Is endometrial cancer really that scary? Actually, it is not. Overall, endometrial cancer is a gynecologic malignancy that is very well treated. While endometrial cancer has become the most common gynecologic malignancy in the United States and other developed Western countries, it is not the most common gynecologic malignancy causing death in women. The fundamental reason is that the vast majority of endometrial cancers are early stage lesions at the time of diagnosis! Early stage endometrial cancer is treated very well, with a 5-year survival rate of 97-99%, and the majority of patients survive long-term with unaffected life expectancy. Some studies even suggest that since endometrium often occurs in conjunction with obesity, hypertension, diabetes and other diseases, patients tend to change their lifestyle after endometrial cancer is diagnosed and treated, resulting in a lower chance of dying from concomitant diseases. Nevertheless, the treatment outcome of advanced endometrium is still poor. So, what are the signs of endometrial cancer and how can it be diagnosed early? It is generally believed that menstrual disorders, irregular vaginal bleeding, and postmenopausal reoccurrence of vaginal bleeding (commonly known as inverted blossoming) are signs that require special attention. Of course, 80% of women eventually prove to be false alarms. For these women, an ultrasound of the pelvis is necessary. If abnormal echogenicity or irregular changes in the endometrium are found, or if the endometrium is more than 5 mm in postmenopausal women, it is necessary to consider obtaining endometrial tissue for pathological examination. The common methods used to obtain endometrial tissue are diagnostic curettage and hysteroscopy. The former is similar to the procedure of abortion and is a blind scraping; the latter is a direct vision examination and is more accurate. Both operations are invasive and have certain injuries and complications (it is also believed that hysteroscopy may lead to the spread of cancer), and people are less willing to accept them. At present, some people collect the exfoliated cells for pathological examination after irrigation of the uterine cavity by special instruments, which is much less damaging. In addition, cervical cancer prevention cytology, which is now widely used, is also helpful in diagnosing endometrial cancer. If abnormal cells (atypical glandular cells) are found, after excluding lesions in the cervix itself, it is important to suspect whether there are lesions in the endometrium upstream of it. Blood sampling for two tumor markers called CA125 and HE4, respectively, can also be helpful in diagnosis. Therefore, as far as the early diagnosis of endometrium is concerned, from the physician’s point of view, it is important not to venture into initiating long-term pharmacological treatment (including sex hormone-based western drugs, herbal tonics and proprietary Chinese medicines) for menstrual disorders in pre- and post-menopausal women. Although short-term observational treatment (e.g. adjusting menstruation with contraceptive drugs) can be used, endometrial tissue must be obtained by the aforementioned methods before long-term drug treatment, except for malignant lesions, so as not to delay the diagnosis of endometrial cancer; from the patient’s perspective, women themselves should pay attention to the symptom of abnormal vaginal bleeding, especially for women before and after menopause. No matter how busy and strong a woman is, she should not take it lightly!