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Suggest Treatment For Cyst On Pancreas, Nausea And Vomiting
Posted on
Sun, 13 Sep 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 13 Sep 2015
Answered on
Tue, 6 Oct 2015
Last reviewed on
Question : I have a cyst on my pancreas. I have setup a six/nine month check by C-Scan or a MRI done to monitor any changes that may be occuring. When I became aware of the problem (2011) I went from 235lbs on Oct 10th, to 130lbs by XXXXXXX 1, 2012. At that time my GP, was not on board in my health care. The only doctors showing interest were surgeons who wanted to preform exploratory surgery. I did not want this surgery if they had no idea but cut and search, I wanted more tangelable facts before any cutting. I met with my GP, told her that I was feeling that she was not on my team. I made it clear to her that if she did not get on board, I would need to search for another GP that would work as my partner in searching the cause of my illness. She became the doctor that I needed. I've gained some of my weight back. But, I still have the feeling of vomiting and at times i do vomit. The pain is still in the local and it travels to my back w/ heat. My bowel movements is tan-orange in color very loose and floats on top of the water in the toilet. I go 3 to 4 days before having a BM; and use laxatives to help with having a BM on a more frequent time schedule. The cyst has not grown in size since my diagnosis. She arranged for me to go out of Kaiser, and see specialists to get a diagnosis for my problem.
Is there anything else that should be doing at this time for my care? I do go online to get as much information as possible. I did see a specialist surgeon and discussed with him about the "Whipple" surgery. Before meeting with him I read everything on the procedure, so that I could ask him questions and being an informed possible client. After meeting with him, I do not think that the surgery is an avenue that I want to try with all the possible complications that come with that surgery.
What else should I be doing right now? I try to be an informed client. I am alone now, as my wife passed away this year after fighting Ovarian cancer for the last six years.
Thank you, XXXXXXX XXXXXXX
Is there anything else that should be doing at this time for my care? I do go online to get as much information as possible. I did see a specialist surgeon and discussed with him about the "Whipple" surgery. Before meeting with him I read everything on the procedure, so that I could ask him questions and being an informed possible client. After meeting with him, I do not think that the surgery is an avenue that I want to try with all the possible complications that come with that surgery.
What else should I be doing right now? I try to be an informed client. I am alone now, as my wife passed away this year after fighting Ovarian cancer for the last six years.
Thank you, XXXXXXX XXXXXXX
Brief Answer:
further tests required,surgery not recomended now
Detailed Answer:
Hi and welcome to HCM.
Ok, first, pancreas cysts can be malignant or benign: some benign may show malignant alteration and become cancerous in future (precancerous cysts) ,this is a reason why any cyst should be adequately followed. MAlignant cysts are cystic adenocarcinoma, undifferentiated carcinoma, pancreatoblastoma etc. Some cysts that are benign, almost never become malignant such as serous adenomas and some carry high risk for alteration such as IPMN or Mucinous Cystic Neoplasms and it is advisable to treat these surgically.
in your case,it is obvious that in 2011 this cyst wasnt malignant because in this case, cancer would already spread and cause significant difficulties and infiltration. 3 years survival for adenocarcinoma without treatment is almost 0%. So I dont think that your symptoms are sign of malignant disease.
Such symptoms may be caused if cyst grows to much or presses some important structures in pancreatic head or duodenum.
There is a possibility that cyst became cancerous in last 4 years but signs of malignancy would be detected on CT scan or MRI scan.
It is not uncommon that doctors cant figure out what exactly this cyst is, this is very difficult to establish in pancreas since biopsy cant be easily taken. What I suggest is to do ERCP or endosocopic ultrasound with needle biopsy of the cyst.
Surgery, especially Whipples procedure should be the last choice. Whipple is sometimes performed in cases where no biopsy confirmed malignancy but only if other indirect signs of cancer are proved such as jaundice,rapid growth of lesion, rapid weight loss or intensive pain. I don tthink you are candidate for it. Exploratory laparotomy is bit less invasive and may be performed in unclear cases. Here intraoperative tumor biopsy can be taken and then appropriate surgery performed.
Wish you good health. Regards
further tests required,surgery not recomended now
Detailed Answer:
Hi and welcome to HCM.
Ok, first, pancreas cysts can be malignant or benign: some benign may show malignant alteration and become cancerous in future (precancerous cysts) ,this is a reason why any cyst should be adequately followed. MAlignant cysts are cystic adenocarcinoma, undifferentiated carcinoma, pancreatoblastoma etc. Some cysts that are benign, almost never become malignant such as serous adenomas and some carry high risk for alteration such as IPMN or Mucinous Cystic Neoplasms and it is advisable to treat these surgically.
in your case,it is obvious that in 2011 this cyst wasnt malignant because in this case, cancer would already spread and cause significant difficulties and infiltration. 3 years survival for adenocarcinoma without treatment is almost 0%. So I dont think that your symptoms are sign of malignant disease.
Such symptoms may be caused if cyst grows to much or presses some important structures in pancreatic head or duodenum.
There is a possibility that cyst became cancerous in last 4 years but signs of malignancy would be detected on CT scan or MRI scan.
It is not uncommon that doctors cant figure out what exactly this cyst is, this is very difficult to establish in pancreas since biopsy cant be easily taken. What I suggest is to do ERCP or endosocopic ultrasound with needle biopsy of the cyst.
