MRI MRCP - Cyst (IPMN) - Newbie

I was already a six year survivor of metastatic pancreatic cancer when a 0.8mm IPMN was discovered by routine MRI surveillance in 2018. I was familiar with the guidelines for IPMN surveillance on size and location. Since mine was in the tail of the pancreas and not in a branch duct directly communicating with the main duct, the international guidelines were propose for surveillance. My concern was that I already had pancreatic cancer and I couldn't find anything specific to that scenario. So I sought additional opinions from three surgical oncologists at three ivy-league affiliated medical centers with pancreas programs. All consults were covered by insurance and I did not require referral or prior authorization for seeking additional opinions.

What resulted is six month surveillance scans for the foreseeable future. Since its discovery four years ago, no growth has been observed. The most recent scan indicated 0.7mm which is within the measurement margin of error and not necessarily shrinkage.

Happy Sunday and thanks for asking. I had my fillip this past Friday. He said it wasn’t a concern until it was 4x my current size of .6 cm, no monitoring or nothing. Not sure if I like that reply. A second opinion?

Meanwhile I await a biopsy result of a very deep aggressive and probable squamous cell carcinoma. Not sure I like getting older, 54 this week 😉

Thank you and everyone for all you do on this board.

@chasenkw, did you hear back about the results of your recent magnetic resonance cholangiopancreatography (MRCP)? Any updates to share?

Good morning and thank you so much for replying. Your reply and experience is the most helpful information that I have read on these cyst.

I will look into this trial as well. I just finished a 6 month trial for Gulf War Illness.

Thank you and many years of continued health.

A side branch IPMN commonly abbreviated BD-IPMN for branch duct tend to be the benign form of this cystic neoplasm. They rarely become malignant whereas the main duct IPMN (MD-IPMN) has a higher tendency to go from pre-malignant to a malignant form. There is a protocol that is used for surveillance of IPMN’s. Generally IPMN’s are surveilled and watched for growth that could lead to ductal dilation, changes in shape or content and size. BD-IPMN’s are monitored and if the diameter reaches 3 cm regardless if benign, surgical intervention is used to prevent severe bouts of acute pancreatitis and the prevention of chronic pancreatitis which could result further into pancreatic cancer. MD-IPMN’s and one’s located where it is communicating closely between a branch duct and the main duct are more likely to have surgical intervention when they reach 1 cm because of their likelihood to transform into malignancy.

The next step for you is to meet with a surgical oncologist that specializes in IPMN’s and pancreas surgery. A surveillance schedule/frequency will be determined where a pancreas protocol CT or MRI is used to do the monitoring. In the majority of patients, IPMN’s remain stable and never cause problems. I was diagnosed with a likely BD-IPMN in the tail several years ago and it has remained at just under 8mm and causes no symptoms. My surveillance is done by an MRI pancreas protocol every 6 months since I had been diagnosed with pancreatic cancer over 10 years ago. So I get routine surveillance scans every six months to detect signs of reoccurrence and the IPMN status has been incorporated into the scan.

There is a National clinical study recruiting patients with IPMN’s. There are numerous sites around the USA in nearly every State and you may be interested in participating in the study. The following link describes the scope of the study, eligibility criteria and locations-
https://ecog-acrin.org/clinical-trials/ea2185-pancreas-cancer-prevention/