Review Question - QID 213586

A 63-year-old Asian man presents to his primary care doctor with a 2-week complaint of abdominal pain. Yesterday, his family noticed that he started looking yellow, which is especially pronounced in his eyes. The patient has lost 20 pounds in the last 6 months. The patient denies any fevers, smoking, or alcohol history. Of note, the patient recently immigrated to the United States to live with his relatives. On exam, his temperature is 99.0°F (37.2°C), blood pressure is 130/82 mmHg, pulse is 70/min, and respirations are 14/min. The patient has dull right upper quadrant tenderness and is noted to be jaundiced with scleral icterus. His total bilirubin is found to be 12.0 mg/dL, and his direct bilirubin is elevated to 2.0 mg/dL. Serum transaminases are normal. Both CA19-9 and carcinoembryonic antigen (CEA) are elevated. Titers are negative for HBV or HCV antigens. Which of the following is characteristic for the development of this disease?