HIF-1α influences both tumor cells and TAMs, stimulating the expression of EMT-related factors such as VEGF 41, histone deacetylase 3 (HDAC3) 42, AXL 43, membrane-type 4 matrix metalloproteinase (MT4-MMP) 44, MMP-9 36, lysyl oxidase (LOX) 5, COX-2 18, Twist, Snail1/2, and Zeb1 42, and activating the Notch 5 and Hedgehog (Hh) 42 pathways. Here, PTGS2 is linked to neoplasm.