Exosomes in Colorectal Cancer: From Tumor Biology to Diagnostic and Therapeutic Applications

Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide despite advances in screening, surgical techniques, and systemic therapies. In recent years, exosomes—nanoscale extracellular vesicles involved in intercellular communication—have emerged as critical regulators of CRC biology. Exosomes mediate tumor progression, metastatic dissemination, immune evasion, and therapeutic resistance through the transfer of bioactive molecules including proteins, lipids, and non-coding RNAs. Moreover, exosomes have gained increasing attention as promising liquid biopsy tools and therapeutic platforms due to their stability, biocompatibility, and ability to reflect tumor molecular dynamics. This review provides a comprehensive overview of exosome biogenesis, molecular composition, and their functional roles in CRC pathogenesis. We further discuss their diagnostic and prognostic value, involvement in therapeutic resistance, and emerging therapeutic applications, with particular emphasis on translational and surgical oncology implications. Finally, we highlight current limitations and future perspectives for clinical integration of exosome-based strategies in CRC management.