

Angiogenesis is tightly regulated by a number of pro- and anti-angiogenic molecules. Under normal conditions, there is a delicate balance between pro- and anti-angiogenic factors, and angiogenesis does not occur. However, during tumor growth, a variety of environmental and cellular triggers leads to overexpression of pro-angiogenic factors. These factors, including vascular endothelial growth factor (VEGF), can tip the balance toward angiogenesis.2
The moment at which a tumor begins to overexpress pro-angiogenic factors, such as VEGF, is generally referred to as the angiogenic switch. The switch overwhelms the delicate balance of pro- and anti-angiogenic factors to grow new vasculature, thereby facilitating the growth of the tumor.2
The images below depict the switch from nonangiogenic to angiogenic tumor phenotype.

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Bergers G, Benjamin LE. Nat Rev Cancer. 2003;3:401-410.