Pancreatic cancer is among the most fatal cancer types due to the difficulty in diagnosis and treatment. Better understanding of the molecular pathogenesis of pancreatic cancer will facilitate early diagnosis and treatment. Recently, numerous genetic and epigenetic alterations ranging from point mutations to chromosomal changes have been described. Such changes involved in the pathogenesis of the disease include K-Ras2 mutation, Her2/Neu gene overexpression, CDKN2A/p16 gene deletion, mutation and hypermethylation, inactivation of BRCA2, MADH4/SMAD4/DPC genes and changes in expression of STK11 and p53 genes. In this review, we aimed to outline the molecular pathogenesis of pancreatic cancer and describe new diagnosis and treatment approaches with in the light of new findings.