Sugarcane (Saccharum spp.) is a vital crop globally, playing a significant role in sugar and bioethanol production. It significantly supports the agricultural economies of both tropical and subtropical regions. However, abiotic stresses such as drought, waterlogging (WL), heat, cold and salinity significantly hinder its productivity by disrupting physiological, biochemical and molecular processes. These stresses reduce yield and sucrose content and threaten the crop’s economic viability under changing climatic conditions. Developing stress-tolerant sugarcane cultivars is crucial to ensure yield stability under changing climatic conditions. Traditional breeding approaches, though effective, are time-consuming and limited by the crop’s complex polyploid genome. Progress in molecular biology and biotechnology has introduced tools such as marker-assisted selection (MAS), genome-wide association studies (GWASs) and quantitative trait loci (QTL) mapping, transgenesis and genome editing techniques like clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), all of which offer promising solutions for developing stress-resilient varieties. The role of transcription factors (TFs), microRNAs (miRNAs) and antioxidant mechanisms in modulating stress responses is also explored. Integrating genomic, proteomic and transcriptomic data has facilitated the discovery of genes and pathways associated with stress tolerance. Incorporating wild relatives and related genera, like Erianthus and Saccharum spontaneum, further enhances the genetic diversity available for breeding. Despite the challenges posed by genome complexity, recent advancements have paved the way for developing climate-resilient sugarcane varieties. This review underscores the need for a multidisciplinary approach that combines traditional and modern tools to mitigate the impacts of abiotic stresses, ensuring sustainable sugarcane production in an era of global climate change.