An elderly woman has metastatic liver disease but no obvious primary site. In view of her age, what should be done to find a primary site?
I recently saw an 85-year-old woman who had been very fit all her life but now felt tired and anorexic. On examination, she had a very hard, craggy, enlarged liver. An upper abdominal ultrasound showed multiple deposits consistent with metastases. This finding was confirmed by a CT scan. No obvious primary site was found. The liver function tests were very abnormal, in line with metastatic liver disease. In view of the patient’s age, what, if anything, should be done to find a primary site?