title: The pathology and genetics of metastatic pancreatic cancer.
abstract: BACKGROUND
  Metastatic disease is the most critical determinant of resectability of pancreatic cancer and accounts for the poor outcome of patients with this disease. Thus, a better understanding of metastatic pancreatic cancer will afford new opportunities for therapeutic intervention.
  
  
  OBJECTIVE
  To summarize and discuss the current understanding of the clinical and molecular features of metastatic pancreatic cancer.
  
  
  METHODS
  Published literature on advanced stage pancreatic cancer, pancreatic cancer metastasis, and autopsy findings in patients with pancreatic cancer.
  
  
  CONCLUSIONS
  In the clinical setting, it can be difficult to distinguish a metastatic pancreatic carcinoma from primary neoplasms in the liver, lung, or ovary. However, immunolabeling for DPC4 protein as part of a diagnostic panel is useful for making this distinction. Emerging data from a variety of investigators now indicate that overexpression of EphA2, loss of DPC4 and MKK4, and aberrant activation of the Hedgehog signaling pathway are associated with metastatic propensity of pancreatic cancers, providing novel therapeutic targets for the most lethal stage of this disease.
authors.affiliation: The Johns Hopkins Medical Institutions, The Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland 21231, USA.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yachida
authors.forename: Christine A
authors.initials: CA
authors.lastname: Iacobuzio-Donahue
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D003937:Diagnosis, Differential; D006801:Humans; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology*; D036104:Receptor, EphA2 / Q000378:metabolism; D051901:Smad4 Protein / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D036104:Receptor, EphA2