A 78-year-old man is evaluated because of shortness of breath of acute onset. The patient reports a 13.6-kg (30-Ib) weight loss, vague upper abdominal discomfort, nausea, loss of appetite, and fatigue. He has hypertension and symptomatic atherosclerotic coronary artery disease despite optimal medical management. Even before the recent episode of dyspnea, his physical activity has been limited; he spends most of the day resting either in bed or in a chair.Laboratory studies: Hemoglobin 10.5 g/dL Serum albumin 2.6 g/dLSerum alanine aminotransferase 65 U/LSerum aspartate aminotransferase 78 U/L CA 19-94500 U/LArterial oxygen saturation 85% by pulse oximetrySpiral CT scan of the chest shows a pulmonary embolism.The patient is hospitalized for anticoagulation and oxygen therapy and gradually improves. Subsequent CT of the abdomen shows a 4-cm mass in the tail of the pancreas and numerous low-attenuation lesions in the liver. CT-guided biopsy of the hepatic lesions and the pancreatic m

• A. Best supportive care and referral to a hospice
• B. Diagnostic CT-guided biopsy under a heparin window when the patients clinical status improves
• C. Neurolytic celiac axis block
• D. Palliative chemotherapy
• E. Palliative radiation therapy