# Tuberculosis and Lung Cancer: Insights from a Narrative Review

## TL;DR

This review explores how tuberculosis might increase the risk of lung cancer and other cancers due to long-term lung damage and immune changes.

## Contribution

The paper provides a narrative review of the mechanisms and timing linking tuberculosis to cancer, emphasizing clinical implications.

## Key findings

- TB-induced chronic inflammation and immune changes may increase cancer risk.
- Lung cancer is more likely to develop after TB, with elevated risk periods identified.
- TB patients may be at higher risk for other cancers like head and neck and gastrointestinal malignancies.

## Abstract

Tuberculosis (TB) can cause long-lasting changes in the lungs, and these changes may increase the chance of developing lung cancer (LC). Although this possible link has been discussed for many years, it remains unclear how strong the relationship truly is or why it occurs. This review brings together current knowledge on how TB may influence LC risk, including when LC is most likely to appear after TB and what biological processes may connect the two conditions. We describe how ongoing inflammation, altered immune responses, and structural damage in the lungs caused by TB could help cancer develop. By clarifying these connections, this work aims to support researchers and clinicians in better identifying people at higher risk and improving strategies for prevention, early diagnosis, and patient care.

The interaction between LC and active TB has been known for many years. The first description of ‘cancerous phthisis’ was reported by Bayle in 1810. The results of subsequent attempts to establish an etiological correlation between the two clinical entities have ranged from insignificant—even antagonistic—to a direct causal relationship. This narrative review explores the relationship between tuberculosis and LC assessing overall and site-specific malignancy risks in individuals with TB compared with the general population. We also examine the timing of cancer development following TB, highlighting periods of elevated risk. Chronic inflammation, immune dysregulation, and metabolic changes associated with TB may contribute to tumor initiation and progression, with organ-specific factors influencing susceptibility to cancers such as lung, head and neck, gastrointestinal, and hematologic malignancies. Clinically, awareness of these interactions supports targeted TB screening in high-risk cancer patients, careful monitoring for TB reactivation during cancer therapy, and consideration of immunological and metabolic factors when planning treatment.