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The pancreas is part of the digestive system which helps your body regulate blood sugar and digest food. Sometimes cysts can develop inside the pancreas. These small, fluid-filled sacs usually don’t cause any symptoms, and most people don’t even realize they have them.
“About 10% to 20% of people over the age of 60 have pancreas cysts,” says surgical oncologist Michael Kim, M.D. Most of these are benign and will never cause problems.
But if you have pancreas cysts, you are more likely to develop pancreatic cancer.
Symptoms of pancreatic cysts
“If you experience any of these symptoms without relief for more than two weeks, you should talk to your doctor,” Kim says.
How a pancreas cyst diagnosis is made
Most of the time, pancreatic cysts are found during medical treatment for other conditions. “You may experience back pain and go to the emergency room,” Kim says. “Or, if you get a CT scan after an injury, your care team may find cysts that way,” he adds.
If you have pancreatic cysts, your care team will also look at the size of the cyst. “Cysts smaller than 2 centimeters usually don’t require treatment, unless they’re causing pain or other symptoms,” Kim says.
Your care team will also look to see if you have any of the following:
Dilation of the main duct of the pancreas
Nodules inside the cyst
Enhancement of the cyst walls during an IV contrast test
Your care team will likely perform a biopsy to learn about features and the type of cyst if you have any of these risk factors.
Looking for a genetic link to pancreatic cysts
After a biopsy, fluid from inside the cyst may be sent for genetic sequencing.
There are two main genes associated with cysts in the pancreas: KRAS and GNAS. Kim says other genes associated with higher cancer risk, like BRCA mutations, can also play a role in cyst development.
“We’re not sure why some people have cysts that develop into cancer and some don’t,” Kim says. That’s why he and his team are working to better understand the genetic link between pancreatic cysts and cancer.
Types of pancreatic cysts
There are several types of pancreatic cysts. Some are more likely to develop into cancer than others.
- Intraductal Papillary Mucinous Neoplasms (IPMNs) are the most common type of cyst found in the pancreas. These are also divided into different categories depending on where they’re found within the system of ducts that helps the pancreas secrete digestive enzymes.
- Main duct IPMNs are the most likely to become cancerous and are found in the main duct to the pancreas.
- Side branch IPMNs are most common and are found in the branches off the main duct.
- Mixed IPMNs can be found in both the side branches and the main duct.
- Mucinous cystic neoplasms tend to develop in younger healthy women. These typically develop inside the pancreas, not in the ducts.
- Solid pseudo papillary neoplasms may look like cysts, but they’re solid masses made up of cells.
- Serous cystadenomas are benign but can sometimes become quite large and need to be removed.
- Pseudo cysts are benign and caused by inflammatory responses in the pancreas. These generally don’t cause problems unless they’re very large and cause symptoms.
Pancreatic cyst treatment options
For most pancreatic cysts, surveillance is a good option. “We can watch cysts through routine scans for a long time,” Kim says.
Cysts that are cancerous or pre-cancerous are most commonly treated with surgery, depending on the patient’s age and risk factors. “We can take out the cyst, as well as the part of the pancreas where it was found, to reduce the risk of cancer growing or spreading,” Kim says.
The exact type of surgery will depend on the cyst’s location.
If the cyst is located in the head of the pancreas, patients will undergo a type of surgery called the Whipple procedure.
A procedure called a distal pancreatectomy is used to remove cysts located in other parts of the pancreas. Talk to your care team about which treatment is right for you.
“It’s important to seek care at a center like MD Anderson that has specialized expertise in diagnosing and treating pancreatic cysts,” Kim says.
New research focuses on pancreatic cyst prevention and growth
Kim and his colleagues, including Florencia McAllister, M.D., are working on designing a clinical trial to detect precancerous cysts or to develop vaccines to prevent pancreatic cyst growth or progression.
“If we can get the immune system to attack antigens on the surface of problematic cysts, we could potentially keep them from growing, or get rid of them altogether,” Kim says.
