Pancreatic cancer will account for about 6% of all cancer-related deaths in 2008. Patients often present with advanced disease, so treatment remains a challenge. This article will review the risk factors, pathology features, clinical symptoms, diagnosis and staging guidelines, treatment, and nursing implications of pancreatic cancer. This article also will review studies that have precipitated the shift in systemic treatment from 5-fluorouracil to gemcitabine. Targeted therapies will further shift treatment strategies to improve survival as more is learned about the molecular basis of pancreatic cancer.