Review Question - QID 214441

A 72-year-old man presents to his primary care physician with a 3-month history of increasing cough and shortness of breath. He says that he first noticed these symptoms when he started a new morning walk routine, but they have worsened over time so that he is no longer able to perform activities of daily living without getting winded. Otherwise, he has felt constipated over the last 2 months and has been urinating more frequently than before. He thinks that this may be why he has lost about 18 pounds over the last 6 months despite no changes to his diet or exercise. He drinks 2 alcoholic beverages per day and smoked 1 pack per day for 30 years before quitting 4 years ago. He worked in a shipyard for 30 years before retiring 7 years ago. Physical exam reveals bony tenderness and costovertebral angle tenderness. Which of the following is the most likely cause of this patient's symptoms?