The updated role of exosomes in cancer diagnosis and therapy

Exosomes are nanoscale extracellular vesicles secreted by cells via endosomal pathways. They mediate intercellular communication by transporting bioactive molecules, including proteins, lipids, and nucleic acids. During tumorigenesis, exosomes critically participate in multiple oncogenic processes, including metastatic dissemination, immune evasion, tumor microenvironment remodeling, angiogenesis, and the development of chemoresistance. Comprehensive characterization and molecular profiling of vesicular surface epitopes are essential for tracing their origins. These membrane-bound biomarkers not only facilitate precise vesicle classification but also enable the selective enrichment of tissue-specific molecular signatures that are crucial for targeted therapeutic applications. Accumulating evidence indicates that tumor-derived exosomes have emerged as promising diagnostic biomarkers with exceptional specificity, while their intrinsic biocompatibility and cargo-loading capacity confer transformative potential for next-generation drug delivery platforms. This review critically examines exosome roles in tumor biology. It highlights clinical applications in oncology. We focus on exosome biomarkers in liquid biopsy, engineered exosomes for drug delivery, and pharmacological or genetic strategies targeting exosome biogenesis.