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Cancer therapy has long been constrained by challenges such as high recurrence rates, high metastasis rates, and damage to normal tissues, and conventional therapeutic approaches struggle to achieve a precise balance between efficacy and safety. The innovation of nanotechnology has brought breakthroughs to this field. As a typical class of zero-dimensional carbon-based nanomaterials, carbon dots (CDs) generally exhibit a size of less than 10 nm. Owing to their favorable biocompatibility and abundant surface functional groups, CDs offer a novel avenue for tumor therapy. This review systematically summarizes the various application strategies, mechanisms of action, and research progress of CDs in cancer therapy. First, it introduces two critical functions of CDs in tumor therapy: drug delivery and targeting. Subsequently, we delve into the applications of CDs in a series of anticancer strategies, including photodynamic therapy (PDT), photothermal therapy (PTT), chemodynamic therapy (CDT), sonodynamic therapy (SDT), gas therapy (GT), immunotherapy, gene therapy, and nanozyme-based therapy. Finally, the challenges faced by CDs in cancer therapy are summarized, and their future development directions are prospected, providing theoretical references and research ideas for the clinical translation of CD-based tumor therapeutic systems.