How immunotherapy works with the immune system

Immunotherapy helps the body’s immune system better recognize and fight off cancer cells. Immunotherapy can work in a few different ways for melanoma:

• By boosting the overall function of the immune system to destroy cancer cells
• By using a targeted attack on specific types of cancer and immune cells, called immune checkpoint inhibitors
• With cell therapy, which uses the patient’s own tumor cells to help kickstart the immune system
• With virus therapy, which uses lab-altered viruses to attack cancer cells

Here’s a closer look at each type of immunotherapy for melanoma.

General immunotherapy

In theory, the body’s immune system can recognize and attack cancer cells to prevent their growth. But sometimes cancer cells can grow too quickly for the immune system to keep up with, or the cells can even hide from or attack the immune system. General immunotherapy uses medications that can help improve the overall function of the immune system. For instance, interleukins are proteins that can boost the immune system so it can better recognize and attack melanoma cells. Melanoma treatment uses lab-made versions of the protein, interleukin-2 (IL-2).

IL-2s are not used as often as they once were because they can have serious side effects and typically don’t work as well as immune checkpoint inhibitors.

Immune checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) are a targeted form of immunotherapy. A key way that immunotherapy works in melanoma is by “turning off” specific proteins in immune cells that stop the cells from attacking the cancer.

In a healthy person, the immune system has built-in “checkpoints” that keep immune cells from destroying healthy cells. Unfortunately, melanoma cells use those checkpoints against the body and can bind with them to allow cancer to grow. Immune checkpoint inhibitors are medicines that “turn off” those specific checkpoints, allowing the immune cells to identify the melanoma and work to destroy it.

• PD-1 inhibitors: PD-1 inhibitors target an immune cell protein called PD-1. PD-1s normally function to stop immune cells from destroying other cells. Blocking PD-1s frees up those immune cells to better fight cancerous melanoma cells. PD-1 inhibitors are called pembrolizumab (brand name: Keytruda) and nivolumab (brand name: Opdivo) and are given as IV infusions. They can only be used for melanoma that has spread and can’t be removed by surgery. They may also be used as a secondary treatment (called adjuvant) and preventive treatment to lower the risk of the cancer recurring.
• PD-L1 inhibitors: PD-L1 inhibitors, atezolizumab (brand name: Tecentriq), work the same way, by blocking the PD-L1 protein on immune cells that normally stop the cells from attacking. This type of immunotherapy can be used specifically for people who have metastasized melanoma with the BRAF gene mutation. It can be given through IV or injection.
• CLTA-4 inhibitors: This type of checkpoint inhibitor targets the CTLA-4 proteins, located on T-cells in the immune system. Used alone, CLTA-4 inhibitors are less effective and have more serious side effects than other immunotherapy medications, but may be given alongside a PD-1 inhibitor. Ipilimumab (Brand name: Yervoy) is given via IV infusion.
• LAG-3 inhibitors: LAG-3 inhibitors (called relatlimab) block the LAG-3 checkpoint protein. Relatlimab is typically given via infusion in combination with a PD-1 inhibitor called nivolumab. (Together, relatlimab and nivolumab go by the brand name Opdualag.)

Checkpoint inhibitors are a promising development in melanoma treatment. Before treatment with ICIs, the average survival rate with advanced melanoma was only six months. Now, however, survival rates have far exceeded the six-month rate.

Tumor-infiltrating lymphocyte (TIL) therapy

T cells are a specific type of immune cell that the body uses to fight cancer. When they move into a tumor, they are called tumor-infiltrating lymphocytes (TILs). TIL therapy is a newer cancer treatment that removes TILs from a tumor, multiplies them in a lab, and returns them to the body in the form of an infusion. TIL can be effective for advanced melanoma because the T cells taken from the cancer cells have “learned” to specifically recognize melanoma.

The treatment is complex and given in several steps in the hospital. In 2024, the U.S. Food and Drug Administration (FDA) approved lifileucel (brand name: Amtagvi) as the first FDA-approved tumor-derived T-cell immunotherapy.

