8. Desmoplasia and chemoresistance in pancreatic cancer

The desmoplastic reaction is a prominent pathological characteristic of pancreatic cancer. Desmoplasia is marked by a dramatic increase in the proliferation of alpha-smooth muscle actinpositive fibroblasts and is also accompanied by increased deposition of many extracellular matrix components. Changes in stromal cell proliferation and the deposition of extracellular matrix components result in dramatic changes in overall tissue heterogeneity and elasticity, as well as accompanying interstitial fluid pressure. These changes have been suggested to contribute to chemoresistance in cancer. Chemoresistance brought about by desmoplasia has both biological and physiological causes and consequences. In this chapter, we discuss some of the origins of desmoplasia in pancreatic cancer, and how it might be contributing to resistance to current chemotherapeutic interventions.