Impact of plant-based interventions on gynecological cancers: a narrative review of mechanistic interplays and clinical evidence.

Gynecological cancers account for approximately 1.4 million new cases and 680,000 deaths annually. Cervical, ovarian, endometrial, vulvar, and vaginal cancers collectively impose a major and disproportionate burden on women in low- and middle-income countries. Conventional treatments, including surgery, platinum-based chemotherapy, and radiotherapy, are limited by systemic toxicity, acquired chemoresistance, recurrence, and financial inaccessibility in resource-limited settings. Approximately 80 percent of patients with advanced ovarian cancer eventually develop platinum resistance, and cervical cancer persists as a leading cause of cancer death in regions with inadequate screening and vaccination infrastructure. Plant-derived phytochemicals have attracted substantial scientific attention as adjunct or complementary anticancer strategies. This review synthesizes preclinical, epidemiological, and emerging clinical evidence for alkaloids, flavonoids, terpenoids, polyphenols, coumarins, and organosulfur compounds in gynecological cancer prevention and management. These compounds modulate multiple oncogenic pathways relevant to gynecological malignancies: tumor cell proliferation, intrinsic and extrinsic apoptosis, angiogenesis, oxidative stress, inflammation, hormone receptor signaling, HPV E6/E7 oncoprotein expression, and epigenetic regulation. Paclitaxel, a taxane terpenoid, serves as the definitive proof of concept that plant-derived compounds can achieve gold-standard clinical status in gynecological oncology. Critical barriers limit clinical translation for most non-approved phytochemicals: oral bioavailability is poor, botanical preparations are unstandardized, randomized trial data in gynecological cancer populations are scarce, and herb-drug interaction profiles are incompletely characterized. Nanoformulation approaches, including liposomal encapsulation, PLGA nanoparticles, and phytosomes, offer practical routes to overcome these pharmacokinetic obstacles. Future work should prioritize biomarker-embedded clinical trials, molecular subtype-stratified patient selection, and rigorous evaluation of phytochemical-chemotherapy combination regimens.