Oxygen and cancer

Oxygen is required for most multicellular, aerobic organisms to survive and function. The vasculature provides the conduit for delivering oxygen via haemoglobin in the blood to organs, tissues, and cells. In diseases such as cancer, low tissue oxygenation or hypoxia occurs in solid tumours because of an inadequate supply of oxygen due to aberrant tumour vasculature. Hypoxia is a key feature of most solid tumours and underlies many of the processes associated with how cancer progresses; including tumour cell survival and proliferation, genetic instability, immune responses, angiogenesis, invasion and metastasis, and metabolic adaptive responses. Solid tumours contain several different cell types that respond to hypoxia within the tumour microenvironment. Hypoxia-inducible factors (HIFs) are a highly evolutionarily conserved family of dimeric transcription factors that are central to mediating the cellular response to hypoxia by regulating the expression of a diverse array of targets. Hypoxia and HIF activation is associated with treatment failure, resistance, and poor clinical outcomes. This chapter will provide an overview of the role of hypoxia in cancer, outline the methods used to measure hypoxia clinically, and discuss the impact of hypoxia on current front-line therapies being used to treat cancer.