Duodenal cancer: 8 things to know about this rare gastrointestinal cancer
July 08, 2026
- Duodenal cancer develops in the first part of your small intestine.
- Symptoms may not appear in early stages, or they may mimic symptoms of other digestive issues, like abdominal pain or bowel changes.
- Early-stage duodenal cancer can often be cured with surgery called a Whipple procedure.
The duodenum is the first part of your small intestine, also known as your small bowel. It is connected to your stomach. It helps with digestion by absorbing nutrients and water from the foods you eat after they enter your stomach.
Cancer that develops in the duodenum is known as duodenal cancer. You may sometimes hear it called “small intestine cancer” or “small bowel cancer.” But those actually describe all cancers that develop in the small intestine. Duodenal cancer is cancer that specifically develops in the duodenum.
Here, I’ll share more about duodenal cancer, including symptoms, treatment and why it can be hard to diagnose.
How rare is duodenal cancer?
The most common type of duodenal cancer is duodenal adenocarcinoma. This is a very rare type of cancer. Other types of cancer, such as neuroendocrine tumors, lymphomas or sarcomas, can also occur in the duodenum in rare cases.
To put it in perspective, small intestine cancers account for just 3% of all gastrointestinal cancer diagnoses in the U.S. About 4,000 to 5,000 of those diagnoses are small intestine adenocarcinomas, with over half of them being duodenal adenocarcinomas.
Some doctors may see only one or two of these diagnoses in their lifetime. But we see a lot of duodenal cancers at UT MD Anderson because we’re a specialized cancer center and we’ve done a lot of research in this space.
What causes duodenal cancer?
Doctors don’t know exactly what causes duodenal cancer. It’s most often diagnosed in older adults in their 60s.
There are factors that increase your risk for developing duodenal cancer. These risk factors include:
- Celiac disease: This is an autoimmune disorder in which digesting gluten causes damage to the lining of the small intestine.
- Lynch syndrome: This is a genetic condition that increases the chance of a person developing several cancers and developing them earlier than normal.
- Familial adenomatous polyposis (FAP): This inherited disorder is caused by a mutation in the APC gene. It leads to the development of hundreds to thousands of precancerous colon polyps throughout the gastrointestinal tract.
- Peutz-Jeghers syndrome: Caused by a mutation in the STK11 gene, this genetic disorder can cause polyps to form in your gastrointestinal tract. It increases your risk for several cancers.
What are the symptoms of duodenal cancer?
Duodenal cancer and small intestine cancer typically have the same symptoms. The most common duodenal cancer symptoms include:
- Abdominal pain
- Bowel changes
- Nausea
- Weight loss
- Iron deficiency anemia
- Blockage in the gastrointestinal tract
These symptoms are similar to symptoms caused by other digestive issues. So, people often overlook duodenal cancer symptoms, which can allow the cancer to grow.
See your doctor if you have any of these symptoms, so they can determine the cause and provide treatment.
How is duodenal cancer diagnosed?
Diagnosing duodenal cancer can be challenging because the small intestine is not an easy area to evaluate. It’s about 20 feet long, and it wraps and curls.
Imaging tests like CT scans and MRIs can help your doctor see inside your small intestine. Your doctor may also perform an upper endoscopy to see inside your duodenum. This is when a scope is inserted into your mouth and passes down your digestive tract into your duodenum. During the procedure, your doctor may also get a tissue sample to biopsy.
At UT MD Anderson, we use a capsule endoscopy. This is a procedure in which you swallow a capsule that contains a camera. As it passes through your digestive tract, it takes pictures of your small intestine and sends them to a recorder on a belt that is placed around your waist.
Because symptoms of duodenal cancer are often non-specific, it’s often diagnosed at advanced stages. At times, symptoms may not appear until the tumor grows large enough to cause a blockage in the small intestine. Often, a person will then have surgery to remove the blockage, and a biopsy shows that they have adenocarcinoma.
Adenocarcinomas can develop in the pancreas, biliary duct, the ampulla of Vater and duodenum. It’s important to determine where exactly the cancer developed, so you get the correct treatment.
