Tumor biology rules
In a recent study, it was shown that the tumor size per see (mm; T-stage 1, i.e. up to 20 mm) seems inferior to tumor biology, as even pancreatic tumors up to maximum 5 mm in diameters are associated with remote metastases in some 30% (Ansari D et al. Relationship between tumor size and outcome in pancreatic ductal adenocarcinoma. BJS 2017;104:600-7). This corresponds well with the renewed model of pancreatic cancer evolution where the development is not only traditionally "sequential" (for years), but also suddenly might become very aggressive and metastatic (Notta F et al. A renewed model of pancreatic cancer evolution based on genomic rearrangement patterns. Nature 2016; 538:378-829). This has recently required a redefinition of "what´s an early pancreatic cancer" and those dealing with that, emphasised by Swedish radio and the Swedish Medical Association Journal (ref). The future is in biomarkers (tissue and serum/plasma) expressing not only a diagnostic "panel", but especially prognosis/prediction, choice of therapy and potentially future targeted/personalized therapy.