Oncolytic virus therapy

Oncolytic virus therapy involves “hijacking” viruses to target cancer cells. Viruses are notorious for their ability to hide from the immune system and attack healthy cells, so scientists have discovered a way to put that power to good use by altering viruses (called oncolytic viruses) in a lab to attack cancer cells instead.

In addition to directly destroying cancer cells, oncolytic viruses can also alert the rest of the immune system to attack the cancer cells. For melanoma, talimogene laherparepvec (brand name: Imlygic), also known as T-VEC, is an oncolytic virus that can be used to try to shrink tumors that can’t be surgically removed. Currently, the primary purpose of oncolytic virus therapy in melanoma is to shrink tumor sizes, and some data show it may help increase survival rates.

Many of the immunotherapy treatment options for melanoma can be used with each other, which offers more opportunity for effective treatment. Increased immunotherapy options have offered new hope for a very challenging type of cancer.

The best outcomes from treatment always happen with earlier diagnosis, so knowing the signs of skin cancer and practicing regular skin checks is very important in the fight against melanoma.

El linfedema con cáncer de próstata

El lugar en el que ocurre el linfedema depende de dónde se encuentren los ganglios linfáticos afectados. Para personas con cáncer de próstata, el linfedema podría afectar las piernas, el pene, el escroto o la parte inferior del cuerpo en general.

Los síntomas de linfedema podrían incluir:

• Hinchazón
• Piel apretada o inflamada
• Piel escamosa y gruesa, denominada hiperqueratosis
• Bultos y llagas pequeñas en la piel
• Líquido (linfa) que se filtra de la piel

¿Tiene tu pareja riesgo de linfedema?

Una prostatectomía radical, que remueve la próstata y los ganglios linfáticos pélvicos, es la causa más común de linfedemas para personas que tienen cáncer de próstata. La radiación a veces también daña los ganglios. Hombres que se sometieron a cirugías y a radioterapia tienen un mayor riesgo de linfedema y entre más resulten afectados los ganglios, mayor será el riesgo.

El linfedema también podría ser el resultado de:

• Infecciones u otras complicaciones en el lugar en el que se hizo la cirugía de los ganglios linfáticos
• Una acumulación de líquidos cerca de la herida, denominada seroma.
• Un cáncer avanzado

El diagnóstico y el inicio del tratamiento de linfedemas en etapas tempranas pueden frenar su progreso. Una hinchazón moderada grave podría hacer que sea difícil caminar y realizar actividades cotidianas.

El cuidado de alguien con linfedema en el hogar

El simple acto de levantar la pierna afectada puede ser muy útil, dijo Kancharla. Y hacer algunos ejercicios sencillos también puede ser útil. Los ejercicios mueven la linfa y fomentan un buen rango de movimiento alrededor de las articulaciones, algo que podría volverse difícil si hay mucha inflamación.

Un proveedor de atención médica (HCP, por sus siglas en inglés), terapeuta físico o especialista en linfedemas podría mostrarles a ti y a tu pareja cuales son los mejores ejercicios. Muchos pueden realizarse incluso sentado.

Algunos ejercicios buenos para linfedemas incluyen:

• Marchar sin desplazarse o sentado
• Extensiones de la rodilla sentado, levantar la pierna y extender la rodilla
• Extensiones de los dedos de los pies, también sentado, levantar los dedos del pie lo más posible y luego relajarlos

Aquí encontrarás otros consejos con los que podrías ayudar a tu pareja a reducir la inflamación causada por el linfedema:

