A 65-year-old postmenopausal woman presents to the clinic with a 3-month history of a gradually enlarging, firm nodule at her umbilicus. She reports mild abdominal discomfort and unintentional weight loss of 8 kilograms over the past six months. The nodule has become tender over the last few weeks, and she has noticed occasional serosanguinous discharge. She denies nausea, vomiting, or changes in bowel or urinary habits. Her medical history is unremarkable, and she has no significant family history of cancer. On physical examination, there is a 2 cm firm, irregular, non-reducible nodule at the umbilicus with overlying erythema and a small amount of discharge. Abdominal palpation reveals mild diffuse tenderness but no palpable masses. No ascites is detected on percussion. Laboratory investigations show an elevated CA-125 level of 580 U/mL (normal <35 U/mL), while other routine blood tests, including a complete blood count and liver function tests, are within normal limits. A CT scan of the abdomen and pelvis reveals a 10 cm complex ovarian mass on the left side with irregular margins and solid components. There is evidence of peritoneal carcinomatosis with omental thickening, and the umbilical nodule appears consistent with metastatic spread. Fine-needle aspiration cytology (FNAC) of the umbilical nodule confirms adenocarcinoma, likely of ovarian origin. What is the appropriate management for this patient with a Sister Mary Joseph nodule associated with advanced ovarian cancer?
