The interplay between cancer and follicular fluid: molecular changes and tumor-promoting properties

Follicular fluid is a complex biological microenvironment essential for oocyte maturation and folliculogenesis. Alterations in follicular fluid composition have been associated with reproductive disorders reflecting compromised oocyte quality. Emerging evidence suggests that malignancies also significantly alter the composition of follicular fluid, potentially compromising the follicular microenvironment and impacting fertility preservation outcomes. Interestingly, the follicular fluid itself exhibits tumor-initiating and tumor-promoting properties, inducing DNA damage, pro-inflammatory signaling, mild proliferation, and suppressing apoptosis. Understanding cancer-associated follicular fluid alterations may improve fertility care, identify early biomarkers, and inform strategies for ovarian cancer prevention and therapy. This review aims to summarize current knowledge on how cancer can alter follicular fluid composition and its role in ovarian malignancies.