• Controlar el peso: Tener sobrepeso u obesidad puede empeorar el linfedema en las piernas. También puede aumentar el riesgo de una infección de la piel denominada celulitis. Tú o tu pareja podrían hablar con un nutricionista si necesitas un plan nutricional más saludable o si tu pareja podría necesitar ayuda para tener un peso saludable.
• Reducir el consumo de sal: La sal hace que tu cuerpo retenga líquidos, algo que deberías evitar si tienes linfedema. Si preparas las comidas de tu pareja y el sabor es una preocupación, muchos platos saben bien si agregas hierbas frescas en vez de sal.
• Beber mucha agua: La meta del tratamiento de linfedema es reducir los líquidos, pero todavía es importante que tu pareja beba al menos ocho vasos de 8 onzas de agua cada día. Esto será útil para purgar líquidos no deseados.
• Usar ropa floja: Incentiva a tu pareja a que evite medias y pantalones ajustados (especialmente con elásticos). Zapatos de un tamaño adecuado también son importantes para prevenir ampollas o llagas, que podrían infectarse.
• Proteger la piel: Recuerda a tu pareja que mantenga su piel limpia y seca para prevenir infecciones. Si le ayudas cortando las uñas de los pies, asegúrate de no cortar sus cutículas. También sugiere pantalones largos para jardinería, para caminar o para cualquier actividad en la que la piel pueda sufrir raspones. Usa protección solar (FPS de 30 o más) y repelentes de insectos para evitar picaduras de insectos.
• No ignorar lesiones de la piel: Trata cualquier lesión de la piel inmediatamente limpiándola, aplicando ungüentos antibióticos y cubriéndola. Monitorea el lugar para detectar señales de infección, tales como un color rojizo o temperatura caliente. Esto será útil para reducir el riesgo de infecciones, celulitis y una complicación grave denominada sepsis.

Si tu pareja necesita más ayuda

Si las primeras medidas en el hogar no funcionan, hay otras opciones. El proveedor de atención médica de tu pareja también podría referir otros profesionales médicos, tales como terapeutas ocupacionales o físicos.

• Medias de compresión: Según Kancharla, a veces los pacientes deben usar medias de compresión o masajes para alivio además de elevar la pierna. Las medias de compresión se ajustan especialmente a la pierna para evitar la acumulación de líquido en el tejido. Se requiere una receta médica y un profesional debe hacer el ajuste de las medias. Puesto que puede ser difícil ponerse estas medias, pide al proveedor que te muestre el mejor método para hacer esto y cualquier consejo o truco que pueda hacer que esto sea más fácil. Nadie debería prestar sus medias de compresión porque si no se ajustan específicamente a las piernas podrían empeorar el linfedema.
• Masajes para la circulación linfática: El proveedor médico de tu pareja podría recomendar un tipo especial de masajes que se denomina circulación linfática manual. Este no es el tipo de masaje al que la mayoría de nosotros estamos acostumbrados. Un masaje de circulación linfática usa una presión suave para mover el líquido con linfa del tejido hacia los ganglios linfáticos. Terapeutas físicos, terapeutas con capacitación especial en masajes y otros proveedores de atención médica pueden realizar estos masajes. Tú o tu pareja también pueden realizarlos en el hogar, pero es importante aprender la técnica de una persona calificada.
• Compresión neumática intermitente: Si el linfedema es más grave, el proveedor de atención médica de tu pareja podría recetar compresiones neumáticas intermitentes que se realizan con bombas. Se envuelve una manga de compresión alrededor de la pierna y luego se infla y se desinfla, lo cual estimula la circulación. La duración de las sesiones depende de lo que recomiende el proveedor de atención médica.

Control de costos

Los ejercicios, los masajes linfáticos y comer una dieta saludable son cosas que la mayoría de personas pueden hacer en el hogar, pero no todos pueden pagar fácilmente masajes linfáticos que se realizan en una clínica o consultorio, medias de compresión o bombas. Medicare cubre artículos para el tratamiento de compresión de linfedemas, al igual que algunas aseguradoras privadas. Los seguros privados también podrían cubrir masajes. Es importante que tu pareja solicite asistencia si la necesita.

