<p>The global rise in cancer incidence represents the second leading cause of death worldwide, accounting for approximately one in six deaths annually. Extracellular vesicles (EVs) research addresses this issue in more innovative ways. Exosomes are (a subpopulation of EVs) originate from the endosome. In general, exosomes are involved in intercellular communication. In cancer, tumor derived exosomes (TEXs) play a significant role in cancer deployment and progression. TEXs molecular cargo, such as DNA, RNA, protein, and lipids associated with tumor growth. Tumor microenvironment (TME) related hypoxia, immunosuppression, angiogenesis, metastasis, premetastatic niche formation, ECM, EMT and organ-specific metastasis. It becomes a promising biomarker source for cancer. Exosome-based sensors serve as promising tools for early cancer detection. Therapeutic prospective exosomes also open an innovative horizon for a cell-free approach. There are several therapeutic exosome sources, such as stem cell exosomes, immune cell exosomes, plant exosomes, modified and synthetic exosomes. This nanosized cell-free approach offers several advantages over previous therapeutics methods in different aspects, such as exosomes generally exhibit low toxicity and immunogenicity have shown potential to cross the BBB (blood-brain-barrier) in preclinical models, enhancing drug life and transporting therapeutics with high precision. The current time combination of exosomes with nanotechnology, AI, ML, and multi-omics transforms cancer research. In this review, we are exploring the landscape of tumor-derived exosomes-based cancer development, to the theranostics signature of exosomes as a cancer nanomedicine. Exosome-based cancer nanomedicine holds promise as an effective and accessible approach</p> Graphical Abstract <p></p>