Carcinoma of the exocrine pancreas remains a challenging disease with poor prognosis mainly due to advanced stage by the time of presentation, the early systemic dissemination and its extraordinary local tumor progression. Surgery has little more to offer in improvement of curative percentage of disease and some progress has been made in the medical management of pancreatic cancer with the introduction and use of new chemical agents and with combined immunochemotherapy and chemoradiotherapy. The purpose of this review article is to focus on all recent advances in the management of pancreatic cancer. We review the current trial literature emphasizing the risk factors, the molecular biology of the tumor, and the therapeutic approach.