The tumor microenvironment (TME) is a complex ecosystem comprising tumor cells, cancer-associated fibroblasts, vascular endothelial cells, immune cells, and interstitial cells. Tumor-derived exosomes (TDEs) play a crucial role in modulating TME and accelerating tumor progression through various mechanisms. These mechanisms include inducing epithelial-mesenchymal transition (EMT), macrophage polarization, angiogenesis, and metabolic reprogramming. TDEs also contribute to immune escape by suppressing immune cells and facilitating tumor cell proliferation and metastasis. The unique biogenesis and characteristics of TDEs make them promising targets for diagnostic and therapeutic applications. Potential biomarkers derived from TDEs, such as miRNAs and long non-coding RNAs, have been identified for early cancer detection and prognosis. Additionally, TDEs can be engineered as therapeutic agents to enhance immunotherapy and target specific cell types. However, challenges remain in improving the quantification accuracy, production volume, and stability of TDEs for clinical use. Further research is needed to optimize their delivery and therapeutic efficacy.The tumor microenvironment (TME) is a complex ecosystem comprising tumor cells, cancer-associated fibroblasts, vascular endothelial cells, immune cells, and interstitial cells. Tumor-derived exosomes (TDEs) play a crucial role in modulating TME and accelerating tumor progression through various mechanisms. These mechanisms include inducing epithelial-mesenchymal transition (EMT), macrophage polarization, angiogenesis, and metabolic reprogramming. TDEs also contribute to immune escape by suppressing immune cells and facilitating tumor cell proliferation and metastasis. The unique biogenesis and characteristics of TDEs make them promising targets for diagnostic and therapeutic applications. Potential biomarkers derived from TDEs, such as miRNAs and long non-coding RNAs, have been identified for early cancer detection and prognosis. Additionally, TDEs can be engineered as therapeutic agents to enhance immunotherapy and target specific cell types. However, challenges remain in improving the quantification accuracy, production volume, and stability of TDEs for clinical use. Further research is needed to optimize their delivery and therapeutic efficacy.