Integrated Review of Cervical Cancer: Etiology, Pathogenesis, Pathology, Microbiome, Diagnosis, Treatment, and Emerging Therapeutic Advances

Cervical cancer remains a leading cause of global health burden, particularly in low- and middle-income countries. The main etiological factor is persistent infection with high-risk human papillomavirus (HPV), particularly HPV16 and HPV18, in which the viral E6 and E7 oncoproteins disrupt tumour-suppressor pathways and drive malignant progression. Host immunity, reproductive and behavioral factors, smoking, hormonal exposure, and cervicovaginal dysbiosis further influence disease development. Histopathology remains central to classification and staging, with squamous cell carcinoma as the predominant type, followed by adenocarcinoma and adenosquamous carcinoma. Emerging evidence suggests that cervicovaginal and gut microbiomes may modulate HPV persistence, inflammation, and tumor progression. Diagnostic approaches are advancing from conventional cytology toward HPV DNA testing, molecular biomarkers, p16/Ki-67 dual staining, methylation assays, and multi-omics strategies. Artificial intelligence (AI) and machine learning (ML) are increasingly applied to cytological and histological imaging, colposcopy, radiomics, and molecular-data analysis. Therapeutic advances include immunotherapy, nanomedicine, RNA-based approaches, therapeutic vaccines, and CRISPR/Cas technologies targeting HPV-associated pathways. This review summarizes recent advances in cervical cancer biology, pathology, microbiome research, diagnosis, treatment, and computational technologies, while highlighting the potential integration of microbiome signatures, molecular biomarkers, AI, and targeted delivery systems for precision management. Key translational challenges include external validation, standardization, safety, data diversity, and equitable clinical implementation.