Intraductal Papillary Mucinous Neoplasm (IPMN)

What is an intraductal papillary mucinous neoplasm (IPMN)?

An intraductal papillary mucinous neoplasm (IPMN) is a benign pancreatic cyst in the ducts of your pancreas. Healthcare providers call this a cystic tumor and consider them precancerous. This means they aren’t cancer, but do have the ability to become cancer later in life.

Researchers believe IPMNs are responsible for 20% to 30% of pancreatic cancer cases, meaning 2 or 3 out of 10 people with pancreatic cancer may have developed it from an IPMN. You can have this kind of tumor for several years before noticing symptoms. IPMNs are either treated with surgery or carefully monitored over time.

Is intraductal papillary mucinous neoplasm cancer?

Not all IPMNs become cancerous. However, some can eventually become pancreatic ductal adenoma carcinoma (PDAC). PDAC is the most common type of pancreatic cancer. Pancreatic cancer cases are relatively rare. They account for 3% of all cancer cases in the United States, but also account for 7% of all deaths caused by cancer. Too often, pancreatic cancer isn’t found early enough when treatment can make a difference.

Who’s affected by IPMNs?

Healthcare providers aren’t sure how many people may have these tumors. Studies show IPMNs are most often found in men and people who are assigned male at birth (AMAB) age 50 to 70 years old.

How does this condition affect my body?

IPMNs have cysts filled with a jelly-like substance called mucin. When benign cystic tumors become cancerous, they secrete more mucin. Mucin can block your pancreatic ducts. The ducts are tiny tubes that help you digest food. Blocked ducts can cause pancreatitis, a painful condition that may be a symptom of an intraductal papillary mucinous neoplasm.

What are IPMN symptoms?

Many people have this condition without feeling sick or having specific symptoms. Many times, people learn they have these tumors while being tested for other conditions. Typical symptoms include:

• Stomach pain that comes and goes. Some people have stomach pain after eating, which can affect their appetite.
• Unintended weight loss.
• Nausea and vomiting.
• Back pain.
• Oily poop (stool).

Other times, these tumors can cause signs and symptoms that are similar to specific conditions, including:

• Jaundice (yellowing of skin) because of blocked bile ducts.
• New-onset diabetes (high blood sugars) because of the effect on the pancreas itself.
• Pancreatitis (inflammation of the pancreas) because of blocked ducts in your pancreas.

What causes IPMNs?

Researchers believe IPMN happens when genes that manage cell growth or prevent tumors begin to change, or mutate. People with family members who have or have had pancreatic ductal adenocarcinoma (PDAC) have an increased risk of developing an IPMN.

How do healthcare providers diagnose this condition?

Healthcare providers diagnose IPMN with imaging devices, including magnetic resonance cholangiopancreatography. This is a special imaging exam that uses an MRI machine. It creates detailed pictures of your liver, bile ducts, gallbladder, pancreas and pancreatic duct. Healthcare providers use this test to look for changes in your pancreatic ducts. Providers identify specific IPMNs by category. Here’s information on those categories:

• Main duct type (MD-IPMN): These are tumors blocking your main pancreatic duct, making it get bigger or dilate. Main ducts usually measure 3.5 millimeters around. Dilated main ducts that measure more than 5 millimeters could be a sign of cancer.
• Branch duct type (BD-IPMN): These are tumors in smaller ducts that branch out from your main duct. These tumors are usually benign (noncancerous).
• Mixed type (MT-IPMN): These are tumors in both the main and branch ducts of your pancreas.

What other tests are done to diagnose IPMNs?

Healthcare providers may also use endoscopic ultrasounds (EUS) to create detailed images of your pancreas and the tumor. During this test, they can perform a type of biopsy called fine-needle aspiration (FNA) to get a sample from the tumor. They then look at the sample under a microscope for dysplasia and perform genetic tests to determine the risk of it becoming cancerous.

What is dysplasia and why is it significant?

Dysplasia is when your cells look abnormal when seen under a microscope. High-grade dysplasia means your cells look more like cancer cells than healthy cells. Low-grade dysplasia means some of your cells look like cancer cells but are believed to be lower risk of becoming cancer. Healthcare providers use information about dysplasia and the tumor’s genetic makeup to classify IPMNs as one of four categories.

