Pancreatic carcinogenesis

Abstract

Pancreatic cancer is an almost universally lethal disease. Research over the last two decades has shown that pancreatic cancer is fundamentally a genetic disease, caused by inherited germline and acquired somatic mutations in cancer-associated genes. Multiple alterations in genes that are important in pancreatic cancer progression have been identified, including tumor suppressor genes, oncogenes, and genome maintenance genes. Furthermore, the identification of noninvasive precursor lesions of pancreatic adenocarcinoma has led to the formulation of a multi-step progression model of pancreatic cancer and the subsequent identification of early and late genetic alterations culminating in invasive cancer. In addition, an increased understanding of the molecular basis of the disease has facilitated the identification of new drug targets enabling rational drug design. The elucidation of genetic alterations in combination with the development of high-throughput sensitive techniques should lead to the discovery of effective biomarkers for early detection of this malignancy. This review focuses mainly on the current knowledge about the molecular insights of the pathogenesis of pancreatic ductal adenocarcinoma.

Fig. 1.

Progression model of pancreatic ductal adenocarcinoma from normal (left) to carcinoma (right). The histological progression is associated with the accumulation of specific genetic alterations. Reprinted with permission from Maitra et al. [164].

Fig. 2.

Consecutive PanIN lesions with progressive histological changes from normal to PanIN-3. Reproduced with permission from http://pathology.jhu.edu/pancreas_panin.