Pancreatic cancer, early diagnosis of at-risk cysts: here's who to look out for

Elderly people and people with larger cysts would be at higher risk. All indications for personalised surveillance

by Federico Mereta

3 June 2026

4' min read

Translated by AI

Versione italiana

Key points

Detecting the disease: research on 6 thousand patients
Injuries to keep under control
How to behave
Improvement proposals

4' min read

Translated by AI

Versione italiana

Get there early. This is the fundamental rule for dealing with cancer. the earlier a diagnosis is made, the better the chances of treating the disease. For pancreatic cancer, in particular, an early diagnosis of the lesion can multiply the prospects of survival to five years, from less than 20% to almost 80% in the earliest stages. Easy to say.

Disease difficult to detect: research on 6 thousand patients

Unfortunately, however, it is tremendously difficult to detect the disease in its early stages as it often manifests itself with non-specific symptoms and sometimes tends to develop extremely rapidly, spreading to neighbouring and distant organs. There are, however, conditions that, even if discovered by chance, can trigger a specific surveillance pathway that could improve the prospects of rapid recognition of the lesion in its early stages. We are talking about cysts, which are often detected during a computed tomography or MRI scan of the abdomen performed for other reasons. Those who have these lesions, in the presence of particular suspicious features, may have an increased risk of developing malignant neoplasms of the pancreas over time. But how to know who and when to monitor the development of the picture? One answer comes from research involving more than 6,000 patients and conducted by experts from the Mass General Brigham in Boston, co-ordinated by Ramin Khorasani (first author Arya Haj Mirzaian), published in JAMA Network Open.

Injuries to keep under control

The study clearly shows how cysts should be monitored over time, albeit with customised pathways, without underestimating the situation. the experts used abdominal images (MRI or computed tomography) of 499,631 patients seen at the Mass General Brigham between 2009 and 2021, identifying 6,064 patients with low-risk pancreatic cysts.

These patients were followed up for an average of 3.3 years after the initial diagnosis of pancreatic cysts in order to identify any subsequent recognition of pancreatic tumours. These developed in a very small percentage of patients, a little more than one in 200. It was found that the likelihood of developing the tumour was higher in the presence of larger pancreatic cysts, if they were older than 70 years and if the main pancreatic duct (a kind of 'channel' that runs inside the organ) was ectasic, i.e. particularly dilated. Not only that. Monitoring must be continued over time. 26.3% of cancers were diagnosed more than five years after the first detection of pancreatic cysts, which means that long-term monitoring of patients with low-risk pancreatic cysts could reduce missed or delayed diagnoses of pancreatic cancer.

How to behave

'Our study emphasises the need for long-term personalised surveillance strategies for patients with incidentally discovered low-risk pancreatic cysts,' Khorasani comments. 'This approach could allow early diagnosis of pancreatic cancer, when the likelihood of successful treatment is highest. In short: even low-risk cysts should not be underestimated, considering that, according to the study, their presence raises the risk of developing pancreatic cancer in the future almost 14-fold. This is why experts point out how important it is to include imaging in a multidisciplinary surveillance plan for every patient with low-risk pancreatic cysts, in order to reduce diagnostic errors and patient harm associated with missed or delayed diagnoses of pancreatic cancer.

'To date, there is no effective screening programme dedicated to pancreatic neoplasms, and the instrumental methods considered to be first-rate, such as ultrasound and laboratory tests, do not allow these neoplasms to be detected early and in their earliest stages in the general population,' comments Giuseppe Tirino, Medical Director at the Uoc Medical Oncology Unit of the AORN San Giuseppe Moscati in Avellino and Coordinator of the Multidisciplinary Oncological Group for Pancreatic Tumours. Similarly, the onset of symptoms is almost always late and represented by a set of complaints that are often nuanced and misleading'.

Proposals for improvement

Identifying subgroups of patients who are particularly at risk can, in the right clinical and organisational context, amplify the chances of an early diagnosis and, consequently, of a trajectory leading to a potential cure. "In this sense, reference should be made to patients with a history of chronic inflammatory diseases of the pancreas (often ethylists, with diabetes or obesity), to patients with a strong family history of pancreatic neoplasms and other malignant tumours (sometimes in the context of true hereditary-familial genetic syndromes such as those correlated with the presence of germline mutations of the BRCA1 and BRCA2 genes) and, finally, to individuals who are carriers of particular cystic lesions of the pancreas, the so-called 'PCLs' (Pancreatic Cystic Lesions),' the expert said. The methodical clinical-instrumental monitoring of subjects with 'suspicious' cystic lesions, on the basis of clinical-instrumental elements defined in the literature as 'worrisome features', is based on the integrated use of various second-level instrumental investigations, such as MRI and ecoendoscopy, and on periodic surveillance with clinical examination and dedicated laboratory tests, including, for example, the use of blood-destable tumour markers such as CA19.9'.

Carrying out this surveillance within the so-called Multidisciplinary Oncology Groups, with the collaboration of the various specialists involved (such as the medical oncologist, the radiologist, the surgeon, the radiotherapist, the endoscopic gastroenterologist and others), makes it possible to harmonise and personalise and thus make more efficient, these diagnostic pathways, which are in themselves very complex and burdened by a high rate of potential 'error' or confusion, in some cases even within the highly specialised multidisciplinary units of reference centres called 'Pancreas Units'.