Unveiling the multifaceted roles of extracellular vesicles in cancer: insights from molecular imaging and engineering strategies

• EVs are versatile nanocarriers of biomolecules, playing dual roles in tumor promotion and antitumor immunity. • Molecular imaging and tracing technologies enable real-time monitoring of EV dynamics in vivo, enhancing cancer theranostics. • Engineered EVs serve as both therapeutic vehicles and imaging probes, offering precision in tumor targeting. • EV-based strategies hold promise for improving the precision and efficacy of tumor therapies, paving the way for clinical translation.