Table of ContentsView AllTable of ContentsWhat Are IPMN Cysts?TypesSymptomsCancer RiskDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What Are IPMN Cysts?
Types
Symptoms
Cancer Risk
Diagnosis
Treatment
Intraductal papillary mucinous neoplasm (IPMN) is a type of cyst that is found in the pancreas. These cysts are benign (not cancer), but they are concerning because about 8% of pancreatic cancer cases arise from IPMN cysts that develop intomalignant (cancerous) tumors.
These cancerous tumors become invasive and are a form ofpancreatic cancerthat is difficult to diagnose and treat. Symptoms include abdominal pain, nausea and vomiting, andunexplained weight loss. People can developjaundiced(yellowed) skin.The cause is unclear but certain genetic changes have been associated with IPMN.
This article explains IPMN cysts and how they are diagnosed and treated, including surgical removal to prevent cancer. It discusses potential causes and risk factors for IPMN.
The pancreas is an organ in the abdomen that produces vital hormones, includinginsulinand glucagon to help regulate body metabolism. It works with other digestive organs, including theduodenumsection of the small intestines and the liver.
Pancreatic cysts form in a sac. They form and extend into pancreatic ducts including the main duct connecting with the duodenum.An IPMN is a mucinous cyst, filled with thicker fluid than some other cyst types such asserous cystadenomasor cystic neuroendocrine tumors.
How Common Are IPMN Cysts?IPMN are the most commonly identified pancreatic cystic lesion, or PCL, especially as people age. A 2023 study of 2,114 people aged 50 or older found cysts in 10.9% of those studied. In most cases, cancer was not an immediate concern.Most people had just one IPMN cyst.
How Common Are IPMN Cysts?
IPMN are the most commonly identified pancreatic cystic lesion, or PCL, especially as people age. A 2023 study of 2,114 people aged 50 or older found cysts in 10.9% of those studied. In most cases, cancer was not an immediate concern.Most people had just one IPMN cyst.
Types of Cysts in the Pancreas
Pancreatic cysts are generally considered either mucinous or non-mucinous. Along with IPMN, other mucinous types include:
Non-mucinous types of pancreatic cysts include:
It’s less likely for non-mucinous cysts to develop into pancreatic cancer, as the risk is higher with IPMN and MCN, but it does occur.
Different genetic patterns are associated with these types. Other risk factors may include smoking andobesity. Some studies suggest thatblood typeplays a role but results are mixed and more research is needed to understand IPMN risk factors.
Symptoms of IPMN Cysts
In most cases, people don’t know that they have an IPMN and there aren’t any symptoms. An IPMN may be found during imaging tests that are being done to look for another problem or condition. A study of 21,745 people who had no symptoms found that 457 of them (about 2%) had IPMN they weren’t looking for.
However, people with an IPMN may develop acutepancreatitis, which prompts them to seek treatment.Early signs and symptoms can occur with a number of conditions, making IPMN harder to diagnose. They include:
Backache also occurs in about 10% of people.
What Are the Symptoms of Pancreatitis?
IPMN Cysts and Risk of Cancer
The presence of IPMN cysts is linked to an increased risk of pancreatic cancer, although the outcomes may be more optimistic than when pancreatic cancer is due to other causes.
Certain IPMN cysts themselves may be more concerning, too, including cysts that are larger in size and those that are not within the smaller ducts of the system. Classifications include:
An IPMN of 10 millimeters (mm) or larger in the main duct is considered high-risk, for example. Many of the more concerning IPMNs are treated with surgery. Surgery isn’t always the first-line treatment option for all IPMN, though. Surveillance is common for other IPMN, depending primarily on its size and where it is located.
Outcomes can depend on whether a developing cancer is defined as colloid or tubular, a description based on its tissue makeup. Tubular types may be more concerning.
Main duct IPMN is considered more aggressive than branch duct and surgical removal is typical care. Branch duct IPMN is less likely to lead to invasive cancers.A cancer associated with IPMN is reported in approximately 30% of patients diagnosed with them.
What It Means if You Have Precancerous Cells
Diagnosing IPMN Cysts
Several tests might be used to look for an IPMN or to monitor one once it’s discovered. These tests can include:
The use of blood tests remains limited in diagnosing IPMN but the importance of genetic markers for specific types continues to increase.
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Treating IPMN Cysts
Treatment for IPMN will depend on the size and location of a cyst, as well as the presence of cancer or the risk that it will occur. Surgery is recommended to have IPMN removed from the main pancreatic duct in all cases, as well as in many cases of branch duct IPMN.
