Initially, metal derived nanoparticles have been used exclusively as contrasting agents in magnetic resonance imaging. Today, green routes of chemical synthesis together with numerous modifications of the core and surface gave rise to a plethora of biomedical applications of metal derived nanoparticles including tumor imaging, diagnostics, and therapy. These materials are an emerging class of tools for tumor theranostics. Nevertheless, the spectrum of clinically approved metal nanoparticles remains narrow, as the safety, specificity and efficiency still have to be improved. In this review we summarize the major directions for development and biomedical applications of metal based nanoparticles and analyze their effects on tumor cells and microenvironment. We discuss the advantages and possible limitations of metal nanoparticle-based tumor theranostics, as well as the potential strategies to improve the in vivo performance of these unique materials.