Although the estimated time for development of pancreatic ductal adenocarcinoma (PDA) is more than 20 years, PDAs are usually detected at late, metastatic stages. PDAs develop from duct-like cells through a multistep carcinogenesis process, from low-grade dysplastic lesions to carcinoma in situ and eventually to metastatic disease. This process involves gradual acquisition of mutations in oncogenes and tumor suppressor genes, as well as changes in the pancreatic environment from a pro-inflammatory microenvironment that favors the development of early lesions, to a desmoplastic tumor microenvironment that is highly fibrotic and immune suppressive. This review discusses our current understanding of how PDA originates.

尽管估计发展为胰腺导管腺癌（PDA）的时间超过20年，但通常在晚期转移阶段检测到PDA。PDA从导管样细胞发展到一个多步骤的致癌过程，从低度增生异常病变到原位癌，最终到转移性疾病。该过程涉及逐渐获取致癌基因和肿瘤抑制基因的突变，以及胰腺环境的变化，从有利于早期病变发展的促炎性微环境到高度纤维化和免疫抑制的去增生性肿瘤微环境。这篇评论讨论了我们目前对PDA起源的理解。