Diagnostic aspects of 23 patients with carcinoma of the pancreas were analyzed and four cases of small cancer (less than 2 cm) were presented. These tumors were resected between January 1975 and December 1982 in the National Cancer Center Hospital, Tokyo. Initial signs and symptoms were generally vague and none of them were specific for pancreatic cancer. The most important clues to the detection of the tumor were jaundice in the cases of pancreas head cancer, and extragastric compression demonstrated by x-ray examination in cases of cancer of the pancreas body and tail. In those cases without jaundice, elevated levels of amylase and glucose in the serum and urine were important findings. In regard to imaging diagnosis, endoscopic retrograde cholangiopancreatography and ultrasonography were the most helpful means of diagnosis of small pancreatic carcinoma.