DIPG

  The image above is an MRI scan of a patient with Diffuse Intrinsic Pontine Glioma, or DIPG. A Glioma is a tumor that arises from the Glial cells(also known as Neuroglial cells). Glial cells maintain the signaling of Neurons. They are somewhat smaller than Neurons, however. The tumor is located in the pons, or brain stem (hence "pontine").  Intrinsic simply means that it relates to the pons, while Diffuse indicates that the tumor affects many aspects of the patient's Neurological functions.
       The first symptoms of DIPG include neuromotor issues. These include but are not limited to : loss of balance, dizziness,, lack of hand-eye coordination, speech impediments, and drooling. DIPG is is more often found in juveniles. The mean age of diagnosis is age six, although in rare cases individuals over eighteen have developed this form of cancer. 
     These symptoms usually go ignored, as they are not concerning enough for the patient to see a physician. They occur because the brain stem controls these involuntary functions, and when a tumor develops, it causes the pons to malfunction. The symptoms that usually bring a patient to their care provider are a persistent headache, vomiting, paralysis of one or more body parts, and facial numbness. The headache generally subsides after the patient vomits.
       This usually warrants a referral to a neurologist, then a CT scan or an MRI. The benefits of a CT scan would be that it is less expensive, takes less time to perform, and is less sensitive to motion. However, it is not as detailed as an MRI scan. MRI scans detect  tumors as small as 2 mm. If Gadolinium Contrast Medium is given to the patient intravenously during the test, any  tumor on the scan will appear enhanced and easier to spot.
        Treatment depends on the size and progression of the Diffuse Intrinsic Pontine Glioma.  Surgery is never an option. The pons is extremely vital to respiratory function, digestion, and circulation. Any type of operation on this part of the brain would most likely result in death. Chemotherapy is usually not effective in DIPG. The tumor is too difficult for it to "reach" so to speak. However, it will sometimes prolong the life of the patient, so is often given toward the end stages. Radiation, steroids, and other drugs to slow the progression down are the most commonly used treatments. Active Clinical Drug Trials for DIPG include but are not limited to Vandetanib, Dasatinib, Gemzar, and Toposin. These drugs help shrink the tumor.
    However, these treatments can only prolong the patient's life, not allow them to go into remission. Over 97% of patients die within three years of diagnosis. 37% survival rate at 1 year, 20% at 2 years, and 13% of patients survive with DIPG over 3 years. Over 90% die within 18 months of diagnosis. The tumor grows at an extraordinary rate, soon causing other problematic symptoms. The patient should have an MRI scan at least twice a month to determine the current size of the tumor.
     You may wonder why radiation can treat cancer but also cause it. My theory is that it is somewhat similar to a vaccine: a small amount of a deactivated form is given, which causes the body to fight off the ailment. Also, gamma rays are used in cancer therapy, and these have smaller wavelengths than other cancer-causing forms of radiation.
     Steroids cause a host of issues. The patient begins to gain a remarkable amount of weight, particularly in the facial area and the stomach. Psychological consequences can occur, such as hostility and anxiety.Abnormal amounts of unwanted hair can grow.  As the tumor progresses, the patient gets weaker. Mental capacity often remains the same, but the Wernicke's area of the brain becomes damaged, thus causing the patient to eventually be unable to speak.
    Muscle control weakens. If one arm or leg is not already paralyzed, the patient often loses the sense of feeling in a body part. Walking becomes difficult as the tumor takes over that function. The patient begins to need a wheelchair more often, until he or she becomes wheelchair-bound. As the Cerebral Cortex is soon affected, swallowing is no longer able to occur. At this point a thin feeding tube is inserted through the patient's nose leading to the stomach.
     Two complications of DIPG are a tumor bleed and seizures. Seizures occur when the tumor overstimulates the brain. The patient is prescribed anticonvulsants to reduce the amount of seizures. A tumor bleed may signify the end. In other tumors, surgery can be performed to stop the bleed, but as I mentioned before, there are no surgical options with this form. At this point, the patient is made as comfortable as possible.
     The patient should be prescribed medication for pain. When he or she passes away, they should be in as least pain as possible. 


I do believe we have a cure in our midst, although it has not been discovered quite yet. This is my explanation of Diffuse Intrinsic Pontine Glioma. It may sound blunt, but it consists of facts and the most likely events to occur when a person is diagnosed.