A 66-year-old woman, a retired nurse, consults her GP with a 4-month history of tiredness, slight breathlessness on exertion and loss of weight from 71 to 65 kg. History Her appetite is unchanged and normal; she has no nausea or vomiting, but over the last 2 months she has had an altered bowel habit with constipation alternating with her usual and normal pattern. She has not seen any blood in her faeces and has had no abdominal pain. She has had no post-menopausal bleeding. There is no relevant past or family history, and she is on no medication.
She has smoked 20 cigarettes daily for 48 years and drinks 20–28 units of alcohol a week. Examination She has slight pallor but otherwise looks well. No lymphadenopathy is detected, and her breasts, thyroid, heart, chest and abdomen, including rectal examination, are all normal. The blood pressure is 148/90 mmHg. Source: 100 Cases in Clinical…
