In Belgium, approximately 1100 new cases of pancreatic ductal adenocarcinoma are diagnosed each year. Although in the last twenty years several advances have been registered in the field of pancreatic pathology, few therapies are efficacious, and it remains one of the deadliest of all cancers. Histological variants with a somewhat different prognosis have been recognised, and precursor lesions identified. This article reviews the histological aspects of ductal adenocarcinoma, its variants and the precursor lesions. Study and knowledge of these precursor lesions offers the best hope for treating pancreatic cancer before an incurable invasive tumour develops.