Contigo y tu pareja trabajando en equipo, podrían reducir su ansiedad y estrés. Al comprender el trastorno y tratamiento de tu pareja, también podrás defender sus derechos si fuese necesario. “El linfedema [con cáncer de próstata] es extremadamente infrecuente en estos momentos, algo que vemos raramente”, dijo Kancharla. “Pero si alguien tiene linfedema, especialmente con relación a un tumor, cáncer o después de cirugías, tenemos muchos recursos”.

Sexual fantasies are about imagination

I explained that fantasies reveal less about what we want to do and more about how we want to feel. I told her to keep that in mind as we explored the nuance of sharing it with her husband.

A recent study that explored the choice to disclose sexual fantasies had some interesting findings.

While 92% of respondents had disclosed a fantasy, 55% harbored a secret fantasy they had yet to share. There were a variety of reasons participants gave for not sharing the fantasy. This included concern that sharing it would threaten the relationship bond, seeing sharing as futile since the fantasy was about something they’d never want to try in real life and concern that the nature of the fantasy was too different from how their partner typically perceives them.

People who chose to share, on the other hand, reported doing so because the process of sharing it was exciting and added to arousal. Also, people in long-term relationships shared because they felt their partner deserved to know, and they felt secure enough to reveal the fantasy to their partner.

There were a couple of factors that most strongly determined the outcome of sharing a fantasy. The researchers found that partners tended to have a positive or neutral response if the couple had strong communication skills and if they were used to at least some sexual experimentation.

I asked Camilla how her relationship and experiences stacked against the research findings. She said she and her husband had used toys here and there, but they’d never experimented much beyond that. She also had concern that he’d see her fantasy as a part of her psyche that was in total contrast to their shared feminist ideology.

“That’s probably part of the appeal,” I told her. “We often eroticize things that are in stark contrast to our normal everyday persona. Let’s come back to the feeling that the fantasy evokes,” I told her. “You said that you and your husband have a solid foundation and can usually communicate quite effectively. I wonder if there’s a way to explore the feeling without revealing every detail of the fantasy. What feelings does the fantasy evoke in you?”

“It’s a couple of things,” she told me. “I get turned on by a man feeling overwhelmed with desire. Also, the idea of being bound with no choice to surrender to the experience is appealing to me. My head is so flooded with to-dos that sometimes I struggle to focus during sex. It’s a turn-on to feel totally free of responsibility.”

“That makes a lot of sense to me,” I said. “Here are my tips for what to share and how.”

1. Don’t bring anything up immediately before, during or after sex. It’s never a good idea to take someone off guard when it comes to trying new things in bed. Give them time to process.
2. Open with the following, “There is something I want to share with you. I feel a little bit awkward, but I trust you won’t judge me.” People always ask how to avoid the feeling of awkwardness, but most of the time, there is no way around — only through. Also, if you tell your partner you know they won’t judge you, they’ll want to live up to the standard you’ve set.
3. Try a scaffolded approach. Rather than revealing every detail of your fantasy, start by expressing your longing for surrender. Assess how they respond to that before choosing to reveal more.
4. When sharing any sexual desire, it’s crucial to include the why. Don’t say you want them to tie you up without also explaining why it’s appealing to you. In this case, it’s to help you get out of your head.
5. While I always encourage open dialogue when possible, sometimes the idea of sharing a fantasy is just too intimidating. There are wonderful apps available that will allow you to complete separate sexual preference questionnaires. The app then exchanges only the items on which you align.

Our conversations helped Camilla realize that fantasy was natural. She also learned to view her fantasy as information — a clue to what her erotic energy needed to thrive. When she eventually shared a softened version with her husband, she was surprised by his response. He didn’t judge her at all. He smiled and said, “I think I could help with that.” She felt bolder, and he felt trusted. They both described feeling closer than they had in years.

Fantasies are part of being human. They’re a creative expression of our inner world, and when shared with care, they can become a bridge to deeper intimacy. As I often tell my clients, it’s not about revealing your “weird” side; it’s about revealing your whole self. And that — not the fantasy itself — is what turns good sex into something truly extraordinary.

