Previous studies have shown that arecoline activates multiple oncogenic pathways, including those involving TGF-β, HIF-1, MAPK, EGFR, and oxidative stress, thereby facilitating fibrosis, epithelial–mesenchymal transition (EMT), and cancer progression (Gocol et al., 2023; G. Huang et al., 2024; Senevirathna et al., 2023; Singh and Chaturvedi, 2024). Here, HIF1A is linked to cancer.