The role of the gastrin peptide hormones (G17, G34) and their precursors (progastrins, PG; glyextended gastrin, G-gly), in gastrointestinal (GI) cancers has been extensively reviewed in recent years (1-3). A possible important role of progastrin peptides in colon carcinogenesis has become evident from experiments with transgenic mouse models (1;3). It is now known that growth stimulatory and co-carcinogenic effects of gastrin/PG peptides are mediated by both proliferative and anti-apoptotic effects of the peptides on target cells (4;5). Several receptor subtypes have been described that mediate growth effects of gastrin peptides (1;2). Recently, we identified Annexin II as a high affinity binding protein for gastrin/PG peptides (6). Importantly, the expression of Annexin II was required for mediating growth stimulatory effects of gastrin and PG peptides on intestinal epithelial and colon cancer cells (6), suggesting that Annexin II may represent the elusive novel receptor for gastrin/PG peptides. The importance of this finding in relation to the structure and function of Annexin II, especially in GI cancers, is described below. Since this surprising finding represents a new front in our understanding of the mechanisms involved in mediating growth effects of gastrin/PG peptides in GI cancers, our current understanding of the role of Annexin II in proliferation and metastasis of cancer cells is additionally reviewed.