INS and hyperinsulinism: Triglyceride levels, reflecting insulin and glycemia status, may also express the complex indirect effects of hyperglycemia and/or hyperinsulinemia on tumor-promoting pathways.38 The mechanism for the insulin-cancer link has been hypothesized to be mainly related to increased production of free insulin-like growth factor-1, a potent mitogen, and adipocyte-derived vascular endothelial growth factor, a key factor in tumor angiogenesis that leads to cell survival and migration.38,39