Exosomes in cancer diagnosis based on the Latest Evidence: Where are We?

•Exosome isolation techniques have limitations, necessitating the development of more efficient methods.•Integration of AI and bioinformatics tools is crucial for analyzing the complex data in exosome studies.•Understanding the roles of exosomes in normal and pathological conditions is essential for successful clinical translation of exosome-based therapeutics.•Engineered exosomes present a promising avenue to advance therapeutics and ensure reproducibility in clinical applications. Exosomes are small extracellular vesicles (EVs) derived from various cellular sources and have emerged as favorable biomarkers for cancer diagnosis and prognosis. These vesicles contain a variety of molecular components, including nucleic acids, proteins, and lipids, which can provide valuable information for cancer detection, classification, and monitoring. However, the clinical application of exosomes faces significant challenges, primarily related to the standardization and scalability of their use. In order to overcome these challenges, sophisticated methods such as liquid biopsy and imaging are being combined to augment the diagnostic capabilities of exosomes. Additionally, a deeper understanding of the interaction between exosomes and immune system components within the tumor microenvironment (TME) is essential. This review discusses the biogenesis and composition of exosomes, addresses the current challenges in their clinical translation, and highlights recent technological advancements and integrative approaches that support the role of exosomes in cancer diagnosis and prognosis.