Tumor cells are not only susceptible to signals from the environment, but they likewise release signal substances. It is well known that
tumor cells secrete angiogenic factors--most prominently the
vascular endothelial growth factor--which initiate the vascularization of the
tumor for its nourishment. This process has been termed neoangiogenesis. Besides this, two further processes have recently been discovered that facilitate the interaction of the
tumor with the lymphatic system and the nervous system, named lymphangiogenesis and neoneurogenesis. These three "geneses" have a cognate, in part common regulation and conjointly promote
metastasis development. Neoangiogenesis and lymphangiogenesis provide the structures for the two routes of
tumor cell dissemination, i.e. either hematogenous or lymphatic. Neoneurogenesis accomplishes the innervation of the
tumor by the ingrowth of nerve endings into the
tumor and alternatively or additionally by the protection of existing nerve cells from destruction. These
tumor-innervating nerve cells may release
neurotransmitters which are proliferative or promigratory signals for the
tumor cells. Furthermore, nerve fibers are used as routes for
tumor cell dissemination, too, which is known as perineural invasion.