In this study, serum VEGF levels did not distinguish patients with metastatic disease from patients with no sign of metastasis, consistent with a recent report in which lymphovascular invasion rather than angiogenesis was associated with poorer recurrence-free and cancer-specific survival (Mohammed et al, 2013), suggestive that tumour growth is dependent on angiogenesis, whilst lymphovascular invasion may be essential for metastasis. Here, VEGFA is linked to metastatic neoplasm.