Advances in genomics have identified an array of clinically relevant mutations that drive tumor initiation and maintenance. There is an urgent need to utilize this genomic information to improve patient outcomes. Many oncogenes induce metabolic reprogramming, which is a hallmark of cancer, and this relationship provides the unparalleled opportunity to identify metabolic imaging biomarkers that enhance diagnosis and treatment response assessment for cancer patients. In this talk, I will discuss the use of X-nuclei imaging (hyperpolarized 13C-, 31P- and 2H-magnetic resonance spectroscopy) for monitoring oncogenic events in cancer and examine the ways in which these modalities can guide patient management.