The incidence of pancreatic cancer is on the rise worldwide. Pancreatic cancer has now become one of the 10 most common malignancies in Western countries. The incidence of pancreatic cancer in the United States has increased fourfold in the past 10 years, with about 28,000 new cases detected each year and less than 10% surviving more than one year after diagnosis, ranking fourth among the causes of death from malignant tumors, with an overall 5-year survival rate of no more than 1% and the worst prognosis among more than 60 types of malignant tumors. About 5,000 people die from pancreatic cancer every year in the UK, and the overall 5-year survival rate is only 0.4%. In China, according to the statistics of Beijing and Shanghai in recent years, the incidence of pancreatic cancer is 8/100,000 people, which is 5 times higher than 20 years ago and has become the 5th cause of death. 3/4 of pancreatic cancer patients have a survival period of less than 6 months after diagnosis. Studies have shown that the 5-year survival rate of pancreatic cancer patients with tumor diameter ≤2cm is 19%-41%, while the tiny pancreatic cancer with diameter <1cm, mostly without pancreatic parenchymal infiltration, lymphatic metastasis and vascular nerve involvement, can be called "early pancreatic cancer" and the 5-year survival rate can reach 100% after surgery. Therefore, early detection and early diagnosis are the key to effective treatment and improved prognosis of pancreatic cancer. Although the diagnostic technology of pancreatic cancer has made great progress in recent years, the overall prognosis has not changed significantly, and a large amount of literature shows that the 5-year survival rate after surgery is still about 5%, with a poor prognosis. The key to improve the effectiveness of pancreatic cancer diagnosis and treatment is early detection. Therefore, to actively explore the early diagnosis method is the direction of future efforts. Faced with such a grim reality, we have to admit that the diagnosis and treatment of pancreatic cancer are still facing great challenges today as mankind enters the 21st century. It is still necessary to pay great attention and redouble our efforts to improve the early diagnosis rate and prognosis of pancreatic cancer under the present conditions. The significance of early diagnosis of pancreatic cancer Early detection is the key to get the best treatment effect of tumor, and pancreatic cancer is no exception. Although the percentage of clinically detected early stage pancreatic cancer is very low, if we analyze these cases individually, we will find that the surgical resection rate of early stage pancreatic cancer is 90% to 100%, and the 5-year survival rate is 70% to 100%, and there is a huge contrast between the two treatment effects compared with the progressive stage pancreatic cancer. In addition to the characteristics of pancreatic cancer itself, the lack of vigilance and adequate attention by clinicians is one of the main reasons for this situation. Even in western countries, 25% of patients have symptoms of upper abdominal discomfort 6 months before diagnosis; 15% of patients still need more than 6 months to get a diagnosis after visiting the hospital. In China, the proportion of misdiagnosis affecting treatment is even higher, and patients who are referred to a large hospital with a confirmed diagnosis of hepatobiliary and pancreatic specialties are asked about their medical history, and most of them have a history of gastrointestinal or hepatobiliary diseases in hospitals of different levels for at least >3 months, or even longer than 1 year. By the time patients obtain a diagnosis, most have lost the opportunity to undergo radical resection. It can be seen that if the outpatient physician can realize the possibility of the existence of pancreatic cancer when the patient first visits the clinic, and the patient and family can pay enough attention to the physician’s suggestion and perform targeted examinations, the misdiagnosis rate of pancreatic cancer can be significantly reduced, the time to diagnosis can be shortened, and the early diagnosis rate and 5-year survival rate can be improved. Specific measures to strengthen the early diagnosis of pancreatic cancer Strengthen the popularization of the knowledge of pancreatic cancer prevention and treatment, so as to increase the alertness of clinicians and the public to early pancreatic cancer. There are two reasons why pancreatic cancer is difficult to be detected at an early stage: doctors and patients, first of all, should try to make sure that patients who have already visited the hospital are not delayed in diagnosis and are diagnosed early. It is easy for physicians who specialize in hepatobiliary and pancreatic to do so; however, most general physicians, surgeons, outpatients and emergency physicians, as well as primary care workers, should be alert in this regard. For patients over 40 years of age who present with abdominal pain, jaundice, upper abdominal discomfort, dyspepsia, wasting, nausea, vomiting, or sudden onset of diabetes, after excluding other diseases, they should be highly alert to the possibility of pancreatic cancer. The most common reason for misdiagnosis is to be satisfied with the diagnosis of chronic gastritis. When performing gastroscopy, a considerable number of patients have superficial gastritis, therefore, it is important not to be satisfied with this diagnosis, and for the above-mentioned high-risk group, further screening should be performed to avoid delaying the diagnosis. For hospitals that do not have conditions for further examination, patients should be referred to experienced medical specialty centers in a timely manner to complete the necessary tests in