Emerging evidence has suggested that high fructose intake, particularly from added sugars and processed foods, is associated with increased cancer risk and progression. The fructose intake is believed to be mediated by the abnormal expression of glucose transporter 5 (GLUT5), the specific fructose transporter in cancer cells. The GLUT5-regulated fructose metabolism has shown to greatly affect cancer progression, metastasis, and drug resistance. This review aims to synchronize the current knowledge to highlight the underlying mechanisms of those impacts and understand the therapeutic potential of GULT5. First, we review the fructose metabolism and its alteration in cancer cells by comparing with glucose metabolism. Subsequently, the key contributors or biological pathways involved in GLUT5-asosociated tumor growth, cancer metastasis, and drug resistance are discussed. The contributions of specific pathways, metabolites, and key enzymes from the fructose metabolism process are also covered, such as enhanced glycolysis for tumor growth, epithelial-mesenchymal transition and angiogenesis for cancer metastasis, and efflux pump expression and activation of survival pathways for cancer drug resistance. The detailed analysis of these mechanisms will allow further understanding of the therapeutic potential of GLUT 5-mediated fructose metabolism in cancer therapy. In particular, targeting GLUT 5 and its-associated processes in fructose metabolism may offer promising strategies for improving cancer treatment outcomes through dietary interventions, specific GLUT5 inhibitors, or in combination.