Abstract This paper explores the role of psychodynamic psychotherapy in the treatment of patients with cancer, a therapeutic approach that has faced criticism for various unexamined reasons. Given the limited literature on this subject, we aim to contribute by examining (i) the specificity of the cancer experience, particularly its five main existential dimensions and dialectics, (ii) the psychological challenges patients with cancer encounter from a psychodynamic perspective and (iii) the relationship between these psychological dimensions and the existential dialectics experienced by patients, which we consider central to psychodynamic psychotherapy. Notably, this last aspect has not been addressed in the literature. To illustrate our perspective, we present a case vignette of a patient who underwent 2?years of weekly psychotherapy before ultimately succumbing to the disease. Through this discussion, we aim to demonstrate that psychodynamic psychotherapy is particularly well suited for patients experiencing existential threat who wish to benefit from psychological support. Additionally, we hope to contribute to clinician training and to the destigmatisation of psychodynamic psychotherapy within somatic care settings.