Cancer is driven by multiple types of genetic alterations, which range in size from point mutations to whole chromosome gains and losses, a condition known as aneuploidy.Chromosome instability, the process that gives rise to aneuploidy, can promote tumorigenesis by increasing genetic heterogeneity and promoting tumor evolution. However, much less is known about how aneuploidy itself contributes to tumor formation and progression. Unlike some pancancer oncogenes and tumor suppressor genes that drive transformation in virtually all cell types and cellular contexts, aneuploidy is not a universal promoter of tumorigenesis. Instead, a picture emerges that paints aneuploidy as a context-dependent cancer type-specific oncogenic event. In this Review, we discuss the role of aneuploidy in tumor development, and its clinical relevance as a prognostic marker and as a potential therapeutic target.