Auntie Zhang, 45, started to have irregular menstruation half a year ago, and 2 months ago she started to have spotty bleeding and her underwear was always unclean. She did not care at first and thought it was going to be menopause. After her children knew about it, they always advised her to go to the hospital to check it out. Unexpectedly, after doing several tests and taking a biopsy, the doctor informed her that it was endometrial cancer and needed immediate surgery. This was undoubtedly a bolt from the blue for Auntie Zhang. After admission, the doctor kindly told her that the early lesion was now considered and the treatment would be very effective and could even be close to a cure, and that the surgery would require removal of the uterus and both ovaries. Auntie Zhang was very puzzled, the doctor told me it was uterine cancer, why do I need to remove my ovaries? It is said that the ovaries are the source of a woman’s youth and that the hormones secreted by the ovaries make a woman more “feminine”. Although she knew she was about to go through menopause, she was still very worried: a woman would be incomplete if she lost her uterus, and if she had to have her ovaries removed, would she immediately become an old woman? Auntie Zhang was sad for a long time and was once very depressed, even resisting surgery. The family was so anxious that they communicated with the doctor about whether the ovaries could be removed. The family was anxious to talk to the doctor about whether or not the ovaries could be removed, and whether or not the removal would affect their lives. The doctor said, “Don’t be anxious, there is a reason for cutting or not cutting: endometrial cancer is common in postmenopausal women, more than 90% of patients are over 50 years old, but 4% of patients are still diagnosed before the age of 40. The number of young women with endometrial cancer is on the rise as the incidence increases worldwide. These patients not only do not face menopause or still have reproductive function and requirements, but also have better general health condition, often without chronic diseases such as hypertension and diabetes, and their clinical stage is generally earlier, with good histological differentiation and relatively better prognosis. The conventional surgical treatment for early endometrial cancer is extrafascial uterus + bilateral adnexal resection, among which removal of bilateral ovaries is one of the steps of standard surgery, based on the following two theoretical bases: 1. The endometrium is located in the uterine cavity, which is connected to the ovaries through the fallopian tubes, and tumor cells may occur through this pathway to micro-metastasis in the ovaries, which cannot be judged by visual inspection during surgery and needs to rely on postoperative pathology. If the ovaries are preserved, tiny metastases may be missed, resulting in higher recurrence rate after surgery. 2. Long-term estrogen stimulation is one of the pathogenesis of endometrial cancer, and after preserving the ovaries, the ovaries will continue to secrete estrogen to stimulate the growth and metastasis of residual cancer cells, which also increases the risk of recurrence after surgery. Therefore, the standard endometrial cancer quality principle is that both ovaries must be removed. However, as Auntie Zhang knows, ovaries are important endocrine organs for women, secreting important hormones. What kind of effects will surgical removal of ovaries actually have on women? 1, vasodilatory symptoms: mainly manifested as hot flashes and sweating, which is often referred to as “menopausal symptoms”. 2. Increased incidence of cardiovascular disease: Cardiovascular events are rare in premenopausal women because estrogen has a protective effect on the cardiovascular system. The incidence of cardiovascular events increases significantly after ovariectomy, and the risk of cardiovascular events in postmenopausal women is 2.62 times higher than that of normal women of the same age, and the risk of fatal heart attack in women increases 2.2 times. 3, increased incidence of osteoporosis: after ovariectomy, the decline in sex hormone levels can lead to bone loss, the earlier this phenomenon occurs, the greater the impact on the patient’s bone density in later life, increasing the patient’s risk of fracture in old age. 4. Others: These include changes in neurological and cognitive function, and changes in sexual function. All naturally menopausal women experience ovarian failure, commonly referred to as “menopause,” along with the symptoms described above. Natural menopausal symptoms begin around age 45 and can last 4-10 years. Surgical removal of the ovaries is called “surgical menopause”. Compared to natural menopause, surgical menopause is associated with earlier and more severe vasodilatory symptoms, especially in patients before the age of 40. Therefore, there is a growing international call to preserve the ovaries of young patients with early stage, low-risk endometrial cancer in order to slow down the symptoms of surgical menopause and improve the quality of life after surgery. So, under which circumstances can ovaries be preserved for patients with early-stage endometrial cancer? Based on the results of domestic and foreign studies and expert consensus, the indications for preserving ovarian function in early-stage endometrial cancer patients are: 1. patients aged <45 years; 2. no family history of cancer (Lynch syndrome excluded); 3. stage I highly differentiated endometrioid adenocarcinoma, excluding high-risk factors (myxoid infiltration, hypofractionation, positive choroidal space); 4. negative abdominal cytology; 5. preoperative examination or intraoperative exploration No suspicious retroperitoneal lymph nodes were found; 6. Intraoperative ovarian dissection and rapid frozen pathology were required to exclude ovarian metastases; 7. Both estrogen and progesterone receptors were positive; 8. The patient had an urgent need for ovarian preservation and agreed to close follow-up. The above conditions must be strictly met at the same time before intraoperative ovarian preservation can be considered, which requires preoperative and intraoperative comprehensive evaluation and careful decision to avoid increasing the patient's risk of recurrence and metastasis. In the case of Aunt Zhang, who is 45 years old, preservation of her ovaries is not recommended as a matter of principle. However, if she strongly requests to preserve her ovaries, she can try to do so, but she must also agree to regular postoperative follow-up only under the conditions of surgery, pathologically confirmed stage I highly differentiated endometrioid adenocarcinoma, exclusion of high-risk factors, negative lymph nodes, exclusion of ovarian metastasis, and positive estrogen and progesterone receptors. If any of the above conditions are not met, preserving the ovaries is like preserving a hidden danger that may lead to a higher recurrence rate of the disease after surgery. After listening to these words, Auntie Zhang's family realized that there is a great deal to learn about the removal of ovaries or not, and that it is not just a matter of the doctor's words. After discussing with her family, Auntie Zhang weighed the pros and cons and decided to keep the unilateral ovary. Eventually, the pathology reported early stage highly differentiated endometrioid adenocarcinoma with a 5-year survival rate of over 95%. After undergoing the surgery, Auntie Zhang's quality of life did not decline significantly, and her family cared for her so much that she was in a better frame of mind and soon regained her old glow!