Kim credits the volume of patients MD Anderson sees with the ability to build upon clinical trial data. “We're in a position where we can make our guidelines for informing our practices, based on the results we’ve seen so far,” he says.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
There are over 6 billion letters, or nucleotides, of DNA in the genome. These contain all the information needed to create an individual organism. Certain sequences of DNA, called genes, contain instructions for making proteins that determine everything about how we look and how we function. We expect there to be some differences in those sequences that lead to differences in individual humans, but sometimes these instructions have significant mutations, or changes, that can lead to serious diseases such as cancer.
Imagine having to figure out which changes in which sequences in that long string of 6 billion letters are important for targeting treatments for diseases. And, once you identify some of those important genes, how do you fix those mutations?
A game-changing discovery in 2012 of a system called CRISPR has triggered a revolution in biomedical breakthroughs over the last decade. Scientists can use it to target, edit, modify and regulate genes and put any enzyme or protein they want at any location in the genome. This allows them to find new treatment targets and understand how different genes affect cells in a way that was previously impossible.
But how do we apply CRISPR to understanding cancer? We spoke with Traver Hart, Ph.D., associate professor in Bioinformatics and Computational Biology, to learn more about CRISPR and how it could be used to advance cancer treatment.
What is CRISPR?
CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats. That’s a mouthful, so scientists refer to it as simply CRISPR. These are repeated sequences in the genetic code that were first found in bacteria and were later found to be part of a novel bacterial adaptive immune system against phages, which are viruses that attack bacteria.
This system combines the CRISPR DNA sequences and a set of Cas (“CRISPR associated”) proteins to identify and destroy invading viral DNA. It also embeds a sample of that viral DNA between these CRISPR sequences so that it can easily recognize and attack the same virus in the future. Thanks to this unexpected discovery in E. coli bacteria, scientists can now harness this method and use it in a similar way within human cells.
How does CRISPR work?
The main part of the CRISPR system is the Cas endonuclease, the Cas protein that cuts DNA strands. These Cas proteins can be programmed to find a 17- to 24-letter sequence by attaching a guide RNA that uniquely matches the specific DNA target. It’s similar to a key matching a lock. Researchers have a large library of guide RNAs available that can match certain parts of different genes in the human genome.
Once CRISPR is added to a cell, it searches for and binds to that matching target sequence in the DNA, and the attached Cas protein gets activated to do what scientists have asked it to do. Some Cas proteins – such as Cas9 – can cut or break the DNA. This is the original protein that was found in bacteria. Others have been engineered to turn a gene on or off without having to cut it. This allows researchers to find out more about what happens if cells make too much (upregulation) or too little (downregulation) of a certain protein and how that can affect the outcome of a cell.
How do we use CRISPR to study cancer in human cells?
For the past several decades, studies have been done in yeast cells and other model organisms where scientists can efficiently edit the genome. The discovery of CRISPR has been instrumental in changing that.
We can edit the genome directly in human cells with unprecedented ease thanks to CRISPR.
Once CRISPR cuts the target DNA, it gets repaired or replaced with a different sequence. Scientists use this method to knock out human genes in cancer cells and identify which of those genes are essential for the growth of tumor cells without harming normal cells. This allows us to nominate gene candidates for drug targets that can be very highly tumor-specific. My lab is trying to find better ways to kill tumor cells by disabling multiple genes at a time using a different Cas protein called Cas12a. This gives us more insight into how different genes and proteins work together in tumor cells to promote cancer progression.
A recent study by Yohei Yoshihama, Ph.D., and Ronald Depinho, M.D., used CRISPR to screen cancer cells and identify a protein called JMJD1C as a candidate target in castration-resistant prostate cancer. Another study by Chao Wang, Ph.D. and Junjie Chen, Ph.D., used CRISPR to screen human cancer cells growing in mouse models and discovered a protein named KIRREL, which was shown to be important for tumor suppression.
Can CRISPR fix genes in people?
While the idea of being able to fix “bad” genes to cure diseases is a worthy pursuit, science isn’t at the point to be able to safely and effectively do so – yet. Researchers are looking at how to use CRISPR to correct the genetic defects that cause beta-thalassemia and sickle cell anemia, diseases that affect the amount of hemoglobin in the body and cause patients to require constant blood transfusions. If approved, this type of therapy, called exa-cell, would become the first CRISPR-based medical treatment, which is incredibly exciting.
