Surgery is the mainstay of cancer treatment and lack of surgical treatment is a major driver in holding back optimal cancer care. Surgery is essential for global cancer care in all resource settings. Of the estimated 18.1 million new cases of cancer in 2018, over 80% of cases will need surgery, some several times. Many patients throughout the world do not have access to cancer surgery. Many of the key adjunct treatment modalities for cancer surgery—e.g., anaesthesia, pathology and imaging—are also inadequate. Solutions are necessary and should include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials and new approaches to improve quality and scale up cancer surgical systems through education and training. Delivery of safe, affordable and timely cancer surgery to all must be at the heart of global and national cancer control planning.