Patients with endometriosis who have the following high-risk factors for endometriosis malignancy should be monitored more closely and followed up closely to be alert to the occurrence of endometriosis malignancy.
(1) Women of menopausal age > 50 years.
(2) The duration of endoheterosis is higher than 8 years.
(3) Those with high estrogen levels or receiving estrogen replacement therapy, especially those with obesity.
(4) Those treated with Danazol.
(5) Early menarche, short cycles, late menopause, and low maternal frequency.
(6) Those with a history of environmental exposure to dioxin contamination.
At present, there is no definite preventive measure for endometriosis malignancy. The following management plan for patients with endometriosis may help to reduce the occurrence of malignancy.
(1) When the diameter of ectopic cyst is >6 cm, surgery should be chosen.
(2) Use puncture and aspiration methods with caution.
(3) Indications for radical surgery should be relaxed appropriately in high-risk groups according to age and fertility requirements.
(4) Specimens resected by conservative surgery should be followed closely for a long time if atypical hyperplasia or endometriotic lesions are found.
(5) In postmenopausal patients, radical surgery is the preferred option.
Meanwhile, the possibility of malignancy in patients with endometriosis should be noted when they present with the following clinical manifestations.
(1) Ovarian endometriosis cysts >10 cm in diameter or with a tendency to increase in size significantly.
(2) Recurrence after menopause, change in pain rhythm, progression of dysmenorrhea or persistent abdominal pain.
(3) Imaging reveals solid or papillary structures within the ovarian cyst or abundant blood flow to the lesion.
(4) Excessive serum CA125 level (>200 kU/L).
(5) The contents of ovarian endometriosis cysts become thin (fewer fine light spots) on ultrasound.
In conclusion, with the increasing incidence of endometriosis, the problem of malignant changes in endometriosis should be given sufficient attention by clinicians. The following questions should be carefully considered: whether it is safer for patients with endometriosis to enter the perimenopausal period or more likely to become malignant after interventional treatment of ovarian ectopic cysts, and whether the residual ectopic endothelial tissue becomes a potential risk for malignancy and the resulting treatment options for patients with perimenopausal endometriosis and the indications for interventional treatment need to be further explored.