question: Q:A 64-year-old woman comes to the physician because of a 7.2-kg (16-lb) weight loss over the past 6 months. For the last 4 weeks, she has also had intermittent constipation and bloating. Four months ago, she spent 2 weeks in Mexico with her daughter. She has never smoked. She drinks one glass of wine daily. She appears thin. Her temperature is 38.3°C (101°F), pulse is 80/min, and blood pressure is 136/78 mm Hg. The lungs are clear to auscultation. The abdomen is distended and the liver is palpable 4 cm below the right costal margin with a hard, mildly tender nodule in the left lobe. Test of the stool for occult blood is positive. Serum studies show:
  Alkaline phosphatase 67 U/L
  AST 65 U/L
  ALT 68 U/L
  Hepatitis B surface antigen negative
  Hepatitis C antibody negative
  A contrast-enhanced CT scan of the abdomen is shown. Which of the following is the most likely diagnosis?"? 
  {'A': 'Hepatic echinococcal cysts', 'B': 'Cholangiocarcinoma', 'C': 'Hepatocellular carcinoma', 'D': 'Metastatic colorectal cancer', 'E': 'Cirrhosis'},