international (Fukuoka 2012 and 2017, Kyoto 2024) guidelines cited on the cyst page use the same high-risk stigmata, with a threshold of an enhancing mural nodule of 5 mm or more and positive cytology, and a longer list of worrisome features: a cyst of 3 cm or more, a thickened or enhancing cyst wall, a main duct of 5 to 9 mm, a nodule under 5 mm, an abrupt change in duct calibre with distal atrophy, lymphadenopathy, a raised CA 19-9, rapid growth, pancreatitis and new-onset diabetes; worrisome features prompt EUS and shorter-interval surveillance rather than immediate surgery. The features are applied to intraductal papillary mucinous neoplasms and to mucinous cystic neoplasms; for MCNs the size (40 mm or more) and nodules predicted malignancy in the resected series (Crippa 2008; Yamao 2011). Two facts frame their use: cysts of 2 mm or more were found on MRCP in 49.1 percent of adults in a German population study, only 6 percent of them over 1 cm, and no cancer arose in five years (Kromrey 2018), so most cysts are trivial; and in the CAPS surveillance cohort 93 percent of the people who progressed to cancer or high-grade dysplasia had had detectable worrisome features first (Canto 2018), so the features work when applied to the right people. The Baltimore consensus (Basturk 2015) sets out the pathology grading behind the terms.
Showing the technology this term belongs to: MRI.
Shares Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting), CA 19-9, CT (computed tomography), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Colloid (mucinous non-cystic) carcinoma of the pancreas, Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma), Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares CA 19-9, High-risk pancreatic surveillance (CAPS / PRECEDE), Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Obstructive jaundice and biliary obstruction, CT (computed tomography), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Endoscopic ultrasound and EBUS systems, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares CA 19-9, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Obstructive jaundice and biliary obstruction, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.