Background Lung cancer remains a leading global health concern, largely due to its high rates of morbidity and mortality. Smoking impact on the disease may differ based on gender and the type of lung cancer. This study aims to investigate the relationships between smoking, additional potential risk factors, and lung cancer, particularly focusing on gender-specific differences and histologic subtypes in Peshawar. Methodology A study was conducted at the Khyber Teaching Hospital Peshawar, Pakistan, total 80 patients were selected which was further divide into 2 group: 40 lung cancer group and 40 normal health individuals. The patient selection process ensured the inclusion of different histologic subtypes and both genders. Data was gathered through structured interviews, review of medical records, and collaboration with relevant hospital departments. The collected information covered smoking habits, histologic classifications, demographic characteristics, and any history of tuberculosis (TB). Statistical analyses included descriptive methods, chi-square tests, and odds ratio calculations to assess the relationships between smoking, gender, histologic type, TB history, and lung cancer. Results Conclusion Out of the 80 participants, 40 were cases and 40 were controls. A history of pulmonary TB was observed in 25% of the cases and 20% in the controls. Furthermore, 15% of the cases and 10% of the controls indicated a family ‘history of lung cancer’ Male smokers showed a ‘significantly elevated risk of lung cancer’ (Odds Ratio = 1.2, p = 0.001), while female non smokers demonstrated a trend toward increased risk (Odds Ratio = 0.8, p = 0.020). Histologic differences were also observed, with squamous cell carcinoma representing 30% of cases, and small cell carcinoma accounting for 20%. The study highlights the complex interactions between gender, smoking habits, a history of TB, and different histologic types in the risk of lung cancer. These findings contribute to a more nuanced understanding of lung cancer risk factors and underscore the need for prevention strategies tailored Peshawar.