Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor with a unique geographical distribution, predominantly prevalent in East Africa and Asia. Despite advances in understanding its pathogenesis and risk factors, prevention and treatment efforts remain limited. Numerous studies indicate that exosomes actively participate in NPC development by delivering bioactive molecules such as non-coding RNAs and proteins to target cells. In NPC, exosomes regulate the tumor microenvironment, mediate chemoradiotherapy resistance, induce immunosuppression, promote pathological angiogenesis, and support metastasis, making them promising biomarkers. Due to their critical roles and unique biological properties, exosomes hold significant potential for diagnostic monitoring and prognostic evaluation. Although technical challenges exist in their large-scale application, exosomes offer unparalleled advantages in clinical management. This review summarizes the biological functions of exosomes in NPC and explores their prospects as clinical biomarkers.
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