However, they lack sensitivity and specificity as pancreatic cancer biomarkers.285,286 To date, novel markers such as ncRNAs (miRNA and lncRNA),287,288 genetic markers (e.g., KRAS, TP53, SMAD4, and CDKN2A),17,289 circulating tumor DNA (ctDNA),290 circulating tumor cells (CTCs),291,292 and exosomes293,294 have been explored. The gene discussed is SMAD4; the disease is familial pancreatic carcinoma.