Inhibiting metastasis is the key to the treatment of malignant tumors. During the development of tumors, the microenvironment plays a significant role, and hypoxia is one of its important characteristics. Exosomes, as an important component of the microenvironment, connect tumor cells with the hypoxic microenvironment and mediate information exchange between cells. Tumor cells secrete more exosomes than normal cells, and hypoxia further stimulates their release. Hypoxia-induced tumor-derived exosomes carry stable genetic material and play key regulatory roles in promoting tumor proliferation, establishing a pre-metastasis microenvironment, and accelerating angiogenesis. This article comprehensively reviews the mechanisms by which tumor-derived exosomes regulate tumor proliferation and metastasis in a hypoxic microenvironment, which has potential clinical significance.