Pancreatic adenocarcinoma is a lethal disease, with a less then 3% five year survival. Our failure in treating this cancer led to the generally accepted assumption that pancreatic cancer is indeed an extremely aggressive disease. Latest studies from Yachida and colleagues (Nature, 2010) using whole genome sequencing on a well characterized series of human primary and metastatic pancreatic cancer tissues and primary cell lines, unveiled a much milder picture of pancreatic cancer, a slow growing tumor whose natural history takes about 20 years to complete. Furthermore metastasis occurs only at the very end (2,7 years before death). Interestingly all mutations found in metastases could be found in the primary tumor, suggesting that metastases heterogeneity reflects primary tumor heterogeneity. Still early diagnosis and local control are the way to go and pancreatic cancer is no exception.
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