Pancreatic cancer cell invasion: mesenchymal switch or just hitchhiking?

For the majority of pancreatic cancer patients, metastatic spread is the most life-threatening issue, significantly shortening survival (1). Yet, the road for a cancer cell to successfully set its metastatic niche and to grow there is fortunately long and sown with pitfalls. Consistently, the estimated time for pancreatic cancer patients to develop a widely disseminated disease through subclonal metastatic evolution from a parental clone inside the primary carcinoma is 6.8-year, as recently reported (2). To the important question of whether the poor prognosis of pancreatic cancer is due to its late diagnosis, or because it metastasizes early during clonal evolution, Yachida et al. indeed answered that there is a long latency to development of an infiltrating cancer, and thus a large window of opportunity for early diagnosis and cure. Yet, until early detection of pancreatic cancer becomes routine, the reality is that most patients will likely continue to be diagnosed with advanced disease, as recently mathematically predicted through a comprehensive study that benefited from a large group of patient’s autopsy data (3).