Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
(Depending on presentation) Abdominal pain, nausea, jaundice, unintentional
weight loss, new diagnosis of pancreatic cyst.
History of Present Illness:
Onset, duration, and character of any abdominal pain (e.g., location, intensity,
radiating qualities).
(If applicable) Describe any associated symptoms like nausea, vomiting,
jaundice, change in bowel habits.
(If known) Size, location, and characteristics of the pancreatic cyst
(obtained from prior imaging studies).
Recent history of pancreatitis (acute or chronic).
Family history of pancreatic cancer or genetic syndromes associated with pancreatic cysts (e.g., Lynch syndrome, familial adenomatous polyposis (FAP)).
Past Medical History:
Underlying medical conditions (e.g., diabetes, chronic pancreatitis).
Prior abdominal surgeries (especially pancreatic surgery).
Smoking history (smoking is a risk factor for pancreatic cancer).
Alcohol use (heavy alcohol consumption can contribute to pancreatitis).
Social History:
Occupational exposures (e.g., chemicals, pesticides).
Physical Exam:
General examination: Assess for signs of weight loss, jaundice, or abdominal mass.
Abdominal examination: Palpate for tenderness, mass, or organomegaly (enlarged liver or spleen).
Laboratory Tests:
(Depending on clinical suspicion)
Serum tumor markers (CA 19-9): While not diagnostic for pancreatic cancer, an elevated level may raise suspicion.
Liver function tests: May be abnormal if there is biliary obstruction
from the cyst.
Electrolytes: May be deranged if there is significant vomiting or pancreatitis.
Blood tests for genetic syndromes: May be considered if there is a family history suspicious for a hereditary cancer syndrome.
Imaging Studies:
Abdominal ultrasound (initial study): May show the presence of a pancreatic cyst and provide information about its size and location.
MRI with magnetic resonance cholangiopancreatography (MRCP): Provides detailed images of the pancreas, bile ducts, and pancreatic duct to assess the characteristics of the cyst and its relationship to surrounding structures.
Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA): May be used for more precise cyst evaluation and to obtain tissue samples for cytological analysis to differentiate between benign and malignant cysts.
CT scan (less preferred due to radiation exposure): May be used in certain situations to evaluate the cyst and surrounding structures, especially if MRCP is contraindicated.
Assessment:
Neoplastic pancreatic cyst: Based on imaging findings (presence of a pancreatic cyst with concerning features).
Cyst characteristics: Describe the size, location, and any worrisome features identified on imaging studies (e.g., septations, mural nodules).
Risk stratification (ABCD system or Fukuoka criteria): These scoring systems use imaging features, patient characteristics, and cytology results to estimate the risk of malignancy in pancreatic cysts.
Differential Diagnoses:
Consider other causes of pancreatic cysts, depending on the presentation:
Serous cystadenoma: Most common benign pancreatic cyst.
Mucinous cystic neoplasm (MCN): Premalignant cyst with potential for progression to cancer.
Intraductal papillary mucinous neoplasm (IPMN): Premalignant cyst with papillary projections inside the pancreatic duct.
Pseudocyst: Fluid collection that can develop after pancreatitis.
Plan:
The plan will depend on the characteristics of the cyst, risk of malignancy, and the patient’s overall health. Possible elements include:
Active surveillance: Monitoring the cyst with serial imaging studies
at regular intervals for any signs of growth or concerning features.
Endoscopic cyst aspiration or drainage: May be performed for symptomatic cysts or those with concerning features on EUS.
Surgical resection: Recommended for high-risk cysts