A 55-year-old man complains of passing pale stools for around one month. The stools are malodorous and difficult to flush away. He has lost around four kilograms of weight during this time period.

He was diagnosed with pancreatic cancer three months ago, after being investigated for jaundice. He refused surgery and was treated palliatively with biliary stenting. He has been drinking around 30 units of alcohol per week for almost three decades now and has a smoking history of 30 pack-years. He continues to drink and smoke at the same levels even after his diagnosis.

A complete blood count is significant for a Hb of 10.9 mg/dL, with a blood film showing normochromic normocytic anemia.

A liver profile is significant for an ALT of 58 U/L (normal: 7-56), AST of 122 U/L (normal: 10-40), GGT of 90 U/L (0-45), total bilirubin of 1.9 mg/dL (normal: 0.3-1.9), direct bilirubin of 0.2 mg /dL (normal: <0.3), and INR of 1.6 (normal: 0.9-1.1). ALP and serum albumin are within normal parameters.