It’s 4:45 PM on a rainy Friday in your oncology clinic. You are reviewing the referral for Mr. Tanner, a 58-year-old construction foreman. He presents with a two-month history of vague abdominal discomfort that has recently become severe, radiating to his mid-back.

He has lost 20 lbs (9 kg) unintentionally over the last eight weeks. His wife, Maria, mentions that his eyes have looked “yellow” for the past few days. He sits hunched forward in the chair, gripping the armrests.