SC Connecticut News

James Farrell, MD, professor of medicine and surgery at Yale Medicine, recently published a review on pancreatic cysts in the New England Journal of Medicine. The paper discusses various types of pancreatic cysts, methods to assess cancer risks, and approaches for managing patients with concerning cysts.

Farrell explains that pancreatic cysts are fluid-filled collections in the pancreas that can vary in size. With advancements in imaging technology, more cases are being identified. "About 15% of adults in the U.S. have pancreatic cysts," he notes.

Most pancreatic cysts are precancerous, known as intraductal papillary mucinous neoplasm (IPMN). While only a small percentage lead to cancer, identifying and managing these cases is crucial. "About 25% of all pancreatic cancers arise from pancreas cysts," Farrell states.

Pancreatic cancer has a five-year survival rate of around 13%, making early identification essential. Many people discover they have pancreatic cysts incidentally during MRI or CT scans for unrelated issues. Research indicates that some patients with new-onset diabetes may be at higher risk for progressing to cancer.

The review article outlines surveillance approaches based on cyst size and features. Benign and low-risk cysts often require no intervention. Physicians must consider various factors including patient risk tolerance when making care decisions.

Farrell co-authored the article with Tamas Gonda, MD, and Djuna Cahen, MD. He reflects on the evolution of treatment practices over the past fifteen years: "Fifteen years ago, the best practice was to surgically remove any pancreatic cyst over three centimeters."

At Yale, ongoing research includes developing a biobank for studying molecular markers associated with cancer risk in pancreatic cysts. Collaborations with Nita Ahuja, MD, MBA, Anup Sharma, PhD, Dennis Shung, MD, PhD, and Stephen Robinson, PhD focus on understanding why some cysts progress to cancer while others do not.

Farrell is also involved in clinical trials through Yale's Multidisciplinary Pancreas Cyst Clinic aimed at improving patient outcomes through different monitoring strategies and evaluating novel biomarkers for detecting pancreatic cancer.

Reflecting on his work's impact over two decades Farrell says: "We’ve made tremendous progress in our understanding of pancreatic cysts and pancreas cancer." Despite significant advances he acknowledges that there is still much more to be done.

For further details on Yale School of Medicine’s Section of Digestive Diseases visit their website.