We read with interest the case report by Akinosoglou et al. 1 on hyperamylasaemia in association with lung cancer, and the accompanying editorial by Crook. 2 Both noted the rarity of hyperamylasaemia in association with malignancy. In our experience, patients with hyperamylasaemia may be labelled as having pancreatic disease irrespective of whether the signs and symptoms fit. This is a very important point, since failure to consider the possibility of malignancy may lead to a delay in the correct diagnosis. 3 If the patient does not have symptoms readily attributable to commoner causes of hyperamylasaemia, less frequent causes like pancreatic pseudocyst and macroamylasaemia may be suspected. Particularly when these causes have also been excluded, malignancy-associated hyperamylasaemia should be considered.