• Duodenum is MC site of small intestinal adenocarcinoma • 15% in the proximal; 40% in the middle and 45% in the distal duodenum (MC) • Resectability and prognosis are better than other upper GI cancers. Clinical Features • Most often presents as obstruction, with nausea, vomiting, and abdominal pain as the most frequent symptoms. • Anemia from bleeding and biliary or pancreatic obstructive symptoms can also be seen on initial presentation if the tumor is located within the periampullary region. Diagnosis • Endoscopy is the diagnostic test of choice for duodenal tumors, which allows for direct visualization and biopsy as needed. Treatment • For 1st or 2nd portion: Whipple procedure • For 3rd or 4th portion: Segmental duodenal resection