Ovarian cancer Quiz: Ace Your Exams

A 62-year-old woman presents to her gynecologist with abdominal bloating, early satiety, and an 8 pound weight loss over the past 4 months. She also has alternating diarrhea and constipation, urinary frequency, and diffuse abdominal pain for the past 2 months. She does not have vaginal bleeding or dysuria. Her medical history is significant for type 2 diabetes controlled by diet and hypertension controlled with chlorthalidone. She is a nonsmoker and does not consume alcohol. Her family history is significant for a mother who died of breast cancer at 69. Vital signs are within normal limits. Abdominal examination reveals diffuse tenderness and a fluid wave on percussion. Pelvic examination reveals a fixed 12 cm irregularly shaped right sided mass, an irregular 5 cm mobile left sided mass, cul-de-sac nodularity and a cystocele. Transvaginal ultrasound shows a 12 cm mass on the right, a 6 cm mass on the left, and the presence of ascites. Both masses are complex with solid and cystic components. CA-125 level is elevated. Which of the following is the most appropriate next step in management?