The development of synthetic routes to the pyrido[4,3-b]carbazole system is reviewed. This system is of interest as some examples are naturally occurring plant alkaloids and as some derivatives of this system show promise as potential anti-cancer drugs. Yields and reaction conditions of the syntheses are examined critically with the aim of highlighting the most expeditious pathways to the widest range of derivatives. 1. Introduction 2. Classification of the Synthetic Routes 3. Syntheses via Fischer Indolisation Reactions 4. Syntheses from Carbazole Derivatives 5. Syntheses from Indole Precursors 6. Conclusions and Biological Results