The x cystine/glutamate antiporter is a major plasma membrane transporter for the cellular uptake of cystine in exchange for intracellular glutamate. Its main functions in the body are mediation of cellular cystine uptake for synthesis of glutathione essential for cellular protection from oxidative stress and maintenance of a cystine:cysteine redox balance in the extracellular compartment. In the past decade it has become evident that the x transporter plays an important role in various aspects of cancer, including: (i) growth and progression of cancers that have a critical growth requirement for extracellular cystine/cysteine, (ii) glutathione‐based drug resistance, (iii) excitotoxicity due to excessive release of glutamate, and (iv) uptake of herpesvirus 8, a causative agent of Kaposi's sarcoma. The x transporter also plays a role in certain CNS and eye diseases. This review focuses on the expression and function of the x transporter in cells and tissues with particular emphasis on its role in disease pathogenesis. The potential use of x inhibitors (e.g., sulfasalazine) for arresting tumor growth and/or sensitizing cancers is discussed. J. Cell. Physiol. 215: 593–602, 2008. © 2008 Wiley‐Liss, Inc.