Lymphedema with prostate cancer

Where lymphedema occurs depends on where the affected lymph nodes are. For people with prostate cancer, lymphedema could affect the legs, penis, scrotum or lower body overall.

Symptoms of lymphedema could include:

• Swelling
• Tight, sore skin
• Scaly and thickened skin, called hyperkeratosis
• Small blisters and bumps on the skin
• Fluid (lymph) leaking from the skin

Is your partner at risk for lymphedema?

A radical prostatectomy, which removes the prostate and pelvic lymph nodes, is the most common cause of lymphedema among people who have prostate cancer. Radiation sometimes damages the nodes too. Men who have both surgery and radiation therapy are at higher risk of lymphedema, and the more nodes affected, the higher the risk.

Lymphedema could also be caused by:

• Infection or other complications at the lymph node surgery site
• A build-up of fluid near the wound, called a seroma
• Advanced cancer

Diagnosing and starting treatment for lymphedema in the early stages can slow down its progress. Moderate to severe swelling can make it hard to walk and perform everyday activities.

Caring for someone with lymphedema at home

The simple act of elevating the affected leg can be quite helpful, Kancharla said. And doing some simple exercises can also help. Exercises move the lymph and encourage good range of motion around the joints — something that could become difficult if there is too much swelling.

A healthcare provider (HCP), physical therapist or lymphedema specialist can show you and your partner the best exercises to do. Many can even be done while sitting down.

Some exercises that are good for lymphedema include:

• Marching on the spot or while sitting
• Knee extension while seated, raising the leg and extending the knee
• Toe extensions, also while seated, lifting your toes up as far as you can, then relaxing them

Here are some other tips you could assist your partner with to help reduce the swelling caused by lymphedema:

• Manage weight: Having overweight or obesity can worsen lymphedema in the legs. It can also increase the risk of a skin infection called cellulitis. You or your partner could speak with a dietitian if you need help coming up with a healthier diet plan or if your partner could use some help getting to a healthy weight.
• Decrease salt intake: Salt makes your body retain fluid, something to avoid if you have lymphedema. If you are preparing your partner’s food and flavor is a concern, many dishes taste good if you add fresh herbs instead of salt.
• Drink plenty of water: The goal of lymphedema treatment is to reduce the fluid, but it’s still important for your partner to drink at least eight 8-ounce glasses of water each day. This helps flush out the unwanted fluids.
• Wear loose clothing: Encourage your partner to avoid tight pants and socks (especially at the band). Well-fitting shoes are also important to prevent blisters or sores, which could become infected.
• Protect skin: Remind your partner to keep his skin clean and dry to help prevent infection. If you help him with cutting toenails, be sure not to cut his cuticles. Also suggest long pants for gardening, walking or doing any activity where the legs could get scratched. Use sun protection (SPF 30 or higher) and insect repellents to stop bug bites.
• Don’t ignore skin injuries: Treat any injuries to the skin right away by cleaning them, applying antibiotic ointment and covering them. Keep an eye on the site for any signs of infection, like redness or warmth. This will help reduce the risk of infections, cellulitis and a serious complication called sepsis

Exercises, doing lymphatic massages and eating a healthy diet are things that most people can do at home, but not everyone can easily afford lymphatic massages done at a clinic or office, compression stockings, or pumps. Medicare does cover lymphedema compression treatment items though, as do some private insurance companies. Private insurance might also cover massages. It’s important that your partner apply for assistance if he needs it.

With you and your partner working as a team, you can help lessen anxiety and stress for both of you. By understanding your partner’s condition and treatment, you can also act as his advocate if necessary. “Lymphedema [with prostate cancer] is extremely rare now, something that we don’t see as often,” Kancharla said. “But if someone does have lymphedema, especially related to the tumor or cancer itself or post-surgery, we do have a lot of resources.”

