Endometriosis, defined by the presence of endometrial-like tissue beyond the uterine cavity, afflicts over 190 million young women worldwide and often significantly reduces quality of life. Despite being historically classified as a benign gynecologic disorder, endometriosis can mimic cancer in imaging findings, serum tumor markers, and molecular signature. Increasing evidence
suggests endometriosis encompasses multiple biologic subtypes rather than representing a single uniform disease, which may explain divergent presentations, from extensive lesions in some patients with minimal pain to smaller implants in others with severe symptoms. Current management relies heavily on empirical hormonal therapies, repeated surgeries, and symptomatic treatment.
Inadequate diagnostic tools and incomplete mechanistic understanding contribute to misdiagnosis, delayed intervention, and suboptimal outcomes. Without deeper elucidation of its complex biology, especially at the molecular level, substantial therapeutic breakthroughs will likely remain elusive. Notably, pathways commonly implicated in malignancy are aberrantly activated in ectopic endometrial tissue, driving proliferation, angiogenesis, and immune evasion. To address heterogeneous endometriosis phenotypes, a rigorous translational framework is essential. Through such structured investigation, novel data and non-hormonal therapies targeting core molecular events could emerge, reducing both protracted diagnostic timelines and lowering the incidence of overtreatment. In recognizing endometriosis as potentially comprising distinct pathologies under one umbrella, the field may advance truly individualized, biology-guided interventions.

Impact statement
Endometriosis, affecting over 190 million people worldwide, displays clinical and molecular profiles that closely resemble malignancies. Framing endometriosis as a “cancer-mimicking” disease highlights why current models, diagnostic tools, and empirical therapies fail to adequately address prolonged diagnostic delays, high recurrence rates, and inconsistent treatment outcomes. This perspective advocates a structured translational approach, integrating meticulous preclinical validation, phase-appropriate clinical trials, and rigorous safeguards in artificial intelligence and biomarker development, to bridge critical gaps in understanding disease biology. Such a bidirectional pipeline, guided by real-world clinical feedback and clear mechanistic insights, aims to optimize pain management, fertility preservation, and overall disease control. Reconceptualizing endometriosis as a systemic condition with cancer-mimicking features underscores the urgency and the opportunity to develop targeted therapies beyond traditional hormonal suppression and empirical surgeries, ultimately enhancing patient quality of life worldwide.