Metastatic ability occurs already early on in pancreatic cancer Pancreatic cancers are associated with poor survival and only some 10 per cent are resectable, but even in this subgroup recurrence is very frequent. The traditional view of sequential development of pancreatic cancer has been challenged by novel molecular biological findings, where the tumor quite rapidly might turn metastatic. In about 60 000 patients with diagnosed pancreatic cancer the association between tumor size, metastatic spread and survival was analyzed. Even the smallest tumors (<0.5 cm) had remote metastases in more than 30 per cent. Tumor biology seems more important than size per se as regards disease course and outcome and thus also sets new demands on how to define an early pancreatic cancer. The data require novel types of biomarkers/panels in serum and cancer tissue in order to take tumor biology into consideration to achieve improved personalized and more effective management of pancreatic cancer patients.