Undifferentiated Weight Loss — DCE Clinical Case

The patient scenario

Mr R, a 68-year-old retired carpenter, was referred by his GP for the investigation of the involuntary weight loss. ^[1]

Over the preceding 3 months he had lost 8 kg (10 per cent of his usual body weight of 80 kg). The loss was documented objectively on the GP record. He had not been trying to lose weight. He described a marked reduction in his appetite — he felt full after a few mouthfuls (the early satiety) — and intermittent nausea. He had the drenching night sweats that soaked the bedsheets. He had noticed increasing fatigue and breathlessness on the exertion (the anaemia). He had no dysphagia, no change in the bowel habit, no rectal bleeding, no abdominal pain, no jaundice, no cough, no haemoptysis, and no urinary symptoms. ^[1]

His past medical history included the hypertension (on the amlodipine 10 mg daily), the hyperlipidaemia (on the atorvastatin 40 mg daily), and the osteoarthritis. He was a non-smoker and drank 10 standard drinks per week. His father had the colorectal cancer at the age of 72. ^[1]

His GP bloods showed: the haemoglobin 102 g per litre (MCV 72 fL), the ALP 320 U per litre, the LDH 480 U per litre, the albumin 32 g per litre, the white cell count 14.2, the CRP 48, the normal electrolytes, the normal TFTs, the normal glucose and the HbA1c, the normal LFTs apart from the ALP. His faecal immunochemical test was positive. ^[1]