Blood and Lymphatic Vessel Networks
Like normal cells, cancer cells require nutrients and oxygen to rapidly grow and survive. They must
also get rid of the toxic substances they generate through their use of these fuels. To achieve these
goals, many cancer cells promote the growth of new blood and lymphatic vessels, processes called
angiogenesis and lymphangiogenesis, respectively.
Among the many molecules cancer cells use to induce angiogenesis and lymphangiogenesis is a family
of growth factors called VEGFs. These molecules attach to proteins on the surface of the cells that form
blood and lymphatic vessel walls, stimulating vessel growth.
Some cancers are more dependent than others on the growth of new blood and lymphatic vessels to
thrive. These cancers, such as the most common type of kidney cancer in adults (renal cell carcinoma),
are particularly susceptible to a group of drugs that target the VEGFs or the proteins to which VEGFs bind,
the VEGF receptors, impeding blood and lymphatic vessel growth (see Table 3).
In addition to nourishing tumors, the new network of blood and lymphatic vessels provides a route by
which cancer cells can escape their primary location. Once cancer cells enter the vessels, they have
the potential to move to and grow in other areas of the body where they can establish new tumors; this
is called metastasis. Metastasis is responsible for more than 90 percent of the morbidity and mortality
associated with cancer.
Cancers that begin in
blood-forming tissues, such
as the bone marrow, or in
cells of the immune system
are called hematologic
cancers, or blood cancers.
Examples include chronic
and multiple myeloma.
Cancers that arise in tissues
other than the blood can
be grouped depending
on the type of cell they
originate from in that tissue.
• carcinomas, which begin
in the skin or in tissues
that line or cover internal
• sarcomas, which arise
from cells of the bone,
cartilage, fat, muscle,
blood vessels, or other
connective or supportive
• blastomas, which
derive from immature
“precursor” cells or
Approved Indication Generic Name Trade Name Formulation
Kidney cancer axitinib Inlyta
Colon; kidney; and lung cancers bevacizumab Avastin
Kidney cancer; soft tissue sarcomas; pazopanib Votrient
gastrointestinal stromal tumors
Colorectal cancer; gastrointestinal regorafenib Stivarga
Kidney cancer sorafenib Nexavar
Gastrointestinal stromal sunitinib Sutent
tumors; kidney cancer; some
Thyroid cancer vandetanib Caprelsa
Colorectal cancer ziv-aflibercept** Zaltrap
Table 3: Currently Approved Angiogenesis Inhibitors for
the Treatment of Cancer