The Study: When we typically think of field cancerization, we think of an organ or tissue that has widespread neoplastic changes. It is assumed that these changes are from field (i.e., whole organ) exposure to carcinogenic effects. This provocative study asks us to rethink all this. The authors microdissected multiple pancreases containing both invasive adenocarcinoma as well as several distinct areas of pre-invasive intraepithelial neoplasias to determine the lesions’ clonal evolution. Now, one might expect that a pancreas with frank cancer may contain other distinct pre-invasive neoplastic lesions, and they do. However, these “distinct” lesions aren’t really so distinct. The authors found that, instead, they often represent a single neoplastic process. In other words, several colonies of neoplastic cells migrate out along the ductal system from a single precursor lesion early in the neoplastic process. As seen before, these colonies then continue to evolve in tandem, with some eventually accumulating the necessary mutations for invasion. Maybe field cancerization is better coined field colonization.
Bottom Line: Pancreatic cancer and intraepithelial neoplasia may derive from a singular process whereby neoplastic cells colonize the pancreatic ductal system. | Makohon-Moore, Nature 2018