癌症是由不受控制的错误细胞的生长和分裂引起的。程序性细胞死亡（PCD）或调节性细胞死亡（RCD）包括消除受损或异常细胞的自然过程。 PCD 失调是癌症的一个标志，因为癌细胞经常逃避细胞死亡并继续增殖。外泌体是由不同类型的细胞分泌的纳米级细胞外囊泡，携带多种分子，包括核酸、蛋白质和脂质，在细胞间的通讯中具有不可或缺的作用，并且可以影响包括PCD在内的各种细胞过程。外泌体已被证明可以通过将促死亡或抗死亡分子转移到邻近细胞来调节癌细胞中的 PCD。此外，外泌体可以促进 PCD 扩散到周围的癌细胞，使其在治疗各种癌症方面具有广阔的前景。外泌体在癌症中的诊断潜力也是一个活跃的研究领域。外泌体可以从多种体液和组织（例如血液和尿液）中分离出来，并且可以提供一种非侵入性的方法来监测癌症进展和治疗反应。此外，外泌体也已被用作治疗剂的递送系统。通过改造外泌体来携带药物或其他治疗分子，它们可以特异性地靶向癌细胞，从而减少对健康组织的毒性。在这里，我们讨论了外泌体在癌症的诊断和预防、肿瘤免疫治疗和药物递送以及不同类型的 PCD 中的应用。© 2023 John Wiley

Cancer arises from the growth and division of uncontrolled erroneous cells. Programmed cell death (PCD), or regulated cell death (RCD), includes natural processes that eliminate damaged or abnormal cells. Dysregulation of PCD is a hallmark of cancer, as cancer cells often evade cell death and continue to proliferate. Exosomes nanoscale extracellular vesicles secreted by different types of cells carrying a variety of molecules, including nucleic acids, proteins, and lipids, to have indispensable role in the communication between cells, and can influence various cellular processes, including PCD. Exosomes have been shown to modulate PCD in cancer cells by transferring pro- or antideath molecules to neighboring cells. Additionally, exosomes can facilitate the spread of PCD to surrounding cancer cells, making them promising in the treatment of various cancers. The exosomes' diagnostic potential in cancer is also an active area of research. Exosomes can be isolated from a wide range of bodily fluids and tissues, such as blood and urine, and can provide a noninvasive way to monitor cancer progression and treatment response. Furthermore, exosomes have also been employed as a delivery system for therapeutic agents. By engineering exosomes to carry drugs or other therapeutic molecules, they can be targeted specifically to cancer cells, reducing toxicity to healthy tissues. Here, we discussed exosomes in the diagnosis and prevention of cancers, tumor immunotherapy, and drug delivery, as well as in different types of PCD.© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.