Cancer poses a massive global health burden with rates set to double over the next decade. In the UK, it is estimated that 42% of the population will experience a cancer diagnosis in their lifetime and for 64% of these, cancer will cause their death. Surgical excision holds the greatest chance of cure for solid tumours yet once spread beyond the primary site has occurred survival rates decrease rapidly. Early detection of cancer allows early intervention with, potentially, the greatest chance of cure. Raman spectroscopy has the ability to detect biochemical alterations in cells prior to any morphological changes a pathologist would identify. Cancer is believed to have genetic and environmental components to its aetiology. These factors depend on site and cancer biology. Many authors have explored the potential of Raman spectroscopy to discriminate between cancerous, non-cancerous and dysplastic (precancerous) cells. Such work has been undertaken using live cells, formalin-fixed cells, pellets and scaffolds as well as whole tissues and body fluids. Raman based technologies can be used as a screening tool for at risk populations. Another avenue for Raman would be in surgical theatre assessing margins at the time of an operation thus optimsing conservation of normal tissue whilst removing all the cancer. A further breakthrough would be the ability of Raman spectroscopy to diagnose cancer through a blood sample. The advantage this would confer would be greatly enhanced if the biological properties of the cancer could be recognized, it may be then possible to offer bespoke treatment, thus keeping some patients under surveillance whilst others have graded treatment ranging from surgery, radiotherapy to chemotherapy and combination therapies.