IGF1 and obesity due to melanocortin 4 receptor deficiency: In addition to the inflammation, carcinogenic mechanisms in obesity include excessive estrogen, hyperinsulinemia, increased insulin-like growth factor-1 (IGF-1) secretion, impaired release of adipose tissue hormones with proliferative (e.g., leptin) or anti-proliferative (e.g., adiponectin) effects, direct or indirect influence of adipocytes on cell growth regulators, including mammalian target of rapamycin kinase (mTOR) and AMP-activated protein kinase (AMPK), as well as an altered immune response affecting NF-κB and inducing oxidative stress [142,143,144,145].