From Inflammation to Malignancy: The Link Between Endometriosis and Gynecological Cancers

Endometriosis, a chronic estrogen-dependent disease, is associated with a risk of developing gynecological cancers. The mechanisms of this association remain unclear, but emerging evidence implicates key signaling pathways, including PI3K/AKT/mTOR and ARID1A alterations, in malignant transformation. This article examines current reports on the association between endometriosis and cervical, ovarian, and endometrial cancers, with particular emphasis on diagnostic challenges and molecular mechanisms. Imaging methods such as ultrasound, magnetic resonance imaging, and computed tomography (CT) are used for diagnosis, as well as biomarkers such as Cancer Antigen-125 (CA-125) and Human Epididymal protein 4 (HE4), but their specificity is limited, motivating research into novel molecular and non-invasive diagnostics. Laparoscopy is an invasive diagnostic method, serving as the gold standard for confirming the diagnosis. We discuss personalized clinical strategies, including risk-based surveillance for patients with atypical lesions or ARID1A alterations, and implications for ovarian cancer management in endometriosis. Prospective cohort studies will be necessary to further understand the complex mechanisms of endometriosis's malignant transformation. Optimizing therapy and improving quality of life require a holistic, individualized approach to patient care. This review provides an integrated synthesis of epidemiological and molecular evidence, highlighting both established and emerging targets for diagnosis and treatment in endometriosis-associated malignancies.