A 67-year-old man presents to his doctor with reports of fatigue, nausea, loss of appetite, near-constant headache, and breathlessness for the past 3 months. He is slightly overweight, with a BMI of 28.4 (height is 6 ft and weight is 210 lb). He has ongoing hypertension and hyperlipidemia, both of which are medically controlled. He has a positive history of cancer. He was diagnosed with stage IIA Hodgkin lymphoma 8 years ago at age 59 years. He was treated with chemoradiation and went into remission. There is no history of cancer in his family.

Physical exam reveals a lump in the left breast, with a pebble-like consistency, as well as axillary lymphadenopathy. The patient appears slightly jaundiced; abdominal distention is evident on palpation. There is also slight hepatosplenomegaly on palpation.

Laboratory testing is performed. Complete blood count shows nothing remarkable; comprehensive metabolic panel reveals elevated liver function tests and alkaline phosphatase (ALP) = 500 IU/L.