History 66-year-old female, retired nurse 4-month history of:Tiredness Mild breathlessness on exertion Unintentional weight loss (71 kg → 65 kg) Appetite: Normal No nausea or vomiting 2-month history of: Altered bowel habits Constipation alternating with normal pattern No visible blood in stools No abdominal pain No post-menopausal bleeding  Past & Personal History No significant past medical history No relevant family history Not on any medications Smoking history: 20 cigarettes/day for 48 years Alcohol intake: 20–28 units/week Examination Findings Mild pallor present No lymphadenopathy Breast, thyroid, cardiovascular, respiratory, and abdominal examinations: Normal Per rectal examination: Normal Blood pressure: 148/90 mmHg