Molecular links between tuberculosis and lung cancer: pathogenesis and therapeutic challenges

Tuberculosis (TB) and lung cancer, two leading global health burdens, increasingly coexist, particularly in high-burden regions of these diseases. Epidemiological studies suggest TB significantly elevates lung cancer risk, as lung cancer increases the risk of TB, yet the molecular basis of this association remains underexplored. TB-induced chronic inflammation, oxidative stress, epithelial-mesenchymal transition (EMT), and immune checkpoint dysregulation create a permissive environment for oncogenesis. Granulomas and tumour microenvironments share immunosuppressive features, while overlapping host genetic and epigenetic signatures exacerbate diagnostic complexity. Immunotherapy in cancer risks TB reactivation, highlighting clinical tensions. Understanding the TB-lung cancer molecular interface is essential for developing integrated diagnostics and safe treatment regimens. This review integrates current evidence on the overlapping pathogenic, immunological and molecular landscapes of TB and lung cancer to identify shared mechanisms, diagnostic dilemmas and therapeutic challenges, while highlighting significant gaps needing actionable interventions. We also suggest some future paradigm shifts toward dual-disease research frameworks, critical to advance care in TB-endemic regions.