Prior to the discovery of cyclooxygenase-2 (COX-2), a beneficial association was shown between chronic usage of non steroidal anti-inflammatory drugs (NSAIDs), that non-selectively inhibit both cyclooxygenase-1 (COX-1) and COX-2, and prevention of colorectal cancer. The cloning of COX-2 allowed the development of enzyme inhibitors that selectively inhibit COX-2 and also facilitated the expression profiling of COX-2 in many cancer tissues. COX-2 selective inhibitors have shown efficacy in vitro and in vivo in several animal cancer models and in limited human clinical trials. The potency of COX-2 inhibitors in vivo can be attributed to the inhibition of the enzyme in the tumor as well as in stromal cells, resulting in reduction of carcinogen production, anti-proliferative and pro-apoptopic actions within the tumor and anti-angiogenic and pro-immune surveillance activities in endothelial and myeloid cells. The combination of COX-2 inhibitor with standard cancer chemotherapeutic and/or radiation may provide additional therapeutic paradigms in the treatment of various human cancers.