A systematic review of oncologic pathways in cervical cancer and the correlation with dietary factors: insights into molecular mechanisms and nutritional influences

Introduction: Cancer is currently the second greatest cause of death worldwide. Cervical cancer, the second most common malignancy in women worldwide, is characterized by dysregulated oncologic pathways contributing to its progression. Goals: This systematic review aims to explore the role of different oncologic pathways in cervical cancer progression and the impact of diet on these pathways. Methods: A systematic literature review was conducted using the PRISMA system and flow charts for quality assurance. The PICOS framework was used for inclusion criteria. Keywords used in six databases included (“signaling pathway”) AND (“pathology”) AND (“oncogenic”) AND (“cervical cancer”). A risk of bias assessment was conducted on selected studies using the QUIN tool for in vitro studies. Results: Nineteen studies were analyzed. Desired outcomes included induced proliferation, inhibited apoptosis, invasion-metastasis promotion, and angiogenesis. Identified oncologic pathways based on these outcomes include P53, TNF-mediated, FOXM1/WNT/β-catenin, EGFR, VEGF, NF-κB, Her-2, Histone 3, ERCC1, JAK/STAT, TGF-β, ErbB, BMP4/Hippo/ YAP1/TAZ, and ERK/c-Myc pathways. Nutritional factors, such as a western diet with processed meats, salty foods, chips, red meat, and instant foods, were found to affect the hyperactivation of these oncologic pathways, increasing cervical cancer risk. Discussion: Each oncologic pathway has distinct mechanisms but some share similarities in triggering tumorigenesis. Increased proliferation results from heightened cell cycle activity and reduced tumor suppressor gene function. The suppression of caspase activity and pro-apoptotic proteins causes apoptosis inhibition. Metastasis and angiogenesis are driven by elevated expression of EMT and MMP proteins, promoting cancer cell invasion, migration, and new blood vessel formation. Nutritional factors influence these pathways, emphasizing the role of diet in cervical cancer progression and prevention. Conclusion: Various and interconnected mechanisms underlie specific oncologic pathways impacting cervical cancer. Diet significantly influences the hyperactivation or inactivation of cancer-related pathways, affecting cervical cancer risk.