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Recent advances in multi\u2010omics and extracellular vesicle profiling have revealed substantial molecular and functional heterogeneity, extending beyond classical membrane\u2010bound exosomes to nonmembranous extracellular nanoparticles such as exomeres and supermeres. Here, we provide a pan\u2010cancer synthesis of exosome biology, integrating mechanisms of biogenesis, cargo sorting, and secretion with emerging concepts of extracellular nanoparticle diversity. We examine how tumor\u2010derived exosomes remodel local and distant microenvironments by promoting angiogenesis, metabolic reprogramming, immune suppression, premetastatic niche formation, and cancer\u2010associated cachexia. We also discuss the relative contributions of active organotropic targeting and passive spatiotemporal accumulation to metastatic dissemination, together with tissue\u2010specific mechanisms governing endothelial barrier crossing, myeloid\u2010cell reprogramming, and intercellular network integration. Clinically, we evaluate exosome\u2010based liquid biopsy, molecular subtyping, engineered delivery systems, and strategies that inhibit endogenous vesicle production or circulation. Finally, we outline key translational challenges, including single\u2010vesicle heterogeneity, limited intravital tracking, and the absence of standardized cGMP manufacturing and analytical frameworks across diverse tumor types and clinically relevant biological contexts worldwide. This review defines a roadmap for exosome\u2010guided precision oncology.<\/jats:p>","DOI":"10.1002\/mco2.71074","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:01:29Z","timestamp":1792602089000},"source":"Crossref","is-referenced-by-count":0,"title":["Exosomes in Cancer: The Biology, Function, Diagnosis, and Therapy"],"prefix":"10.1002","volume":"7","author":[{"given":"Jun","family":"Wu","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery National Clinical Research Center for Geriatric Disorders (Xiangya Hospital) Central South University  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Second Affiliated Hospital of Nanchang University  Nanchang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments 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