Harnessing exosomes for endometrial Cancer: From non-invasive diagnostics to precision therapies

Exosomes, a subset of extracellular vesicles (EVs), have emerged as pivotal players at the intersection of diagnostics and therapeutics in oncology. These nanoscale vesicles, which are secreted by virtually all cell types, function as critical mediators of intercellular communication by transporting diverse cargoes of proteins, lipids, and nucleic acids between cells. In the context of endometrial cancer (EC), a heterogeneous malignancy with increasing global incidence, exosomes offer a unique opportunity for minimally invasive "liquid biopsy" approaches for diagnosis and prognosis while simultaneously serving as highly versatile platforms for targeted drug delivery. Owing to their natural biocompatibility, stability in circulation, and ability to cross biological barriers, these materials are ideal candidates for next-generation theranostic applications that combine both diagnostic and therapeutic functions. This review provides a comprehensive investigation into the dual role of exosomes in EC, integrating preclinical findings, emerging clinical data, and translational challenges. This study examines the utility of exosomal cargo as biomarkers across all EC subtypes and evaluates engineering strategies that enable its use as precision nanomedicines, ultimately charting a course for their future integration into clinical practice.