End-stage renal disease (ESRD) requiring dialysis significantly worsens health outcomes, increasing hospitalization risk tenfold and shortening life expectancy by 13–26%. Though the incidence of cancer in ESRD patients is high, detailed studies on the impact of hemodialysis and surgery for cancer are lacking. Esophageal cancer surgery in dialysis patients is rare due to the high risk of postoperative complications, such as cardiovascular events and death. Less invasive options, like radiation or chemotherapy, may be considered but carry their own risks. Gastric cancer surgery in dialysis patients also presents high morbidity and mortality, with survival rates lower than in non-dialysis patients. Endoscopic treatments may offer alternative options for early-stage gastric cancer, though data remain limited. Small intestine cancers are rare, but dialysis patients face increased risks. Surgical outcomes for these cancers in ESRD patients are poorly documented, and the limited reports suggest a higher likelihood of postoperative complications. A multidisciplinary, patient-specific approach is recommended to balance treatment efficacy with patient safety, especially given the frailty and unique challenges faced by dialysis patients.