Cancer treatment still faces major challenges, including drug resistance, toxic side effects, recurrence, and metastasis. The Nrf2 signaling pathway is a key regulatory axis in the cellular antioxidant stress response and plays a dual role in tumor initiation and progression. Moderate activation of Nrf2 in the early stage helps maintain cellular homeostasis, whereas persistent aberrant activation promotes tumor progression and therapeutic resistance. Recent studies have shown that active components and compound formulas of traditional Chinese medicine can regulate Nrf2 and its related signaling networks, thereby affecting oxidative stress, ferroptosis, autophagy, inflammatory responses, and the tumor immune microenvironment. Through these mechanisms, they can inhibit tumor growth, induce cell death, enhance sensitivity to radiotherapy and chemotherapy, and reduce damage to normal tissues. This review summarizes the research progress on the antitumor effects of traditional Chinese medicine mediated by regulation of the Nrf2 pathway, with the aim of providing references for mechanistic studies and the development of novel antitumor therapeutic strategies.