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With the increasing global burden of cancer, traditional chemotherapy is limited by issues such as high toxicity and poor targeting, making the development of new therapeutic strategies an urgent priority. As natural bioactive macromolecules, herbal polysaccharides have become a hotspot in antitumor research due to their multi‑target effects, low toxicity, and excellent biocompatibility. The present review summarizes recent advances in the mechanisms of plant polysaccharides in antitumor activity and their applications in drug delivery systems. It highlights their synergistic antitumor effects through multiple pathways, including regulation of the immune microenvironment, induction of programmed cell death, modulation of the microbiota‑immune axis, and inhibition of angiogenesis and metastasis. These compounds significantly enhance the efficacy of chemotherapy and immunotherapy while reversing drug resistance. Novel formulations such as polysaccharide‑based nano‑delivery systems, selenium‑modified complexes and gel platforms have further improved drug targeting, stability, and immunomodulatory efficacy, providing a solid theoretical foundation and innovative directions for integrated traditional Chinese and Western medicine in cancer treatment.