Comprehensive review of current management and precision medicine in pancreatic cancer

Pancreatic cancer is one of the most lethal malignancies, with an increasing incidence and limited improvement in survival despite therapeutic advances. Surgical resection remains the only curative option; however, recurrence is frequent, and long-term outcomes remain dismal. Major risk factors include smoking, obesity, diabetes, chronic pancreatitis, and pathogenic germline variants such as BRCA1/2, ATM, and mismatch repair genes. Routine population screening is not recommended; instead, surveillance using endoscopic ultrasonography and magnetic resonance cholangiopancreatography is recommended for high-risk individuals. Diagnosis relies on multiphasic pancreatic protocol computed tomography and histological confirmation. Treatment strategies are determined based on resectability: upfront surgery with adjuvant chemotherapy for resectable disease, neoadjuvant chemotherapy for borderline resectable or high-risk patients, and palliative chemotherapy with or without chemoradiation for locally advanced cases. Systemic therapies, including FOLFIRINOX, gemcitabine plus nab-paclitaxel, and NALIRIFOX, remain the cornerstone of therapies for metastatic disease, with precision medicine offering targeted options such as PARP inhibitors for BRCA-mutated tumors. Modern radiotherapy techniques including stereotactic body radiation therapy and particle therapy enhance local control and reduce toxicity. The integration of next-generation sequencing and multidisciplinary management is essential for improving pancreatic cancer outcomes.