Benign pancreatic tumors

What are benign pancreatic tumors?

Benign pancreatic tumours are characterized by the fact that although the cells proliferate, they do not invade surrounding tissue and do not send “offshoots” (cancer metastases) to other organs. In the case of cancer, such as pancreatic cancer, this is exactly what happens. This type of cancer is considered particularly aggressive, dangerous and difficult to treat. Malignant tumors in the pancreas are far more common than the benign “variants”.

Benign pancreatic tumors can be divided into two main groups:

• Hormone-producing (endocrine) pancreatic tumors: The most important is the insulinoma. Its origin lies in the Langerhans cells of the pancreas, which produce the blood sugar-lowering hormone insulin.
• Cystic pancreatic tumors: The cysts contain either fluid (serous cystadenomas) or mucus (mucinous cystadenomas). Cysts containing mucus carry an increased risk of becoming malignant. The group of cystic pancreatic tumors also includes intraductal papillary mucinous neoplasia (IPMN) – these neoplasms are similar to polyps in the colon. Mucus-forming structures develop in the main duct or the secondary ducts of the pancreas.

The causes of benign pancreatic tumors are often unclear. Why the cells change and start to grow often remains a mystery. Some benign tumors are associated with other diseases.

Benign tumors in the pancreas often remain undetected for a long time because they initially cause no or hardly any symptoms. We often find them as part of a routine examination, such as an ultrasound scan. Some benign pancreatic tumors mean an increased risk of malignant degeneration later on. We therefore usually remove these tumors as part of an operation. This can often prevent cancer of the pancreas.

Benign pancreatic tumors – frequency and age

Benign pancreatic tumors are comparatively rare diseases. There are no exact figures on how many people are affected by the various types of benign tumors in the pancreas. We find malignant tumors of the pancreas, i.e. pancreatic cancer, much more frequently. No general statements can be made about the age of onset of the disease either.

Intraductal papillary mucinous neoplasia (IPMN), for example, occurs predominantly in women and men between the ages of 60 and 70. Women develop mucinous cystadenomas more frequently than men, often at a younger age. Serous cystadenomas are also more common in women.

Benign pancreatic tumors: causes often unknown

There are various types of benign pancreatic tumors, the causes of which are still largely unknown. In any case, certain cells in the pancreas change – depending on the type of tumor, the change affects different cells. It is still unclear why it is taking place. However, the cells then divide and multiply excessively. However, they do not invade surrounding tissue and other organs – this is a characteristic of cancer cells.

Sometimes benign pancreatic tumors occur in conjunction with other diseases. Insulinoma, for example, is more common in so-called multiple endocrine neoplasias (MEN). This collective term covers cancers of hormone-producing glands (e.g. pancreas, parathyroid gland) caused by a genetic defect.

Endocrine pancreatic tumors

Insulinoma is one of the most common benign tumors in the pancreas. It develops from the Langerhans cells of the pancreas, which produce the blood sugar-lowering hormone insulin. The insulinoma is hormonally active and produces insulin. As a result, blood sugar levels drop sharply in those affected. Insulinomas are endocrine tumors. Insulinomas are also called islet cell tumors. They usually form small, individual tumors. If several are present, this is an indication of multiple endocrine neoplasia (MEN).

Cystic pancreatic tumors

Cystic pancreatic tumors are usually filled with fluid or mucus. They can grow to several centimeters in size.

• Serous cystadenoma: Fluid-filled (serous) tumors usually grow over a long period of time, but almost always remain benign and are considered harmless. They occur more frequently in women. Surgery is only advisable if the tumor is causing symptoms.
• Mucinous cystadenoma: Mucinous (mucinous) tumors have a certain risk of degeneration and developing into pancreatic cancer, known as mucinous cystadenocarcinoma. We therefore usually remove these preliminary stages. Here, too, women are more frequently affected.
• Intraductal papillary mucinous neoplasia (IPMN): Polyp-like neoplasms of the pancreas are also known – they are similar to polyps in the large intestine, which can degenerate and cause bowel cancer. The tumors can widen the ducts (the main and secondary ducts) of the pancreas and cause outpouchings. If they grow, this may be an indication that cancer is forming. As a precaution, we also remove the polyp-like tumors during an operation.

Symptoms: Benign pancreatic tumors often show up late

Benign pancreatic tumors often cause no or hardly any symptoms at first and those affected do not notice them. We often find tumors in the pancreas by chance during a routine examination. This applies to cystic pancreatic tumors, for example. Sometimes the long absence of symptoms can have far-reaching consequences, because some benign tumors can develop into pancreatic cancer. This applies, for example, to mucinous pancreatic tumors that are filled with mucus. However, intraductal papillary mucinous neoplasia (IPMN) can also lead to cancer.

The symptoms also depend on the type of benign tumor, but also on its location and how far it has spread. Some tumors are scattered over the entire pancreas, while sometimes they only settle in a specific part, for example in the tail area of the gland.

Cystadenomas, for example, often cause non-specific symptoms that can also occur in many other diseases. These include:

• Abdominal pain,
• Feeling of pressure and fullness in the abdomen
• Nausea and vomiting

As a general rule, always consult your doctor if you experience previously unknown symptoms that do not go away. And take advantage of recommended routine examinations. Even if you already suffer from certain diseases, regular check-ups are advisable.

Benign pancreatic tumors: Diagnosis with us

Benign pancreatic tumors are often incidental findings. We usually detect them as part of a routine examination. Diagnostics always begins with a discussion of your medical history, the anamnesis. For example, we ask you the following questions:

• What exactly are your symptoms?
• How long have the symptoms been present and how severe are they?
• Have you improved in the past in between or have they gotten continuously worse?
• Do you have any known diseases? If yes: Which ones and when were they diagnosed?
• Are you taking any medications? If yes: Which ones and since when?

This is usually followed by a physical examination, which includes palpation of the abdomen. The following tests are also used:

• Ultrasound examination (sonography) of the abdomen
• Computed tomography (CT) – an X-ray examination in which radiologists create detailed cross-sectional images of the inside of the body. The abdominal organs such as the liver or pancreas can thus be visualized well and changes become visible.
• Magnetic resonance imaging (MRI = magnetic resonance imaging): It works with strong magnetic fields and produces high-resolution sectional images.
• Endosonography: A combination of endoscopy and ultrasound (sonography). We use a special instrument equipped with a small camera (endoscope) and simultaneously take ultrasound images during the examination. Not only the organ itself, but also deeper layers of the wall or ducts can be easily recognized.
• Gastroscopy(examination of the stomach): We take samples – from the cysts, for example – to analyze the contents in more detail and differentiate between benign and malignant.
• Blood test: The blood values provide information on the condition of the organs.

Benign pancreatic tumors: prevention, early detection, prognosis

The causes of benign pancreatic tumors are largely unknown. Therefore, there are no special measures for prevention or early detection. We often diagnose benign tumors in the pancreas by chance as part of another examination. In any case, you should always visit us promptly if you have any complaints.

Course and prognosis of benign pancreatic tumors

The course and prognosis of benign pancreatic tumors cannot be generally predicted. Some tumors in the pancreas are considered harmless. We don’t have to treat them at first, we just monitor them. However, this cannot be said for all benign pancreatic tumors. This is because some pancreatic tumors, such as mucinous pancreatic tumors, have an increased risk of degenerating and becoming malignant. We must therefore treat them as early as possible to prevent cancer from developing.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Benign pancreatic tumors: Treatment depends on the type of tumor

The treatment for benign pancreatic tumors depends on the type of tumor, its size and whether it causes symptoms.