BIRC5 and pachyonychia congenita: Chemoresistance in PC has also been linked to pancreatic cancer stem cells which have enhanced epithelial-mesenchymal transition (EMT), altered metabolism, altered key genes (such as KRAS, TP53, CCND1, BIRC5, and BCL-2), dysregulated signaling pathways (including Notch, PI3K/AKT, Hedgehog, and NF-κB), reduced apoptosis, and increased cell cycle (33, 34).