Mr. Palmer, 67 years old and previously well, has had several months of poorly localized upper abdominal pain, decreased appetite, and weight loss. His family physician performs a thorough physical exam and can palpate the liver edge 7 cm below the right costal margin. There is no other abnormal finding on physical exam. He orders a CT scan, which demonstrates that Mr. Palmer's liver is grossly enlarged with multiple lesions throughout the liver, consistent with metastatic malignancy. There is no other abnormality seen on the CT abdomen, and further imaging of the chest and pelvis is also normal.