Causes of diagnostic delay and survival figures were compared in three groups of patients (total 191 patients) with ductal adenocarcinoma of the pancreas between the years 1951 and 1960 and 1971 and 1980. The main causes of delay between onset of symptoms and definitive treatment were patient delay in seeking medical advice and delay by the initial doctor in referring the patient. Recent direct imaging techniques of ultrasound, computerized axial tomographic scanning, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography did not significantly decrease this diagnostic delay. Operative mortality in the groups treated by pancreatoduodenectomy between 1951 and 1960 and 1971 and 1980 were 13.9 and 3.4 percent, respectively. The mean survival rates for these groups were 14 and 20.4 months, respectively. Patients with unresectable carcinoma of the pancreas between 1971 and 1980 had an operative mortality rate of 10 percent and a mean survival of 6.7 months. Various aspects of symptomatology and operative findings in patients with carcinoma of the pancreas are emphasized to aid early diagnosis.