This capstone systematically reviews evidence on how climate change threatens tomato (Solanum lycopersicum L.) production through drought, heat, waterlogging, nutrient limitations, and interacting stresses, with emphasis on global production systems and Ghana’s smallholder context. Publications and production datasets were synthesized to examine plant responses and adaptation options. Abiotic stress disrupts water relations, stomatal regulation, photosynthesis, reproductive development, nutrient uptake, and fruit quality, while inducing osmotic adjustment, antioxidant defenses, hormonal signaling, and transcriptional reprogramming. Combined drought and heat often cause greater damage than either stress alone. The review identifies efficient irrigation, fertigation, mulching, protected cultivation, and stress-tolerant cultivars as complementary strategies for improving water and nutrient productivity. Grafting emerges as a promising tool because selected rootstocks can enhance root hydraulics, water status, photosynthetic performance, ion exclusion, and stress signaling. Integrated, locally appropriate strategies are needed to sustain tomato yield, quality, and resilience under increasingly variable climates.