Per- and polyfluoroalkyl substances (PFAS) have garnered increasing global attention due to their widespread occurrence in groundwater and the potential health risks to humans. This review aimed to clarify the occurrence and treatment of PFAS in groundwater by summarizing literature published in the Web of Science Core Collection from January 2000 to April 2024. Information on 461 reported PFAS-contaminated groundwater sites was compiled, revealing key characteristics of pollution sources and concentrations. The data indicated that firefighting training activities were a major source of PFAS groundwater contamination, accounting for 41 % of cases, followed by other fluorinated industrial activities, landfill leachate, and wastewater leakage. Non-point sources, such as atmospheric deposition, contributed to a lesser extent. The concentrations distribution of 25 PFAS showed a chain-length dependency, with short-chain PFAS generally exhibiting higher concentrations than long-chain PFAS. Additionally, the review systematically examined the application of separation methods and destructive methods at both laboratory and pilot/field-scales for PFAS-contaminated groundwater. Resins were favored for ex-situ treatment, whereas colloidal activated carbon (CAC) was more commonly used for in-situ treatment. In-situ direct injection of CAC was considered a highly promising approach for remediating PFAS source zones and plumes, offering advantages such as minimal surface disruption, high adsorption capacity and long-term effectiveness. Finally, the research focus and development trends in categories and treatment methods for PFAS in groundwater were noted. Overall, this review identified research gaps in the occurrence and treatment of PFAS in groundwater, and suggested further optimization of CAC-based methods to address the challenges of PFAS-contaminated groundwater.