In general, with the exception of young women, when a malignant ovarian tumour is suspected, total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy is performed. This is generally via an abdominal approach. Any ascitic or free peritoneal fluid is sent for cyto-logical examination and if none is present peritoneal washings are performed. In young women with a clinically and/or radiologically malignant ovarian lesion, in whom preservation of fertility is desirable, unilateral salpingo-oophorectomy (usually with omentectomy) may be performed. This should be followed by discussion of the case and assessment of the need for further surgery at a multidisciplinary gynaecological oncology meeting. In occasional cases, where the presence of widespread disease precludes total tumour debulking, then only small fragments or a proportion of the tumour will be removed. Unilateral salpingo-oophorectomy may be performed when a benign ovarian neoplasm or a benign cyst is suspected. Prophylactic oophorectomies, usually with removal of the fallopian tubes, may be performed in those with a hereditary predisposition to developing ovarian cancer.
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