Surgery, especially Whipples procedure should be the last choice. Whipple is sometimes performed in cases where no biopsy confirmed malignancy but only if other indirect signs of cancer are proved such as jaundice,rapid growth of lesion, rapid weight loss or intensive pain. I don tthink you are candidate for it. Exploratory laparotomy is bit less invasive and may be performed in unclear cases. Here intraoperative tumor biopsy can be taken and then appropriate surgery performed.
Wish you good health. Regards
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Dr. Romic:
When Kaiser allowed me to go outside of their system, I was sent to a specialist medical group in San Fransisco that conducts ERCP and Endosocopic Ultrasound. A endosocopic with the ability to perform a needle biopsy of the cyst. The result was the cyst size was 10% of the pancreas and the needle biopsy showed that there was not any sign of malignancy detected. As you stated, there is the possibility that cancer may form sometime in the future. That alone, was the reason why I insisted that we scan it every six months rather than once each year which was what Kaiser proposed. After much discussion of the pros and cons, my doctor ended up supporting my position.
She did indicate that the make up of the cyst has the possiblity of becoming maligment. However, she shared recently that the more time that elapse without becoming maligment is a plus. But, we have decided that we need to keep on top of everything. I am a positive individule and I believe that helps.
Doctor, would you take some time and share with me all the positive and negative results of the Whipple procedures? The longterm effects on a life, after this operation. if this was something a person decided take this route. By the way, I had my Gaul Bladder removed about 15 years ago
Thank you for your expertise! XXXXXXX XXXXXXX
When Kaiser allowed me to go outside of their system, I was sent to a specialist medical group in San Fransisco that conducts ERCP and Endosocopic Ultrasound. A endosocopic with the ability to perform a needle biopsy of the cyst. The result was the cyst size was 10% of the pancreas and the needle biopsy showed that there was not any sign of malignancy detected. As you stated, there is the possibility that cancer may form sometime in the future. That alone, was the reason why I insisted that we scan it every six months rather than once each year which was what Kaiser proposed. After much discussion of the pros and cons, my doctor ended up supporting my position.
She did indicate that the make up of the cyst has the possiblity of becoming maligment. However, she shared recently that the more time that elapse without becoming maligment is a plus. But, we have decided that we need to keep on top of everything. I am a positive individule and I believe that helps.
Doctor, would you take some time and share with me all the positive and negative results of the Whipple procedures? The longterm effects on a life, after this operation. if this was something a person decided take this route. By the way, I had my Gaul Bladder removed about 15 years ago
Thank you for your expertise! XXXXXXX XXXXXXX
Brief Answer:
You re welcome.
Detailed Answer:
First, excuse me for being direct and honest. Having a MRI and CT scan every 6 months is a great privilege for this type of lesion but also unnecessary,this is not recommended by any algortuhm for pancreatic leisons. You ll have 10 scans in next 5 years... This is bit hypochondriatic behaviour, but you have right on it. 6 months versus 1 year has no advantage because such cysts even if become precancerous, wont show features of malignancy in 6 months. If there is a reason for so close follow up then would the surgery already be recommended.
If there was EUS and needle biopsy done that didnt show malignancy then 1 year of follow up is more than enough. Especially considering the fact that this cyst persists for 4 years( it may also be present from before than 2011). Risk for malignant alteration is very low, I ve never seen alteration of such cyst and majority of adenicarcinomas that require Whipple are detectable from the beginning. Wipple in your case would be completely medically unjustified,this is what I can tell. but you have right for it,as women have right for prophylactic mastectomy. But prophylactic Whipple is not standard treatment strategy. This is extensive procedure with resection of pancreas head, duodenum and common bile duct,it makes 3 risky anastomoses, disturbs future digestion, bowel motility. Carries significant risk of postoperative complications. Definitely not something that should be done unnecessary.
Actually, why whipple? where is this cyst located? Your surgeons cant perform partial or distal pancreatectomy or Puestow or Freys procedure?
You re welcome.
Detailed Answer:
First, excuse me for being direct and honest. Having a MRI and CT scan every 6 months is a great privilege for this type of lesion but also unnecessary,this is not recommended by any algortuhm for pancreatic leisons. You ll have 10 scans in next 5 years... This is bit hypochondriatic behaviour, but you have right on it. 6 months versus 1 year has no advantage because such cysts even if become precancerous, wont show features of malignancy in 6 months. If there is a reason for so close follow up then would the surgery already be recommended.
If there was EUS and needle biopsy done that didnt show malignancy then 1 year of follow up is more than enough. Especially considering the fact that this cyst persists for 4 years( it may also be present from before than 2011). Risk for malignant alteration is very low, I ve never seen alteration of such cyst and majority of adenicarcinomas that require Whipple are detectable from the beginning. Wipple in your case would be completely medically unjustified,this is what I can tell. but you have right for it,as women have right for prophylactic mastectomy. But prophylactic Whipple is not standard treatment strategy. This is extensive procedure with resection of pancreas head, duodenum and common bile duct,it makes 3 risky anastomoses, disturbs future digestion, bowel motility. Carries significant risk of postoperative complications. Definitely not something that should be done unnecessary.
Actually, why whipple? where is this cyst located? Your surgeons cant perform partial or distal pancreatectomy or Puestow or Freys procedure?
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Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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