Purpose of Review <p>Gastroparesis is a debilitating gastrointestinal motility disorder characterised by delayed gastric emptying in the absence of mechanical obstruction. Among the various pathophysiological mechanisms associated with gastroparesis, malignancy-associated gastroparesis (MG) represents a distinct yet under-recognised clinical entity. This review aims to synthesise current knowledge on the pathophysiology, diagnostic challenges, and management of MG, highlighting recent advances and knowledge gaps in this emerging area.</p> Recent Findings <p>The exact prevalence of MG remains unknown; It is often underdiagnosed and inadequately managed in both oncology and gastroenterology contexts. Malignancies associated with gastroparesis most commonly involve the pancreas, stomach, and gallbladder or paraneoplastic syndromes. The mechanisms underlying malignant gastroparesis are complex and not yet fully understood. These may involve autonomic neuropathy caused by chemotherapy, immunosuppression leading to opportunistic viral infections, paraneoplastic gastroparesis characterised by autoimmune-mediated neuropathy or myopathy, and palliative procedures such as celiac plexus blocks. Furthermore, malignancies can worsen pre-existing metabolic conditions like diabetes mellitus and hypothyroidism, thereby aggravating gastric dysmotility. Management of MG depends on clinical severity; metoclopramide is the only medication approved by the U.S. Food and Drug Administration for the treatment of gastroparesis. Endoscopic and surgical procedures are usually reserved for refractory cases.</p> Summary <p>Malignant gastroparesis is a complex, multifactorial, and often overlooked cause of gastric dysmotility in cancer patients. A thorough understanding of its varied pathophysiological mechanisms is crucial for early, accurate diagnosis and customised management. Further research is required to define diagnostic algorithms and develop targeted therapies to enhance patient outcomes and quality of life.</p>