A 50-Year-Old Perimenopausal Woman Is Evaluated Because of Abdominal Swelling

A 50-year-old perimenopausal woman is evaluated because of abdominal swelling. CT scan of the chest, abdomen, and pelvis shows mesenteric lymphadenopathy and a small amount of ascites but no ovarian masses. Needle biopsy specimen shows adenocarcinoma; the tumor is found to be negative for hormone receptors. The serum carcinoembryonic antigen level is normal at 2.0 ng/mL and the serum CA-125 is 1200 ng/mL (elevated) . What is the best next step in her treatment?

A) Combination chemotherapy
B) Debulking surgery
C) Radiation therapy to a wide port
D) Positron emission tomography scan to assess other sites of disease
E) Bone scan to rule out skeletal metastases