Your doctor will use their clinical expertise, imaging, pathology and molecular profile of the tumor to diagnose duodenal cancer.
How is duodenal cancer treated?
Duodenal cancer is curable when it’s caught early. The most common treatments are surgery, chemotherapy and radiation therapy. You may have any combination of the three as part of your treatment plan.
Surgery: This is the standard curative treatment for duodenal cancer. A Whipple procedure is the most common type of surgery to treat duodenal cancer. During this operation, a surgeon removes the duodenum, head of the pancreas, gallbladder, bile duct, nearby lymph nodes and sometimes part of the stomach.
Chemotherapy: Chemotherapy may be given before or after surgery to kill cancer cells and stop them from growing. It is also the standard treatment for patients with metastatic disease.
Radiation therapy: Radiation therapy may be used to shrink or slow tumor growth before surgery. It can also be given after surgery to destroy any remaining cancer cells.
Does duodenal cancer ever recur?
After treatment, duodenal has a chance of coming back. Systemic recurrence, or distant metastasis, is a concern for duodenal cancer. This is when the cancer comes back far from the original site of the tumor. It’s also known as stage 4 duodenal cancer.
Duodenal cancer can also recur locally, which is when the cancer comes back in the same location as the original tumor, or close to it.
What is the prognosis if you have duodenal cancer?
Of all gastrointestinal cancers, cancers in the small intestine – like duodenal cancer – tend to have a worse prognosis than colon cancer.
Screening colonoscopies can detect colorectal cancer early, when the chance for successful treatment is higher. There is no screening test for duodenal cancer. This, along with the fact that symptoms may be non-specific or not show up right away, means most people are diagnosed when the cancer is stage 3 or stage 4. Generally speaking, the higher the cancer’s stage, the lower the survival rate.
Adequate lymph node removal also affects prognosis. People who do not have enough lymph nodes removed during surgery for duodenal cancer face less favorable outcomes than those who do have an adequate number of lymph nodes removed.
Early-stage duodenal cancer is curable with surgery, so it’s very important to see a doctor as soon as you notice any concerning symptoms in your digestive tract. Data has shown that curative surgery is even possible in some patients with limited metastasis, though this is rare.
Seeking care at a cancer center like UT MD Anderson gives you a better chance for successful treatment. We see more cases of duodenal cancer than most institutions, and we’re making new research advances that can potentially help extend patients’ lives.
What research is UT MD Anderson doing to advance duodenal cancer treatment?
We’ve conducted several clinical trials for cancers of the small intestine. Two notable areas of research are:
Taxanes to treat metastatic small intestinal cancer
A previous clinical trial showed promising results using taxanes, a class of chemotherapy drugs given intravenously, to treat metastatic small intestinal cancer. Based on those findings, I’m leading a Phase 2 clinical trial that is studying whether it’s better to give the targeted therapy agent ramucirumab in combination with either the paclitaxel (taxane) or the chemotherapy regimen FOLFIRI to treat patients with metastatic small intestinal cancer or small intestinal cancer that is no longer responding to treatment.
We typically use taxanes to treat gastric cancer, not colon cancer. And small intestinal cancer is often treated like colon cancer. So, this would be the first time we treat it more like gastric cancer.
Immunotherapy in MSI-high tumors
Similar to colorectal cancer, our research has shown that advanced small bowel adenocarcinomas that are microsatellite instability-high (MSI-high) have better responses to immunotherapy such as pembrolizumab. This means that immunotherapy can be an effective treatment for this particular molecular subset of advanced small intestinal cancers.
If you’re diagnosed with a rare cancer like duodenal cancer, I recommend seeking a center of excellence, like UT MD Anderson. We have experience in diagnosing and treating the rarest of cancers, and we’re always researching new ways to better treat patients.
Michael Overman, M.D., is a gastrointestinal medical oncologist at UT MD Anderson.
Request an appointment at UT MD Anderson online or call 1-877-632-6789.