Figure 1. Plasticity of Cancer Stem Cells in Pancreatic cancer.

Normal pancreatic acinar cells undergo trans-differentiation in response to injury and metabolic or inflammatory stress in a process known as Acinar-to-Ductal-Metaplasia (ADM). Oncogenic mutations can result in failure to re-differentiate leading to malignant degeneration and cancer formation. Cancer Stem Cells (CSC) are poised to originate from de-differentiation of genetically mutated epithelial cells or from non-cancer stem cells. Factors present in the PDA TME favor persistence of CSC and can promote a more malignant phenotype including metastatic potential. CSC can self-renew or produce differentiated progeny which comprise a majority of tumor cells.