Here’s information on the IPMN classifications:

• Gastric-type IPMNs:These tumors usually appear in pancreatic duct branches. They typically have low-grade dysplasia. More than 90% of people with this tumor type are alive 10 years after diagnosis.
• Intestinal-type IPMNs: These tumors usually involve the main and branch ducts of your pancreas. They typically have high-grade dysplasia and eventually become pancreatic cancer. Approximately 70% of people with this tumor type are alive five years after diagnosis. The survival rate drops to 50% 10 years after diagnosis.
• Pancreatobiliary-type IPMNs:These tumors usually involve the main and branch ducts of your pancreas and have high-grade dysplasia. Up to 80% of people with this tumor type develop invasive pancreatic cancer.
• Oncocytic-type IPMNs:These are relatively rare tumors that appear in your main pancreatic duct and have high-grade dysplasia. About half of people who have this tumor develop invasive pancreatic cancer.

How do healthcare providers treat intraductal papillary mucinous neoplasms?

If an IPMN is considered low risk, healthcare providers may recommend closely monitoring the tumor. Many benign IPMNs don’t become cancerous. That said, if you have a tumor in your main pancreatic duct, healthcare providers may recommend surgery to remove the tumor. Here are examples:

• Distal pancreatectomy: Healthcare providers remove the tail and/or body of your pancreas, therefore, removing tumors found in the main ducts located in these areas of your pancreas.
• Total pancreatectomy: Healthcare providers remove your entire pancreas, gallbladder, common bile duct, portions of your stomach and small intestine, and, most often, your spleen.
• Whipple procedure (pancreaticoduodenectomy): Healthcare providers may recommend this surgery for tumors found in main pancreatic ducts located in your pancreas head. This is the widest part of your pancreas, where it attaches to your small intestine. This surgery removes the head of your pancreas, your duodenum (the first portion of the small intestine), your gallbladder, and part of your bile duct and nearby lymph nodes.

What are potential complications of these surgeries?

There are potential complications whenever you have any type of major surgery. Everyone’s situation is different. Ask your healthcare provider about potential complications.

How long does it take to recover from these kinds of surgeries?

Again, everyone’s situation is different, but most people remain in the hospital for several days after pancreatic surgery.

Will I need to have chemotherapy or radiation therapy after my surgery?

Some studies show that postsurgery chemotherapy and/or radiation may be helpful. However, it’s important to consider that side effects of treatment may outweigh any potential benefit. Ask your healthcare provider for further information.

My provider recommends monitoring my IPMN. What does that mean?

It means the tests you’ve had show that the IPMN is benign and not likely to become cancer. Healthcare providers use imaging tests to continue monitoring these benign tumors in your pancreatic ducts.

How can I reduce my risk of developing an intraductal papillary mucinous neoplasm?

Researchers believe this tumor develops when certain genes change, or mutate. So, there’s nothing you can specifically do to prevent an IPMN from developing. However, it may be helpful to follow these steps to determine your risk of IPMN and potential ways to reduce it:

• Learn about your family’s medical history. Studies show that people with family members who had pancreatic ductal adenocarcinoma have an increased risk of developing IPMNs.
• Pancreatic cancer is linked to smoking. If you smoke, dip, use shush or any other form of tobacco, try to quit.
• Drink alcohol in moderation or stop drinking alcohol entirely.
• Try to reach and maintain a healthy weight.
• Try to avoid getting Type 2 diabetes through proper diet and exercise. If you have diabetes, work with your healthcare provider to best manage your blood sugar levels.

How long can you live with an IPMN?

Similar to nearly all types of cancer, early diagnosis and treatment make the biggest difference in prognosis. Overall, about 95% of people diagnosed and treated for IPMNs before it becomes pancreatic cancer are alive five years after diagnosis. If you have questions about what to expect, your healthcare provider is your best resource for information about your specific situation.

I have an IPMN that’s benign? How do I take care of myself?

Most of these tumors don’t become cancer, but it can be stressful knowing they might. If you’re feeling anxious, ask your healthcare provider to help address your concerns. They’ll explain why you probably won’t develop pancreatic cancer. They may also have suggestions about things you can do to reduce your overall risk of developing pancreatic cancer.

A note from Cleveland Clinic

Intraductal papillary mucinous neoplasm (IPMN) is a long and likely confusing name for a tumor in your pancreatic ducts that carries a risk of turning into pancreatic cancer. This tumor usually doesn’t cause symptoms and is often found incidentally during tests done for other reasons.

It may come as a shock when your healthcare provider says that you have an IPMN. Keep in mind, though, that having this condition doesn’t specifically mean you’ll develop cancer. Many times, further tests will show that the tumors are benign. If your tumor is benign, your healthcare provider will keep a vigilant watch for signs of it becoming higher risk and/or changing into a cancer. Also, it’s important to remember that if your tumor is found to be high risk, about 95% of people diagnosed and treated for IPMNs before it becomes a form of cancer are still alive five years after their diagnosis.

Regardless of your situation, there are things you can do to reduce the chances that you’ll develop pancreatic cancer. Discuss it further with your healthcare provider, who’ll be happy to help guide you.