Tumour versus patient: vascular and tumour survival versus prognosis

The concept that malignant solid tumour growth depends on angiogenesis is widely recognized. For some tumour types, there is a measurable range of vascularity and the link between prognosis and increased vascular density, best observed at the hotspots at the edge, is now established. What is less discussed are the corollaries: that tumour invasion requires tissue destruction; that the neovasculature must be not only protected but also sustained, especially at the tumour edge; that for tumour survival the edge is the future and the centre is history; and that angiogenesis is essential not only for tumour growth but also for tumour invasion. Different patterns of vascular density in tumour edge and centre have been observed, and these are linked to lymphatic spread and prognosis. The variation is attributable to differing interactions between endothelium and the tumour cell that dictate vascular and tumour survival; this may become relevant to anti-angiogenesis therapies.