Treatment failure in nasopharyngeal carcinoma (NPC) is mainly due to local and regional recurrence and at present lacks a marker to identify such cases. VEGF, a potent endothelial cell mitogen and vascular permeability-inducing agent, plays a critical role in tumor growth and neo-vascularisation. VEGF expression was assessed in 103 NPC and 26 benign adenoid lesions by immunohistochemistry and Epstein Bar Virus (EBV) presence by PCR using primers directed against EBNA-1 gene. The localization of the virus to the tumour cells was confirmed by in situ hybridization using EBER in situ hybridization. Over expression of VEGF was seen in 67% of NPC cases. Higher expression of VEGF in EBV positive tumours was related to higher rate of recurrence, nodal positivity and lower survival. This is the first report evaluating the correlation between VEGF expression levels, EBV status and recurrence in Indian NPC. The results point towards the potential of the expression pattern of VEGF as a tumor marker for the early diagnosis of metastastic NPC and also show that presence of EBV is related to up regulation of VEGF.