Pancreatic Cyst Surveillance Clinic

Donald Garmon, NPThe Pancreas Center is dedicated to taking every step possible to help prevent, detect, and treat pancreatic cancer. This commitment has led to a continual flow of medical and surgical innovations at the center, a leading role in research and education, and cutting-edge protocols for early detection and genetic testing. Most recently, the center has established the novel Pancreatic Cyst Surveillance Clinic, a unique clinic specifically focused on managing pancreatic cysts so that they do not develop into cancer.

Pancreatic cysts are abnormal fluid-filled growths on or in the pancreas. There are several types of cysts, many of which are benign (non-cancerous) and some of which are associated with pancreatitis, or inflammation of the pancreas. Because some cysts become cancerous, it is very important that all pancreatic cysts are detected, evaluated, monitored, and if necessary, removed.

In the following interview, coordinator and nurse practitioner Donald Garmon talks about this unique surveillance clinic.

How common are pancreatic cysts?

DG: Between one and two percent of the general population will develop an IPMN, or intraductal papillary mucinous neoplasm (pancreatic cyst), and research indicates the incidence is increasing. Most pancreatic cysts do not cause symptoms, so they are usually found incidentally during a CT scan or MRI that was ordered for another reason such as a kidney stone.

How dangerous are pancreatic cysts?

DG: Some types are benign, with virtually no likelihood of becoming cancerous, while others are more likely to become malignant. Some forms have up to a 70% chance of becoming cancerous. For this reason, it is essential that all cysts be carefully evaluated. While it is possible to view a cyst on a CT scan or MRI, these tests do not tell us everything we need to know about what kind of cyst it is; in order to get a closer look, we have to extract cells with a needle, and a pathologist can then identify which type it is.

How does the Pancreatic Cyst Surveillance Clinic work?

DG: This clinic takes place once each month at the Pancreas Center. We examine each patient and review his or her records and scans, and take new images if needed. Once the cyst has been clearly identified, a treatment plan is determined. In many cases, patients return for follow-up monitoring every 6 or 12 months. In some cases, additional biopsies may be needed, which are performed by our gastroenterologists and interventional endoscopist. After that point, treatment will depend on what the ultrasound and biopsy show. My role is essentially to serve as the hub of the wheel, ensuring that all relevant information is gathered from the patient and presented to the multidisciplinary team.

How are patients referred to the Cyst Surveillance Clinic?

DG: Most of our patients have already been evaluated for pancreatic disease at our center. But anyone who has been diagnosed with a cyst can call for an appointment.

Why was it important to create a special program just for management of pancreatic cysts?

DG: In the general population, pancreatic cysts often fall through the cracks because generalists – whether primary care physicians, gastroenterologists, or other – often are not expert in managing them. As a result, patients do not receive the frequent, close monitoring that they should. The Pancreas Center created this program in order to ensure that patients are thoroughly, continuously monitored, so that we can treat cysts before they become cancerous. Our multidisciplinary team includes experts in every specialty related to management of pancreatic disease, so we are fully prepared to monitor and treat not just cysts but every pancreatic condition.

Do most hospitals have programs dedicated to management of pancreatic cysts?

DG: Ours is one of just two in the nation, so this is highly unique.

Does the Cyst Surveillance Clinic participate in research at the Pancreas Center?

DG: Yes. In addition to providing patient care, we maintain a pancreatic cyst database. Using patients’ data in conjunction with their tissue specimens, we are able to conduct studies with goals such as identifying which patients may need surgery, determining which types of cyst have malignant potential and at what rate, predicting how particular cysts may react over time, and more.