Perspective

It has been recognised that lymphangiogenesis occurs inside tumours and is associated with nodal and distal metastasis. There is now evidence to suggest that there is significant correlation between the expression of these molecules and several clinicopathologiocal parameters in several human cancers. This might be of particular importance in determining patients' prognosis and survival. Although tumours can secrete lymphangiogenic growth factors like VEGF-C and VEGF-D and can induce the growth of new lymphatic vessels, several questions remain unanswered. For example, why different tumours have heterogeneity in regards to the expression and secretion of these growth factors? What are the intrinsic or extrinsic factors that regulate VEGFR-3 signalling? Further work is required to clarify whether these growth factors could also induce pre-existing lymphatic vessels formation? Does interrupting VEGFR-3 signalling have any impact on lymphatic spread and cancer metastasis? The elucidation of molecular components of VEGFR-3 signalling could be beneficial both in terms of diagnosis and therapy by selective targeting of this pathway. Angiogenesis that occurs only in tumour, also known as tumour-specific angiogenesis, has been recently described (174-176). Does tumour-specific lymphangiogenesis exists? Are there potential markers to distinguish the existing lymphactic vessels from the newly derived ones? Finally, the early research results have tentatively suggested that the degree of lymphangiogenesis have prognostic importance in solid tumours. They also pointed a strong possibility that targeting tumour-associated lymphatics may have potential therapeutic value.

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