Nonetheless, metastatic disease as a whole is likely to consist of a complex interplay between disseminating cancer cells exiting the tumours via a combination of both routes, modulated by local and systemic factors and possibly even by sex in cases such as renal clear cell carcinoma where androgen receptor (AR) has been shown to increase haematogenous metastasis yet decrease lymphatic metastasis153. Here, AR is linked to metastatic neoplasm.