IGF1 and obesity due to melanocortin 4 receptor deficiency: The emerging biological mechanisms linking obesity to cancer initiation include alterations in adipokine pathophysiology [28], abnormalities in the IGF-I axis and insulin resistance [29, 30], metabolic reprogramming caused by lipid uptake [31], the existence of subclinical chronic low-grade inflammation and oxidative stress [32], and changes in the local immune microenvironment [8, 33].