What’s next for CRISPR?
The possibilities are endless for the information that can be gained from using CRISPR systems and, just 10 years in, scientists have only scratched the surface. Newer Cas proteins and other enzymes are being studied, and there are still questions about how to make CRISPR more specific so that it doesn’t accidentally have unintended targets.
Here at MD Anderson, our use of CRISPR continues to lead to a better understanding of how cancer cells function and helps uncover many ways to target individual treatments specific to certain tumors that will, hopefully, one day, achieve our goal to end cancer.
Lung cancer can form in any part of the lungs. When lung tumors grow in the upper portion of the lung, above the first rib, they’re called Pancoast tumors, after Henry Pancoast, M.D., the radiologist who first described them in the early 1900s. They’re also sometimes referred to as superior sulcus tumors, based on the location where they’re found.
“Pancoast tumors are quite rare, accounting for only 3% to 5% of lung cancers,” says David Rice, M.D., a thoracic and cardiovascular surgeon at MD Anderson. “But there are treatment options available for patients.”
Here, he shares three facts about Pancoast tumors.
1. Pancoast tumors only occur in the upper portion of the lung.
The difference between Pancoast tumors and other lung tumors is their location. These tumors occur in the uppermost portion of the lung known as the apex.
Even if a tumor is near the upper portion of the lung, it’s not a Pancoast tumor if it’s below the first rib.
They may also spread into the ribs at the top of the chest and affect important areas at the base of the neck, like nerves and blood vessels.
It’s not clear why tumors develop here, though cigarette smoking is often a factor. Exposure to certain harmful chemicals, radon gas and asbestos may also cause these tumors.
2. Pancoast tumors have unique symptoms.
Because of their unique location, Pancoast tumor symptoms are specific to the area where they’re found. Shoulder pain and upper back pain are common symptoms, especially if the tumor is impacting the ribs, spine or nerves of the brachial plexus. Patients may feel neck, back, arm or chest pain on the affected side.
In some cases, these tumors may involve the nerves of the brachial plexus, which provide sensory and motor supply to the arm and hand. When that happens, symptoms may include arm pain and loss of function of the small muscles of the hand.
Additionally, the tumor may involve the sympathetic nerve, leading to Horner’s syndrome. These symptoms include the same side drooping of the eyelid, lack of facial sweating and constriction of the pupil. The combination of severe arm and shoulder pain, Horner’s syndrome, and atrophy of the small muscles of the hand is called “Pancoast syndrome.”
In rare cases, tumors can grow so large that they block vessels that drain blood from the arms or face. This can lead to extreme swelling or may invade the spinal canal, leading to paralysis.
Pancoast tumors are often found during a chest X-ray, CT scan or MRI prescribed to identify the cause of these symptoms. Once a diagnosis is made, PET imaging and an MRI brain scan are also required to exclude the possibility of distant metastases.
3. Treatment for Pancoast tumors requires multidisciplinary care.
Unfortunately, by the time Pancoast tumors are diagnosed, they’re usually at a locally advanced stage and may have invaded the chest wall or wrapped around blood vessels or nerves.
Treating Pancoast tumors requires a team approach. Patients may require a combination of chemotherapy, radiation and surgery. That’s why patients should seek treatment from a comprehensive cancer care center like MD Anderson which has experience treating complex tumors like these.
In general, chemotherapy and radiation are considered standard treatments. In patients without extensive involvement of the brachial plexus or spinal canal and nodal metastases, surgery is often beneficial. Typically, this occurs following preoperative chemotherapy or chemoradiation.
Occasionally, radiation will be administered after surgery. The treatment paradigms are complex and require input from multiple specialists, including surgeons, medical oncologists and radiation oncologists. Due to the location of the tumors and the structures they may invade, surgery is complex and often requires collaboration with expert thoracic surgeons and neurosurgeons.
Although Pancoast tumors are rare, collaboration from a team of experts can help patients get personalized treatment and achieve the best possible results.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.