Growing tumor tissues develop a stressful microenvironment characterized by hypoxia and acidosis. Tumor cells can survive these stresses via induction of adaptive transcriptional changes mediated primarily by the hypoxia-inducible factor (HIF), and via stimulation of ion transport machinery maintaining normal intracellular pH. In addition, through these adaptive responses tumor cells acquire new features endowing them with selective advantage in migration, invasion, metastasis, and resistance to therapy. Carbonic anhydrase IX (CA IX), a highly active cancer-related carbonic anhydrase isoform, is linked to both hypoxia, as a direct transcriptional target of HIF, and acidosis, as a component of mechanisms that facilitate ion transport across the plasma membrane and thereby counteract the intracellular accumulation of acidic metabolic products. Expression pattern of CA IX in human tumors reflects the activation of the HIF pathway by physiologic hypoxia, genetic defects, and/or oncogenic events. Moreover, CA IX plays an active role not only in pH regulation but also in cell migration and invasion. Thus, it is often exploited and/or investigated as an intrinsic marker of hypoxia, a prognostic indicator, and a therapeutic target for antibodies or inhibitors of the enzyme activity. It is believed that these CA IXtargeted therapeutic approaches can mediate the selective killing of CA IX-positive cells or sensitize tumor cells to conventional treatment modalities. In addition, both