A 61-Year-Old Man with Dyspepsia and Weight Loss

A 61-year-old male carpenter presented with ten months’ history of dyspepsia. More recently he had developed epigastric pain and had lost four kilograms in weight because of anorexia. He was otherwise asymptomatic and in particular there was no history of nausea, vomiting, abdominal distension, melaena, haematemesis, diarrhoea, constipation, night sweats, or fevers. There was no past medical history of note, and he had a performance status of zero (see Table 1). His only medication was lansoprazole. He drank no alcohol and smoked 40 cigarettes/day. Examination was unremarkable. All blood tests, including full blood count, biochemistry, and lactate dehydrogenase, were normal.