However, surveillance may be an option for smaller branch-duct cysts that:
If there is a concern about the IPMN evolving into cancer, surgical removal (rarely, of the entire pancreas) is needed. Procedures can include:
Removing the IPMN through surgery is considered curative but other IPMN can occur, and there may be a higher risk of colorectal cancers so colonoscopy screenings may be recommended.
Some studies also find that even low-risk IPMN can lead to a higher risk of liver cirrhosis and cancers other than pancreatic, especially when diabetes, stroke, and heart disease are co-occurring factors.
Additionally, some people may require insulin or other medications due to the loss of pancreatic and digestive function. Your healthcare provider can discuss these treatment options with you.
Pancreas Cancer TreatmentKeep in mind that IPMN can lead to a pancreatic cancer diagnosis for which other treatments, including radiation, chemotherapy, and anti-inflammatory drugs, may be recommended.For people with certain genetic changes, the Food and Drug Administration has approved Keytruda (pembrolizumab), animmunotherapy drug, for pancreatic cancer treatment.
Pancreas Cancer Treatment
Keep in mind that IPMN can lead to a pancreatic cancer diagnosis for which other treatments, including radiation, chemotherapy, and anti-inflammatory drugs, may be recommended.For people with certain genetic changes, the Food and Drug Administration has approved Keytruda (pembrolizumab), animmunotherapy drug, for pancreatic cancer treatment.
How Pancreatic Cancer Is Diagnosed
Summary
An IPMN is a type of cyst that can affect the pancreas. It is one of several cyst types and is known to lead to pancreatic cancer in some people.
Often, there are no symptoms associated with the cyst and it is diagnosed during tests for other conditions. Sometimes, though, it is associated with pancreatitis and other symptoms.
Treatment typically involves surgery or surveillance (careful monitoring). Associated cancers may require additional care, including chemotherapy. Research into IPMN continues to offer a greater understanding of how to manage and treat these cysts, as well as understanding the risk factors.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nista EC, Schepis T, Candelli M, Giuli L, Pignataro G, Franceschi F,et al.Humoral Predictors of Malignancy in IPMN: A Review of the Literature.Int J Mol Sci. 2021 Nov 27;22(23):12839. doi: 10.3390/ijms222312839.Johns Hopkins Medicine.Intraductal papillary mucinous neoplasms (IPMNs).Hu Y, Jones D, Esnakula AK, Krishna SG, Chen W.Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression.Cancers (Basel). 2024 Mar 18;16(6):1183. doi: 10.3390/cancers16061183.de la Fuente J, Chatterjee A, Lui J, Nehra AK, Bell MG, Lennon RJ,et al.Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms.JAMA Netw Open. 2023 Oct 2;6(10):e2337799. doi: 10.1001/jamanetworkopen.2023.37799.Gentiluomo M, Corradi C, Arcidiacono PG, Crippa S, Falconi M, Belfiori G,et al.Role of pancreatic ductal adenocarcinoma risk factors in intraductal papillary mucinous neoplasm progression.Front Oncol. 2023 Jun 6;13:1172606. doi: 10.3389/fonc.2023.1172606.Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW.Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study.Medicine (Baltimore). 2016 Dec;95(51):e5535. doi: 10.1097/MD.0000000000005535.Jabłońska B, Szmigiel P, Mrowiec S.Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management.World J Gastrointest Oncol.2021 Dec 15;13(12):1880-1895. doi: 10.4251/wjgo.v13.i12.1880.Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T,et al.Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017 Sep-Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007Brugge WR.Diagnosis and management of cystic lesions of the pancreas.J Gastrointest Oncol. 2015;6(4):375–388. doi:10.3978/j.issn.2078-6891.2015.057Takahashi K, Takeda Y, Ono Y, Isomoto H, Mizukami Y.Current status of molecular diagnostic approaches using liquid biopsy.J Gastroenterol. 2023 Sep;58(9):834-847. doi: 10.1007/s00535-023-02024-4.Agostini A, Guerriero I, Piro G, Quero G, Roberto L, Esposito A,et al.Talniflumate abrogates mucin immune suppressive barrier improving efficacy of gemcitabine and nab-paclitaxel treatment in pancreatic cancer.J Transl Med. 2023 Nov 23;21(1):843. doi: 10.1186/s12967-023-04733-z.Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T,et al.Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm.United European Gastroenterol J. 2024 Jun;12(5):614-626. doi: 10.1002/ueg2.12540.Fogliati A, Zironda A, Fiorentini G, Adjei S, Amro A, Starlinger PP,et al.Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with de Novo Pancreatic Adenocarcinoma.Ann Surg Oncol. 2024 Apr;31(4):2632-2639. doi: 10.1245/s10434-023-14875-5.Pancreatic Cancer Action Network.Immunotherapy for Pancreatic Cancer.
