Pancreatic cancer is the fourth leading cause of cancer death in the United States [1,2]. Approximately 32 000 individuals in the USA and over 200 000 individuals worldwide die from the disease each year [1-3]. The incidence approximates the mortality rate, which reflects the poor prognosis of pancreatic cancer. Although there have been many advances in pancreatic cancer research, the 5-year survival rate for affected patients remains under 5% [2].
The aggressiveness that characterizes pancreatic cancer arises from multiple heterogeneous genetic changes that occur before the onset of clinical symptoms. Studies performed over the past decade have shed some light on the molecular and histological events that are associated with pancreatic carcinogenesis. This chapter will focus on the genetics and pathology of pancreatic ductal adenocarcinoma. Future progress in this area will hopefully lead to improved diagnostic tests, early detection, and new treatments for patients who suffer from this devastating disease.