Between 1960 and 1989, 207 patients with cancer of the head of the pancreas were diagnosed in the 1st Surgical Department of the University of Rome "La Sapienza". While in the first period (1960-'74) diagnosis was performed on the basis of clinical signs and traditional radiological findings, imaging and endoscopy became progressively the main diagnostic tools in the second one (1975-'89). The authors analyse how the different diagnostic approach has influenced the therapeutical outcome. Earlier diagnosis, increased resectability, proper surgical indication, decreased morbidity and mortality, improvement of survival are the achieved results.