The nervous system is increasingly recognized as an active regulator of oncogenesis rather than a passive structural component of the tumor microenvironment (TME). Neural activity promotes tumor proliferation, invasion, metastasis, therapeutic resistance and immune evasion through dynamic, bidirectional interactions with malignant cells and stromal components. These effects are mediated by diverse mechanisms, including synaptic and pseudo-synaptic communication, paracrine release of neurotransmi