Lymphedema with prostate cancer

Where lymphedema occurs depends on where the affected lymph nodes are. For people with prostate cancer, lymphedema could affect the legs, penis, scrotum or lower body overall.

Symptoms of lymphedema could include:

• Swelling
• Tight, sore skin
• Scaly and thickened skin, called hyperkeratosis
• Small blisters and bumps on the skin
• Fluid (lymph) leaking from the skin

Is your partner at risk for lymphedema?

A radical prostatectomy, which removes the prostate and pelvic lymph nodes, is the most common cause of lymphedema among people who have prostate cancer. Radiation sometimes damages the nodes too. Men who have both surgery and radiation therapy are at higher risk of lymphedema, and the more nodes affected, the higher the risk.

Lymphedema could also be caused by:

• Infection or other complications at the lymph node surgery site
• A build-up of fluid near the wound, called a seroma
• Advanced cancer

Diagnosing and starting treatment for lymphedema in the early stages can slow down its progress. Moderate to severe swelling can make it hard to walk and perform everyday activities.

Caring for someone with lymphedema at home

The simple act of elevating the affected leg can be quite helpful, Kancharla said. And doing some simple exercises can also help. Exercises move the lymph and encourage good range of motion around the joints — something that could become difficult if there is too much swelling.

A healthcare provider (HCP), physical therapist or lymphedema specialist can show you and your partner the best exercises to do. Many can even be done while sitting down.

Some exercises that are good for lymphedema include:

• Marching on the spot or while sitting
• Knee extension while seated, raising the leg and extending the knee
• Toe extensions, also while seated, lifting your toes up as far as you can, then relaxing them

Here are some other tips you could assist your partner with to help reduce the swelling caused by lymphedema:

• Manage weight: Having overweight or obesity can worsen lymphedema in the legs. It can also increase the risk of a skin infection called cellulitis. You or your partner could speak with a dietitian if you need help coming up with a healthier diet plan or if your partner could use some help getting to a healthy weight.
• Decrease salt intake: Salt makes your body retain fluid, something to avoid if you have lymphedema. If you are preparing your partner’s food and flavor is a concern, many dishes taste good if you add fresh herbs instead of salt.
• Drink plenty of water: The goal of lymphedema treatment is to reduce the fluid, but it’s still important for your partner to drink at least eight 8-ounce glasses of water each day. This helps flush out the unwanted fluids.
• Wear loose clothing: Encourage your partner to avoid tight pants and socks (especially at the band). Well-fitting shoes are also important to prevent blisters or sores, which could become infected.
• Protect skin: Remind your partner to keep his skin clean and dry to help prevent infection. If you help him with cutting toenails, be sure not to cut his cuticles. Also suggest long pants for gardening, walking or doing any activity where the legs could get scratched. Use sun protection (SPF 30 or higher) and insect repellents to stop bug bites.
• Don’t ignore skin injuries: Treat any injuries to the skin right away by cleaning them, applying antibiotic ointment and covering them. Keep an eye on the site for any signs of infection, like redness or warmth. This will help reduce the risk of infections, cellulitis and a serious complication called sepsis

Exercises, doing lymphatic massages and eating a healthy diet are things that most people can do at home, but not everyone can easily afford lymphatic massages done at a clinic or office, compression stockings, or pumps. Medicare does cover lymphedema compression treatment items though, as do some private insurance companies. Private insurance might also cover massages. It’s important that your partner apply for assistance if he needs it.

With you and your partner working as a team, you can help lessen anxiety and stress for both of you. By understanding your partner’s condition and treatment, you can also act as his advocate if necessary. “Lymphedema [with prostate cancer] is extremely rare now, something that we don’t see as often,” Kancharla said. “But if someone does have lymphedema, especially related to the tumor or cancer itself or post-surgery, we do have a lot of resources.”

Compounded conclusion

A reputable compounded pharmacy can help you get the safe and effective medication you need — but you need to take steps to make sure you’re getting the real deal.