Exosomes on Endometrial Cancer: A Biomarkers Treasure Trove?

Simple Summary Endometrial cancer (EC) is one of the main causes of cancer-related death among women. Despite the advances in gynecologic oncology, the incidence of EC is on the rise, and the relative 5-year survival remains unchanged in the last decade. This creates an urgent need for a deeper understanding of the pathogenesis of EC that will result in new diagnostic and therapeutic approaches. Ideally, we need biomarkers of clinical value that can be analyzed in non-invasive ways. Exosomes are abundant in biological fluids and are considered as a valuable source of biomarkers. Exosomes are extracellular vesicles that originate from cells and function as shuttles, transferring biomolecules between cells. These biomolecules have a critical role in the cancer pathogenesis and progression and in regulating the tumor cells' proliferation and metastasis, and they represent attractive therapeutic targets. Here, we review the functions of exosomes in EC, focusing on the potential biomarkers of diagnostic and prognostic significance or potential therapeutic use. Endometrial cancer (EC) is one of the main causes of cancer-related death among women. In the last decade, the incidence of EC is on the rise, and the relative 5-year survival remains unchanged. This creates a dire need for new diagnostic and therapeutic approaches that can only result from a deeper understanding of the pathogenesis of the disease. In this direction, exosomes are under heavy research, with two main aims: to identify the potential diagnostic and prognostic markers and to develop technologies based on their use as therapeutic vectors targeting EC cells. Exosomes are widely available in all bodily fluids and are sources of ideal biomarkers for liquid biopsies. They are extracellular vesicles containing DNA, RNA, lipids, and proteins, which they transfer between cells, serving multiple functions and being implicated in both the physiological processes and the pathogenesis of diseases. Of all the biomolecules contained in exosomes, microRNAs (miRNAs) seem to have the most clinical utility in the diagnosis and treatment of EC. Exosomal miRNAs mediate the communication between EC cells, cancer-associated fibroblasts (CAFs), and tumor-associated macrophages (TAMs) and have a pivotal role in the tumor cells' proliferation, epithelial to mesenchymal transition (EMT), and the formation of a tumor microenvironment. They participate in many processes that are tied to carcinogenesis and cancer progression, and they are therefore considered as attractive therapeutic targets. Here, we review the functions of exosomes in EC, focusing on potential biomarkers of diagnostic and prognostic significance or potential therapeutic use.