Cancer is a common disease in Western society that can affect any organ system. It has a high morbidity and mortality despite advances in treatment over the last hundred years. There is a clear need for new approaches to cancer chemotherapy including the possibility of reducing systemic adverse effects associated with current treatments. Vesicle trafficking is an essential cellular process that is perhaps not fully recognized. There is mounting evidence that vesicle trafficking, including the release of extracellular microvesicles, is a highly important process in tumourigenesis. Diverse aspects of tumourigenesis including invasion, metastasis, cell cycle regulation, angiogenesis, tumour immune privilege, neoplastic coagulopathy and multidrug resistance can be explained by altered vesicle trafficking in cancer cells. This paper reviews the evidence in the scientific and patent literature for the role of vesicle trafficking in tumourigenesis and suggests a number of targets and strategies that may be important for cancer therapeutics.