“…Similarly, an adipose tissue dysfunctional pro-inflammatory microenvironment may be induced by interaction with local tumor cells and tumor-secreted factors, independent from obesity with both obesity-related and tumor-related mechanisms forming a dysfunctional metabolic milieu [23][24][25]. These mutually reinforcing microenvironmental interactions contribute to (1) derangement of local and systemic glucose, lipid, and energy metabolic homeostasis [26][27][28]; (2) altered secretory functions as well as the local and systemic release of pro-tumorigenic and pro-inflammatory elements, such as growth factors, cytokines, chemokines, hormones, nutritional substrates, and extracellular vesicles [29][30][31][32][33]; (3) induction of stress, such as the endoplasmic reticulum (ER) stress, oxidative stress, and stress-induced tissue damage [34]; (4) activation, expansion, and recruitment of inflammatory and immune cells [35]; (5) alteration of tumor immunity and immune evasion [36,37]; (6) the extracellular matrix (ECM) remodeling, stromal cell activation, accumulation of adipose stem/stromal cells, fibrosis, and desmoplasia [30,38]; (7) stimulation of tumor cell growth, tumor angiogenesis, and lymphangiogenesis [39,40]. Thus, these local and systemic alterations occurring as a result of chronic obesity create an environment fostering the initiation, progression, and invasiveness of cancer, including PDAC.…”