ABSTRACT
A 24-year-old woman was brought to the emergency department with a 3-month history of worsening epigastric pain. The pain was a dull ache that radiated to the right flank, and was exacerbated by passing urine. She denied any history of fevers or night sweats but did admit to some unintentional weight loss as well as bloating, vomiting and early satiety. On direct questioning, she described intermittent rectal bleeding over the past 4 months. Her past medical history was significant only for asthma. She took the oral contraceptive pill but no other medications. Her family history included first-degree relatives with cancers of the bladder, brain and oesophagus. She worked as a telephone salesperson and neither smoked nor drank alcohol. She had not travelled recently.
