Although traditionally used as a valuable health supporting nutrient, the vegetative parts of Opuntia spp. plants are scarcely used in modern nutrition and medicine. While all kinds of different Opuntia spp. have been studied, a systematic approach regarding the inter-relationships between the composition and the pre- and postharvest conditions is still missing. Therefore, the present review compiles and discusses literature on the chemical composition of cactus stems, the knowledge on uses in food, medicine, and cosmetics. It is concluded that much research is needed to get an insight into the multitude of bioactivities reported in the traditional literature but also to take advantage of the respective constituents for food and pharmaceutical applications.