Purpose <p>Our study endeavors to synthesize the expansive literature on cancer-related extracellular vesicles (EVs), mapping the research landscape and identifying key trends.</p> Methods <p>Bibliometric analysis was conducted on the EVs and cancer-related studies using the bibliometrix R-package, exploring growth patterns, research hotspots, and trends across 647 journals, 2769 institutions, 9919 authors, 4029 keywords, and 82626 references. To identify and explore the mechanical aspects of EV-cancer signatures, the stringr and dplyr packages were used to extract signatures from article titles and keywords. Functional annotation of these signatures was performed using the clusterProfiler package, and the Human Protein Atlas was utilized to confirm the protein activity of EV signatures in cancer.</p> Results <p>Our analysis reveals a global, collaborative research effort, with a 5.76% annual growth in publications, yet a decline in average citations post-2013 suggests a need for more impactful research. China, the United States, and Japan emerge as leading contributors, with China showing a notable upward trend. Research hotspots include exosomes, miRNA, biomarkers, and liquid biopsies, with future directions predicted in cancer treatment and diagnostics. EV-cancer signatures are linked to cancer progression and therapy resistance, offering mechanistic insights. Moreover, functional enrichment analysis revealed that several EV-cancer-related signatures were significantly associated with the ferroptosis pathway (<i>p</i> &lt; 0.01), among which <i>PRNP</i> was found to be overexpressed at the protein level in pancreatic carcinoma.</p> Conclusions <p>This study provides an overview of cancer-related EV research and identifies key directions for further mechanistic exploration and clinical translation of EVs in precision oncology.</p>