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Exosomes are extracellular vesicles of 40-150 nm in size, which are widely distributed in various body fluids. Gastric cancer is the most common digestive tract malignancy in China. Exosomes are involved in the malignant evolution of gastric cancer in multiple ways including growth, progression, metastasis and microenvironment of tumor. Exosomes might be a non-invasive biological marker for early diagnosis of gastric cancer and have also shown potential as drug carriers in the treatment of gastric cancer. This article reviews recent research on exosomes in the pathogenesis and treatment of gastric cancer.