<p>Obesity is a major concern for public health and is associated with a higher risk of various types of cancer. Understanding the fundamental mechanisms of this relationship is essential for effective cancer prevention and treatment. Adipose-derived stem cells (ADSCs) are a specialized subtype of mesenchymal stem cells (MSCs) extracted from adipose tissue. These cells have the ability to undergo lineage-specific differentiation into adipocytes, osteoblasts, and chondrocytes. Although ADSCs have significant therapeutic potential, existing studies have indicated that they may facilitate cancer initiation, progression, and recurrence through multiple pathways, including their capacity to facilitate tumor cell proliferation, epithelial-to-mesenchymal transition (EMT), angiogenesis, formation of cancer stem cells (CSCs), immune evasion, and resistance to therapy. Obese individuals have a higher amount of adipose tissue containing an abundance of ADSCs compared to normal individuals, highlighting the possible role of ADSCs in the link between obesity and cancer. In this review, we have explored the effects of ADSCs on cancer initiation, promotion, and progression and put forward a hypothetical model to explain the elevated risk of cancer among obese patients.</p> Graphical abstract <p></p>