Drug or gene delivery based on nanostructure is promising for treatments of cancers to solve a variety of issues associated with traditional therapeutic agents from poor bioavailability to systemic toxicity. For real-time monitoring of the delivery process, imaging-guided therapy has attracted growing interest in biomedical applications. Luminescent nanostructures serve as an essential tool for illuminating the pathway of drug or gene delivery in biomedical systems. Considering their crucial role in medical applications, we summarize recent progress of luminescent nanostructures as drug- or gene-delivery nanocarriers with simultaneous imaging tracking. We also discuss the design principles and the critical issues faced by multifunctional nanostructure engineering, which might provide guidance for further development in this field.