Extracellular vesicles in ovarian cancer liquid biopsy: Advances, challenges, and clinical potential

Ovarian cancer (OC) remains a major clinical challenge due to its silent onset, marked molecular heterogeneity, and the lack of reliable biomarkers for early detection and disease monitoring. Liquid biopsy (LB) offers a minimally invasive resource to track tumor dynamics, and extracellular vesicles (EVs) have emerged as particularly informative analytes, carrying proteins, nucleic acids, and lipids that reflect the molecular state of OC cells. This review examines recent advances in EV‑based LB for OC, with emphasis on the biological relevance of EV cargo and its roles in tumor progression, immune modulation, and therapy resistance. Despite promising developments, clinical translation is delayed by EV heterogeneity, methodological variability, and limited validation in large, prospective cohorts. By highlighting emerging technological and analytical innovations, this review outlines the key steps required to integrate EVs into clinically actionable LB platforms to enhance the management of OC.