Cancer treatment and therapy has made significant leaps and bounds in these past decades. However, there are still cases where surgical removal is impossible, metastases are challenging and chemotherapy and radiotherapy pose severe side effects. Therefore, the need to find more effective and specific treatments still exists. One of the ways is through the utilization of drug delivery agents (DDA) based on nanomaterials. In 2001, mesoporous silica nanoparticles (MSNs) were first used as DDA and have gained considerable attention in this field. The popularity of MSNs is due to their unique properties such as tunable particle and pore size, high surface area and pore volume, easy functionalization and surface modification, high stability and their capability to efficiently entrap cargo molecules. This review describes the latest advancement of MSNs as DDA for cancer treatment. We focus on the fabrication of MSNs, the challenges in DDA development and how MSNs address the problems through development of smart DDA using MSNs. Besides that, MSNs have also been applied as a multifunctional DDA where they can serve in both diagnostic and treatment of cancer. Overall, we argue MSNs provide a bright future for both the diagnosis and treatment of cancer.