Evidence for and Against Hypoxia as the Primary Cause of Tumor Aggressiveness

In clinical trials, tumor hypoxia has consistently been associated with tumor aggressiveness. The evidence for an association between hypoxia and metastasis and more rapid tumor progression and death is seen in uterine cervical cancer, and sarcoma of soft tissue. Evidence is building in prostate, vulva, head and neck, and breast cancers. A major question is whether hypoxia precedes tumor aggressiveness or whether aggressive tumors incidentally are also hypoxic.