C3orf21 (chromosome 3 open reading frame 21), also known as xyloside xylosyltransferase 1 (XXYLT1), is located on chromosome 3q29. C3orf21 belongs to the glycosyltransferase 8 family, furthermore, it is a retaining glycosyltransferase. In the extracellular domain of target proteins, XXYLT1 catalyzes addition of the second sylose, and then elongates the O-linked xylose-glucose disaccharide attached to EGF-like repeats. XXYLT1 negatively regulates Notch signaling, and aberrations in the Notch signaling pathway were associated with a few types of cancers. So, C3orf21 must be associated with cancer development. Our previous research has found that the C3orf21 polymorphisms were associated with lung cancer risk, and the ablation of C3orf21 gene (XXYLT1) promoted lung cancer MSTO-211H cell proliferation, inhibited apoptosis and accelerated cell migration. Understanding the role of C3orf21 in the cancer development may provide insights into the potential of C3orf21 as a cancer biomarker. Here, we reviewed several representative studies for understanding the C3orf21 and Notch signaling in cancer.