Store Manager With Abdominal Pain, Dyspnea, and Weight Loss

Maurie Markman, MD


October 27, 2023

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A 62-year-old woman presents to her primary care physician with an approximately 2-month history of steadily worsening diffuse lower abdominal discomfort and bloating. She states that during this period, her appetite has gradually decreased, and she notes a 10- to 15-lb (4.5- to 6.8-kg) weight loss, occasional nausea, and shortness of breath with modest exertion. She reports no chest pain, episodes of abnormal bleeding, fever, night sweats, recent infections of any kind, or international travel over the past 20 years.

The patient has type 2 diabetes, which is controlled by diet. She has no history of cardiac or pulmonary disease or hypertension and has never smoked. She works full-time as a manager for a large retail clothing store.

Her past medical history is significant for a hysterectomy at age 53 years for large fibroids. At the time of the surgery, she was menopausal, and her ovaries were also removed. Eight months before her current symptoms developed, the patient underwent upper endoscopy for the evaluation of a several-week history of sharp upper abdominal pain. The procedure revealed a gastric ulcer, which was successfully managed. No additional pathologic findings were noted. The patient states that her current abdominal pain is very different from the symptoms associated with the gastric ulcer. Eleven months ago, she underwent a screening colonoscopy, which showed no abnormal findings.

Her family history is remarkable for an older sister who had early-stage breast cancer diagnosed at age 71 years and an aunt who developed colon cancer at age 64 years. The patient has not undergone genetic testing, and she is not aware of anyone in her family who has had such testing performed.


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