The phosphorylation of glucose, a crucial step in cellular metabolism, is catalysed by hexokinases (HK), of which there are four (HKI-IV) in mammalian tissues. The brain HK, (HK1), like HKII and HKIII, has a molecular weight of approximately 100 kDa. HKII is insulin-sensitive and found in adipose and muscle cells. HKIV, also known as glucokinase, has a molecular weight of 50 kDa and is specific to liver and pancreas. Most brain HK is bound to mitochondria via porins, enabling coordination between glucose consumption and oxidation. Tumour cells are known to be highly glycolytic, and correspondingly increased expression of glycolytic enzymes, including HK, have been detected in resected tumours from patients with lung, gastrointestinal and breast cancer. In the latter group, further increases in HK activity were associated with metastatic disease. Some studies have demonstrated increased HK activity in renal tumours, and also have reported changes in the isoenzymic expression of HK. Experimental studies of the initiation and progression of liver tumours have demonstrated a shift in expression from that of HKIV to HKI and HKII, with increased HK binding to mitochondria and a > 100-fold increase in HK activity. However, studies using xenografts derived from gliomas found decreased HK activity corresponding with loss of chromosome 10, the carrier of the HKI gene. Compared with normal tissues, a number of mechanisms are associated with changes in HK activity seen in tumours of the liver and other sites, and these include HK gene dosage, increased transcription, modulation of HK promoter activity by a broader range of effectors, and increased mitochondrial binding of HK. Increased HK activity, together with increased glucose transport by tumour cells, has been exploited in cancer imaging using the positron-labelled glucose analogue (18F)fluoro-2-deoxy-D-glucose (FDG), which is transported into cells and then phosphorylated, but undergoes little further metabolism. Accumulated FDG then can be detected using positron emission tomography (PET).