INS and hyperinsulinism: Hyperinsulinemia may promote cancer progression either by directly binding to the insulin receptor or indirectly by increasing blood insulin and IGF-1 levels and triggering insulin and IGF-1 signaling that activates the phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin and mitogen-activated protein kinase pathways, which are crucial for cancer cell proliferation, survival, mobility, and drug resistance [12].