<p>Cancer remains one of the leading causes of mortality worldwide, necessitating the development of advanced diagnostic and therapeutic strategies with improved specificity, safety and efficacy. Carbon quantum dots (CQDs) have emerged as a versatile class of nanomaterials with unique optical, physicochemical, and biocompatible properties suitable for biomedical applications. Recently, bioinspired carbon quantum dots (B-CQDs) derived from medicinal plants have gained considerable attention as sustainable and functional nanomaterials for cancer management. This review critically examines the synthesis approaches, physicochemical properties, biological activities and anti-cancer potential of B-CQDs including biosensing, bioimaging, drug delivery, and photo-induced therapies. Current literature reveals that B-CQDs can induce reactive oxygen species (ROS) mediated cytotoxicity, facilitate specific cellular uptake and accelerate photodynamic therapeutic effects, emerging their role in cancer diagnostics and therapeutics. However, recent reports demonstrated that biological activities are interpreted through a precursor-centric framework, in which medicinal plant origin is presumed to control bioactivity. Moreover, surface physicochemical properties primarily influence biological activity while precursor effects are indirect and synthesis dependent. Current challenges including reproducibility, regulatory approval standardization and intellectual property protection sustain limitations on clinical translation and commercialization. Future investigations should uncouple precursor effects from surface chemistry and combine with advanced mechanistic quantitative structure characterization analysis. This will facilitate the rationale-driven design of B-CQDs for clinical application toward precision oncology diagnostics and treatment.</p> Graphical Abstract <p></p>