Inside Tract
November 22, 2016

Late on a Monday afternoon, after dozens of endoscopies and colonoscopies, after hours over a microscope and after many surgeries, the multidisciplinary pancreatic cyst clinic gets underway.

The clinic gathers many of the world’s leading authorities on pancreatic disease in one cluttered Johns Hopkins Hospital conference room. Surgeons, gastroenterologists, pathologists, radiologists, physicians assistants and even genetics researchers assemble weekly to collaborate on pancreatic cyst cases.

“Seventy-nine-year-old female patient,” begins a nurse, who announces each case to the room. “Family cancer history.”

The experts discuss each case, weighing options and assessing risk. Radiologist Atif Zaheer rolls a computer mouse back and forth, displaying on the screen three-dimensional images of the patient’s liver, gall bladder, pancreas and intestines.

“Right there,” Zaheer says, pointing to a bubblelike protrusion in the middle of the screen. “That’s the cyst on the main duct.”

Advances in CT scans, MRI scans and other imaging have, in the past few years, shone light on a whole new world of pancreatic cysts.

Diagnoses of cysts involving the pancreas have increased enormously, thanks to the ever-evolving ability to see the organ.

Very often, patients with pancreatic cysts show no symptoms. But more and more, cysts on the pancreas are turning up on scans of other organs. Some of the cysts are precancerous and can eventually lead to a patient’s demise. Others are completely harmless.

“They’re pretty common,” says Ralph Hruban, pathologist and director of the Sol Goldman Pancreatic Cancer Research Center. “We did a study with radiologist Elliot Fishman looking at everybody who came into Johns Hopkins who got a CAT scan that included the pancreas. About 2.5 to 3 percent had a cyst on their pancreas.”

Hruban says that, given the complexity of pancreatic surgery, operating on all of those cysts would do more harm than good. So the goal is to find the formula: Which cysts need attention, and which cysts can simply be monitored?

The patient whose scans led off the multidisciplinary clinic will get a recommendation for an endoscopic ultrasound so that the team can get an even closer look. The experts in the room are unanimous that, as long as the ultrasound looks OK, the patient doesn’t need surgery yet.

After the clinic, Zaheer says that input from such a diverse group of specialists makes the multidisciplinary clinic so effective.

“It’s very useful to bring together this whole group to look at cases,” says Zaheer. “I think we learn from one another and, ultimately, our patients get the best possible care.”