Abstract: Colorectal cancer (CRC) is one of the most common malignant tumors of the digestive system, its incidence has been in creasing recently. In addition to traditional surgery, radiotherapy, and chemotherapy, immunotherapy and targeted therapy have become crucial areas in clinical research. Recently, the advantages of exosomes in diagnosing and treating CRC have gradually become prominent. Moreover, tumor-derived exosomes are not only involved in the occurrence and development of tumors, angiogenesis, invasion, and metastasis but also play an important role in the immunotherapy and targeted therapy of CRC as diagnostic markers, important intercellular information vectors, and drug carriers. However, the clinical application of exosomes still needs to be further investigated. Therefore, in this study, the role of related factors in the diagnosis and treatment of CRC, such as biomarkers, vector functions, mediating drug resistance, immune regulation, promoting angiogenesis, and other functions, were systematically analyzed. These results would help better apply exosomes in the early diagnosis, treatment, and prognostic monitoring of CRC and provide a reference for the better application of exosomes in clinical diagnosis and treatment of other tumors.