the shortest possible time to achieve early diagnosis and treatment. On the other hand, many patients often do not go to the hospital when their symptoms are mild, which is one of the important factors that make early detection of pancreatic cancer difficult. In view of this situation, medical practitioners, especially those who are engaged in hepatobiliary and pancreatic specialties, have the responsibility to strengthen education and popularize related knowledge. It is believed that with the increase of people’s health care awareness, the number of cases of early presentation to hospitals will gradually increase. Surveillance of high-risk groups is an important way to detect early pancreatic cancer Because pancreatic cancer is basically distributed and lacks specific tumor markers, it is neither economical nor practical to conduct large-scale screening. However, current studies have shown that screening and surveillance for its high-risk groups, make early diagnosis possible. The high-risk groups for pancreatic cancer include the following: ① Patients older than 40 years old with non-specific symptoms in the upper abdomen. ②Patients with a family history of pancreatic cancer, it is believed that genetic factors account for 5% to 10% of the incidence of pancreatic cancer. ③Patients with sudden onset diabetes mellitus, especially atypical diabetes mellitus, age over 60 years, lack of family history, no obesity, and insulin resistance soon. 40% of patients with pancreatic cancer have diabetes mellitus at the time of diagnosis. ④Patients with chronic pancreatitis are now considered to be an important precancerous lesion in a small percentage of patients, especially chronic familial pancreatitis and chronic calcific pancreatitis. ⑤ Intraductal papillary mucinous neoplasm is also a precancerous lesion. (6) Familial adenomatous polyposis combined with pancreatic cancer is higher than the normal population. (7) The incidence of pancreatic cancer is 1.65 to 5 times higher in those with benign lesions undergoing major distal gastrectomy, especially in those who are more than 20 years postoperative. (8) High risk factors for pancreatic cancer include smoking, heavy alcohol consumption, and long-term exposure to harmful chemicals. The pancreatic cancer is detected by ultrasound, CT, MRI, MRCP and serologic tumor markers, etc. Ultrasound is simple, economical, non-invasive and repeatable, and it is sensitive to pancreaticobiliary duct dilatation; however, 15%-25% of patients cannot clearly show pancreatic cancer due to the influence of intestinal gas and pancreatic location. The CT should be used as a routine examination, especially spiral CT, which can reach the level of ultrasound endoscopy (EUS) in the diagnosis of early pancreatic cancer. MRCP is a safe and non-invasive imaging technique for pancreaticobiliary ducts, which is better than ERCP in reflecting the whole picture of pancreaticobiliary ducts, but it cannot completely replace ERCP in the early diagnosis of pancreatic cancer. Current serologic tumor markers are not as sensitive and specific markers as AFP in the diagnosis of primary liver cancer for the diagnosis of early pancreatic cancer. However, combining the current tumor markers (such as CA199, CA50, CA242 and CEA) and corroborating them with imaging findings can help improve the positive rate of early diagnosis of pancreatic cancer. Since more than 80% of pancreatic cancers originate from ductal epithelium, ERCP examination can be used to collect pure pancreatic fluid and brush the exfoliated cells for cytological examination, oncogene mutation and tumor marker detection, which is an important progress in the early diagnosis of pancreatic cancer in recent years and it can significantly improve the detection rate of early pancreatic cancer. The microscopic pancreatic cancer and carcinoma in situ reported in the literature in recent years were detected using the above mentioned methods, and the treatment results of these pancreatic cancer patients were quite satisfactory, with a 5-year survival rate of nearly 100%. It is worth mentioning that a positive K-ras gene point mutation measured in pancreatic fluid can only suggest an early event in the development of pancreatic cancer and does not confirm the diagnosis of pancreatic cancer. However, patients who are positive should be followed up closely, and it has been reported that some patients with pancreatic cancer were found positive for K-ras gene mutations in pancreatic fluid 3 years before they were diagnosed. In addition, many new imaging techniques have gradually started to be used for the early diagnosis of pancreatic cancer, such as endoscopic ultrasound, pancreatic ductoscopy, intrapancreatic ductal ultrasound, dynamic spiral CT (combining ERCP with spiral CT), positron emission tomography (PET), etc. The development of imaging techniques will enable the detection of more and more small pancreatic cancers. To sum up, paying attention to the early diagnosis of pancreatic cancer so that it can be detected early and treated in time is the key to improve the prognosis of pancreatic cancer; raising the vigilance of pancreatic cancer, choosing the examination means reasonably, forming a multidisciplinary consortium of related basic research, internal medicine, surgery, imaging, endoscopy, clinical pathology, experimental diagnostics, etc., creating a new model of multidisciplinary cooperation, with the research of early prevention and treatment of pancreatic cancer as the main focus. In order to improve the diagnosis and treatment level, the current situation that pancreatic cancer is difficult to be diagnosed at an early stage can be improved by giving full play to the advantages of multidisciplinary cooperation.