Despite considerable progress in the areas of epidemiology and molecular genetics, pancreatic cancer is still characterized by a dismal prognosis. The current overview attempts a critical analysis of the published data resulting in recommendations for diagnostic and therapeutic algorithms. The diagnostic work-up of suspected pancreatic cancer patients includes an initial abdominal ultrasound which in case of ambiguous results or the absence of distant metastases is followed by "one-stop-MRI" and explorative laparotomy. Locally confined tumour disease should proceed to resective surgery which however results in cure only in a minority of resected patients even in specialized centers. Adjuvant chemotherapy might be of some benefit in terms of survival. Locally advanced but irresectable disease can be considered for combined radiochemotherapy. Systemic chemotherapy with Gemcitabine -results in marginal benefit of overall survival and may offer clinical benefit to a subgroup of patients. Best supportive care still remains the mainstay of irresectable disease. This summary highlights the urgent need for the development of innovative diagnostic and therapeutic strategies.