As the second most populous nation and one of the fastest-growing major economies, India faces many challenges, one such burning issue is the provision of cancer care. There is a huge gap in the demand and supply of health care resources in Indian oncology scenario, mainly due to steadily aging populations and also to current trends in smoking prevalence and the growing adoption of unhealthy lifestyles. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. Although incidence of cancer is low in India compared with high-income countries, mortality is high; with approximately 600,000- 700,000 deaths in 2012. Many cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Cancer can have profound psychological, social and economic consequences for people in India, often leading to family impoverishment and societal inequity. Currently, overall public expenditure on health care is only 1.5% of GDP. The socioeconomic, service delivery and cost and resource implications from this enormous burden require urgent attention from central and state governments, cancer communities, and public health communities to reduce their effect in a sustainable and cost-effective manner. We discuss specific barriers that must be overcome to improve prevention and early detection, enhance prompt treatment, and provide cost-effective palliative care for patients with advanced stage disease.