Involvement of exosomes in peritoneal dissemination. Exosome-dependent molecular transfer or signaling pathway activation is crucial in the four stages of peritoneal dissemination of gastric cancer: Exfoliation, survival, adhesion and invasion, and angiogenesis (dotted line box indicates lack of evidence). EMT, epithelial to mesenchymal transition; HIF-1α, hypoxia inducible factor-1α; FN1, fibronectin 1; LAMC1, laminin γ1; CD44, cluster of differentiation 44; MMT, mesothelial-to-mesenchymal transition; EGFR, epidermal growth factor receptor.