Early diagnosis of pancreatic cancer is difficult because of the lack of early symptoms, accurate screening methods, and insensitivity of noninvasive imaging. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are the most sensitive procedures to detect early pancreatic cancer. In patients with biliary obstruction, ERCP is performed as the first invasive procedure to assess morphology of the pancreatic and biliary duct and tissue diagnosis by brush cytology. In patients without biliary obstruction, guided aspiration cytology should be performed either by percutaneous sonography, CT scan or EUS. Staging should be performed if no metastases are present. EUS increases accuracy of T and N staging especially in periampullary tumors. Laparoscopy in combination with CT scan and angiography correctly identifies the majority of unresectable cases. Aggressive diagnostic and staging procedures are justified to identify the prognostically more favorable tumors.