The field of miRNA-based therapies is constantly expanding as a result of substantial research conducted across the world. Exosomal origin must be addressed for the use of exosomal miRNA in cancer diagnostics. A uniform procedure for exosome separation and detection should be devised, as current approaches have various limitations. More research on maximizing the benefits of target variety while avoiding off-target impacts is needed. miRNAs are involved in a number of cancer-related pathways, as well as developmental and regulatory processes. miRNAs control a large number of genes. The possibility of miRNA treatments having an off-target impact is a serious worry. Various techniques, including viral, nonviral, and chemical alterations, are recommended to improve target delivery. Nanoparticle-based delivery is being studied extensively, and attempts are being made to reduce toxicity and cellular accumulation. Next-generation sequencing of miRNAs is being used to study the functions that miRNA can play as a biomarker for diagnosis, detection, and prognosis. Several miRNA signatures unique to cancer types have evolved, with some of them now being tested in therapeutic studies. Antisense oligonucleotides that block miRNIs, tumor and CSC-targeted nanoparticle treatment, and combination treatment with chemotherapeutic agents are all promising clinical strategies for cancer personalized medicine.