The pathogen’s playbook in cancer: from oncogenesis to progression

Globally, around 15-20% of cancers are linked to microbial infections, involving viruses, bacteria, and fungi, each with distinct pathogenic features. Advanced multi-omics technologies have confirmed tumor-specific microbial communities within tumor tissues. This review categorizes microbes by their action mechanisms in cancer biology: one group (e.g., <i>Helicobacter pylori</i>, HPV, <i>Aspergillus</i> species) directly induces tumorigenesis via DNA damage, repairing pathway disruption, oncoprotein expression, and carcinogenic metabolite production; the other group (e.g., <i>Fusobacterium nucleatum</i>, HIV, <i>Candida albicans</i>) modulates tumor progression by regulating the tumor microenvironment, enhancing tumor cell chemoresistance, or suppressing anti-tumor immunity. Additionally, this review also explores clinical translation potential, highlights research challenges, and proposes future directions to support precision oncology advancement.