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nista EC, Schepis T, Candelli M, Giuli L, Pignataro G, Franceschi F,et al.Humoral Predictors of Malignancy in IPMN: A Review of the Literature.Int J Mol Sci. 2021 Nov 27;22(23):12839. doi: 10.3390/ijms222312839.Johns Hopkins Medicine.Intraductal papillary mucinous neoplasms (IPMNs).Hu Y, Jones D, Esnakula AK, Krishna SG, Chen W.Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression.Cancers (Basel). 2024 Mar 18;16(6):1183. doi: 10.3390/cancers16061183.de la Fuente J, Chatterjee A, Lui J, Nehra AK, Bell MG, Lennon RJ,et al.Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms.JAMA Netw Open. 2023 Oct 2;6(10):e2337799. doi: 10.1001/jamanetworkopen.2023.37799.Gentiluomo M, Corradi C, Arcidiacono PG, Crippa S, Falconi M, Belfiori G,et al.Role of pancreatic ductal adenocarcinoma risk factors in intraductal papillary mucinous neoplasm progression.Front Oncol. 2023 Jun 6;13:1172606. doi: 10.3389/fonc.2023.1172606.Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW.Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study.Medicine (Baltimore). 2016 Dec;95(51):e5535. doi: 10.1097/MD.0000000000005535.Jabłońska B, Szmigiel P, Mrowiec S.Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management.World J Gastrointest Oncol.2021 Dec 15;13(12):1880-1895. doi: 10.4251/wjgo.v13.i12.1880.Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T,et al.Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017 Sep-Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007Brugge WR.Diagnosis and management of cystic lesions of the pancreas.J Gastrointest Oncol. 2015;6(4):375–388. doi:10.3978/j.issn.2078-6891.2015.057Takahashi K, Takeda Y, Ono Y, Isomoto H, Mizukami Y.Current status of molecular diagnostic approaches using liquid biopsy.J Gastroenterol. 2023 Sep;58(9):834-847. doi: 10.1007/s00535-023-02024-4.Agostini A, Guerriero I, Piro G, Quero G, Roberto L, Esposito A,et al.Talniflumate abrogates mucin immune suppressive barrier improving efficacy of gemcitabine and nab-paclitaxel treatment in pancreatic cancer.J Transl Med. 2023 Nov 23;21(1):843. doi: 10.1186/s12967-023-04733-z.Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T,et al.Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm.United European Gastroenterol J. 2024 Jun;12(5):614-626. doi: 10.1002/ueg2.12540.Fogliati A, Zironda A, Fiorentini G, Adjei S, Amro A, Starlinger PP,et al.Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with de Novo Pancreatic Adenocarcinoma.Ann Surg Oncol. 2024 Apr;31(4):2632-2639. doi: 10.1245/s10434-023-14875-5.Pancreatic Cancer Action Network.Immunotherapy for Pancreatic Cancer.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nista EC, Schepis T, Candelli M, Giuli L, Pignataro G, Franceschi F,et al.Humoral Predictors of Malignancy in IPMN: A Review of the Literature.Int J Mol Sci. 2021 Nov 27;22(23):12839. doi: 10.3390/ijms222312839.Johns Hopkins Medicine.Intraductal papillary mucinous neoplasms (IPMNs).Hu Y, Jones D, Esnakula AK, Krishna SG, Chen W.Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression.Cancers (Basel). 2024 Mar 18;16(6):1183. doi: 10.3390/cancers16061183.de la Fuente J, Chatterjee A, Lui J, Nehra AK, Bell MG, Lennon RJ,et al.Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms.JAMA Netw Open. 2023 Oct 2;6(10):e2337799. doi: 10.1001/jamanetworkopen.2023.37799.Gentiluomo M, Corradi C, Arcidiacono PG, Crippa S, Falconi M, Belfiori G,et al.Role of pancreatic ductal adenocarcinoma risk factors in intraductal papillary mucinous neoplasm progression.Front Oncol. 2023 Jun 6;13:1172606. doi: 10.3389/fonc.2023.1172606.Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW.Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study.Medicine (Baltimore). 2016 Dec;95(51):e5535. doi: 10.1097/MD.0000000000005535.Jabłońska B, Szmigiel P, Mrowiec S.Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management.World J Gastrointest Oncol.2021 Dec 15;13(12):1880-1895. doi: 10.4251/wjgo.v13.i12.1880.Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T,et al.Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017 Sep-Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007Brugge WR.Diagnosis and management of cystic lesions of the pancreas.J Gastrointest Oncol. 2015;6(4):375–388. doi:10.3978/j.issn.2078-6891.2015.057Takahashi K, Takeda Y, Ono Y, Isomoto H, Mizukami Y.Current status of molecular diagnostic approaches using liquid biopsy.J Gastroenterol. 2023 Sep;58(9):834-847. doi: 10.1007/s00535-023-02024-4.Agostini A, Guerriero I, Piro G, Quero G, Roberto L, Esposito A,et al.Talniflumate abrogates mucin immune suppressive barrier improving efficacy of gemcitabine and nab-paclitaxel treatment in pancreatic cancer.J Transl Med. 2023 Nov 23;21(1):843. doi: 10.1186/s12967-023-04733-z.Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T,et al.Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm.United European Gastroenterol J. 2024 Jun;12(5):614-626. doi: 10.1002/ueg2.12540.Fogliati A, Zironda A, Fiorentini G, Adjei S, Amro A, Starlinger PP,et al.Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with de Novo Pancreatic Adenocarcinoma.Ann Surg Oncol. 2024 Apr;31(4):2632-2639. doi: 10.1245/s10434-023-14875-5.Pancreatic Cancer Action Network.Immunotherapy for Pancreatic Cancer.
Nista EC, Schepis T, Candelli M, Giuli L, Pignataro G, Franceschi F,et al.Humoral Predictors of Malignancy in IPMN: A Review of the Literature.Int J Mol Sci. 2021 Nov 27;22(23):12839. doi: 10.3390/ijms222312839.
Johns Hopkins Medicine.Intraductal papillary mucinous neoplasms (IPMNs).
Hu Y, Jones D, Esnakula AK, Krishna SG, Chen W.Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression.Cancers (Basel). 2024 Mar 18;16(6):1183. doi: 10.3390/cancers16061183.
de la Fuente J, Chatterjee A, Lui J, Nehra AK, Bell MG, Lennon RJ,et al.Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms.JAMA Netw Open. 2023 Oct 2;6(10):e2337799. doi: 10.1001/jamanetworkopen.2023.37799.
Gentiluomo M, Corradi C, Arcidiacono PG, Crippa S, Falconi M, Belfiori G,et al.Role of pancreatic ductal adenocarcinoma risk factors in intraductal papillary mucinous neoplasm progression.Front Oncol. 2023 Jun 6;13:1172606. doi: 10.3389/fonc.2023.1172606.
Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW.Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study.Medicine (Baltimore). 2016 Dec;95(51):e5535. doi: 10.1097/MD.0000000000005535.
Jabłońska B, Szmigiel P, Mrowiec S.Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management.World J Gastrointest Oncol.2021 Dec 15;13(12):1880-1895. doi: 10.4251/wjgo.v13.i12.1880.
Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T,et al.Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017 Sep-Oct;17(5):738-753. doi: 10.1016/j.pan.2017.07.007
Brugge WR.Diagnosis and management of cystic lesions of the pancreas.J Gastrointest Oncol. 2015;6(4):375–388. doi:10.3978/j.issn.2078-6891.2015.057
Takahashi K, Takeda Y, Ono Y, Isomoto H, Mizukami Y.Current status of molecular diagnostic approaches using liquid biopsy.J Gastroenterol. 2023 Sep;58(9):834-847. doi: 10.1007/s00535-023-02024-4.
Agostini A, Guerriero I, Piro G, Quero G, Roberto L, Esposito A,et al.Talniflumate abrogates mucin immune suppressive barrier improving efficacy of gemcitabine and nab-paclitaxel treatment in pancreatic cancer.J Transl Med. 2023 Nov 23;21(1):843. doi: 10.1186/s12967-023-04733-z.
Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T,et al.Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm.United European Gastroenterol J. 2024 Jun;12(5):614-626. doi: 10.1002/ueg2.12540.
Fogliati A, Zironda A, Fiorentini G, Adjei S, Amro A, Starlinger PP,et al.Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with de Novo Pancreatic Adenocarcinoma.Ann Surg Oncol. 2024 Apr;31(4):2632-2639. doi: 10.1245/s10434-023-14875-5.
Pancreatic Cancer Action Network.Immunotherapy for Pancreatic Cancer.
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