Detection of pancreatic cancer (PC) at an early stage with curative surgery is the approach with the potential to significantly improve the patient's long-term outcome. Previously, after the first US examination, computed tomography (CT) was mainly performed in cases with dilatation of the main pancreatic duct, or in the presence of a cystic lesion. However, the rate of tumor detection of CT in the case of small pancreatic cancer lesions was unsatisfactory. For the diagnosis of PC lesions less than 10 mm, the rate of tumor detection was higher for endoscopic ultrasound (EUS) than for CT or other modalities, and the histologic diagnosis with EUS- fine needle aspiration (FNA) was helpful in confirming the diagnosis. For the diagnosis of PC in situ, EUS and magnetic resonance cholangiopancreatography (MRCP) played important roles in detecting the local irregular stenosis of the pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) and sequential cytodiagnosis of pancreatic juice using endoscopic nasopancreatic drainage (ENPD) multiple times have been useful in the diagnosis of PC in situ. In the future, the relationship between specialized doctors for PC in medical centers and practicing doctors would be very important to establish a social program for the early diagnosis of PC in a rural doctor's association.