Pancreatic cancer is a nearly lethal disease. Patients have such a poor prognosis because there are no early symptoms. Upon presentation, most patients already have regional and systemic spread of the disease. With cure rates below 3%, long-term survival is difficult to measure. Thus, the assessment of clinical benefit has been based not only on observed 5-year survival but more frequently on actuarial, median, and disease-free survival. Surgery remains the only hope for cure, but median survival remains low despite improvements in peri- and postoperative treatment of complications and sharp decreases in perioperative morbidity and mortality. The addition of adjuvant chemo- and radiotherapy has provided a survival advantage of 6 to 10 months (increasing median survival to 20 months). However, the long-term benefit, if any, is still to be determined. Neoadjuvant therapies are also undergoing evaluation, but their role has not yet been established. True long-term survival may ultimately depend on the development of screening tools that will allow early detection (before regional and systemic spread) of this lethal disease.