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Pancreatic ductal adenocarcinoma is the fourth to fifth leading cause of cancer death in the Western hemisphere with a median survival of less than 6 months. This highly aggressive cancer is characterized by invasive biology, rapid progression and profound resistance to treatment. Most pancreatic cancers are already unresectable at the time of diagnosis. Also, for the patients who undergo potentially curative resection, the 5－year survival is only 10~20%. Recently, the incidence of this fatal cancer has been increased remarkably in our country. It is time to start having a serious considerations to pancreatic cancer. Over the past few decades, a lot of trials were performed to improve survival and symptoms in patients with pancreatic cancer, and some improvements occur in patients who also receive chemotherapy and/or radiotherapy. But the impact on long－term survival has been minimal owing to the intense resistance to all extant treatments. Advances in pathological classification and cancer genetics have improved our descriptive understanding of this disease; however, important aspects of pancreatic cancer biology remain poorly understood. Factors associated with an increased risk of pancreatic cancer include smoking, chronic pancreatitis, diabetes, prior gastric surgery, and exposure to radiation or chemicals such as chlorinated hydrocarbon solvents. A number of syndromes are identified with an increased incidence of pancreatic cancer. Surgical operation has been the dominant procedure for treating pancreatic cancer. But, it is notoriously difficult to detect at its initial condition, and most pancreatic cancers are already unresectable at the time of diagnosis. Until now, gemcitabine has been established as a new standard for the treatment of unresectable pancreatic cancer in terms of clinical benefit response, time to progression, and survival. However their effects were modest. Advancement in the understanding of the biology of pancreatic cancer has helped identify several molecular targets for the development of novel therapies. Gene therapy and immunotherapy are currently in the spotlight as promising new methods for cancer cure. Many studies have revealed the potential of their therapy for the treatment of pancreatic cancer, and early clinical trials are taking place to evaluate the success of each therapy. A better understanding of pancreatic cancer biology will lead the way to more effective treatments, however, we should keep in mind that the single most important factor to improve the survival of pancreatic cancer patient is the early diagnosis in a radically resectable condition.
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