Gastrointestinal (GI) cancers remain among the leading causes of cancer-related morbidity and mortality worldwide. Despite advancements in conventional therapies, the prognosis for patients with GI malignancies remains suboptimal, often due to therapy resistance and adverse side effects. Consequently, there is a pressing need to explore novel, effective, and safer therapeutic agents. Ginsenosides, the principal active components of Panax ginseng, have garnered attention for their multifaceted biological activities, including anticancer properties. Preclinical studies have demonstrated that ginsenosides such as Rg3, Rh2, and compound K exert anticancer effects by modulating key signaling pathways, inducing apoptosis, inhibiting angiogenesis, and enhancing immune responses in various GI cancer models. Notably, ginsenoside Rg3 has been shown to inhibit tumor growth and metastasis in gastric and colorectal cancer models by suppressing vascular endothelial growth factor (VEGF) expression and modulating the NF-κB pathway. Furthermore, ginsenosides have been reported to enhance the efficacy of conventional chemotherapeutic agents and mitigate their side effects, suggesting a potential role as adjuvant therapies. While these findings are promising, clinical evidence remains limited. Some clinical studies have indicated that ginseng preparations may improve postoperative immunity and survival in gastric cancer patients. However, comprehensive clinical trials are necessary to validate the efficacy and safety of ginsenosides in GI cancer treatment. This review aims to consolidate current knowledge on the anticancer potential of ginsenosides in GI cancers, emphasizing their molecular mechanisms of action and highlighting the need for further clinical investigations to translate these findings into therapeutic applications.