The diagnosis of cancer typically evokes anxiety, grief, and fears of physical suffering, dependency and vulnerability. However, the dramatic alteration in the life course and relational equilibrium in such individuals may also trigger a search for meaning, resulting in unique opportunities for emotional growth. Despite the poignancy and power of the therapeutic process in the context of a life-threatening, advanced or terminal disease, the influence of modern psychoanalytic thinking on this area of practice has been minimal. The purpose of this article is to review psychoanalytic concepts about mortality and consider how they may be revised in the light of more recent developments in psychoanalytic theory and of systematic research investigating the psychological impact of advanced and terminal cancer.