A 59-year-old man presents with intermittent epigastric pain and mild jaundice for one month. His urine has become darker over the same time. He has also lost five kilograms of weight over the last three months.
His medical and surgical histories are unremarkable. He is not on any medications, including over-the-counter drugs or herbal supplements. There is no family history of malignancies. He is a heavy smoker, with a total pack-history of 40 years. He has also consumed three to four units of alcohol a day for almost a decade.
A complete blood count and renal profile are within normal parameters. However, a liver profile shows ALP 467 U/L (normal: 45-115), GGT 321 U/L (normal: 9-48), total bilirubin 2.3 mg/dL (normal: 0.1-1.3), and direct bilirubin 2.1 mg/dL. Liver transaminases, serum albumin levels and the INR are all normal. Serum amylase and lipase are also within normal levels.