About Dr. Fontaine
Dr. Jacques Fontaine is board certified by the American Board of Surgery and the American Board of Thoracic Surgery. He currently practices Thoracic and GI Oncology at H. Lee Moffitt Cancer Center in Tampa, Florida.Make an Appointment
Lung cancer is the second most common cancer in men and women. The disease takes the lives of more people in the U.S. and Canada than colon, breast and prostate cancers combined. Dr. Jacques Fontaine and Moffitt Cancer Center give patients the best chances of surviving.
Fontaine, a well-known thoracic surgeon, has what it takes to combat America’s most prevalent cancer killer: Moffitt, the only NCI-designated cancer center in Florida; an experienced and energetic staff around him; and over a decade of experience.
Most patients are diagnosed with lung cancers when the disease is already quite advanced — making it the primary reason it kills so many people. The majority of patients diagnosed with curable, early-stage lung cancers have no symptoms.
CT scans detect these early-stage lung cancers during a screening program or accidentally when the imaging scan is performed for another medical reason.
A recent nationwide clinical trial called NLST, published in the prestigious New England Journal of Medicine, showed a 20 percent reduction in lung cancer deaths among high-risk patients who underwent a low-dose CT screening when compared to those who only had a chest X-ray without the screening test. The H. Lee Moffitt Cancer Center, which serves patients in the Tampa Bay area, including those in Sarasota, St. Petersburg, Clearwater and nearby cities, offers a comprehensive, early-screening program that includes immediate access to support and clinical services, a tumor board review of any abnormal scan and prompt treatment discussion with leading oncologists.
Spots on the lung, referred to as lung nodules or masses, are quite common. Up to 25 percent of men and women age 55 and older, who have absolutely no symptoms, show at least one nodule on the lung. More than 90 percent of these nodules are benign. Performing a biopsy for every lung nodule is not necessary. A biopsy is necessary only if the nodule is suspicious. A nodule is considered suspicious if it displays some of the following characteristics:
- Size greater than 10mm
- Spiculated (not a smooth shape)
- Solid, noncalcified texture
- CT scan shows it’s growing over time
- FDG-avid (hypermetabolic) on PET scan
Moffitt’s team of Tampa oncologists can help patients determine what testing is necessary for an accurate diagnosis.
What is a PET scan?
A PET scan is a CT scan where a special radioactive glucose (sugar) dye is injected in a patient’s vein. Glucose is the basic fuel of the cells. All cells use glucose. The more the cells use the radioactive glucose, the brighter they light up on the PET scan. Cells use more fuel if they are inflamed, fighting an infection or replicating and growing quickly, such as in cancers. Simply because a nodule lights up on a PET scan does not necessarily mean it is a cancer. It may just be an infection or an inflammation.
If a lung nodule is deemed suspicious, a biopsy is recommended. There are various methods to performing a biopsy – each with advantages and disadvantages.
The different biopsy options available to patients with lung cancer include:
Percutaneous needle biopsy: The patient is placed in a CT scan to locate the nodule. After numbing the skin with local anesthetic, a long, thin needle is placed into the chest to sample the nodule. Although very useful, a needle biopsy may not be accurate. Depending on the size and the location of the nodule, there is a possibility this biopsy method may miss the nodule or not obtain enough sample to be diagnostic.
Navigational bronchoscopy: A bronchoscope uses a small camera with a GPS-like system that is introduced through the mouth and into the airway to perform the biopsy. Nodules located far from the airway are difficult to reach with this technique, and the biopsy may not be diagnostic.
Surgical biopsy: This is the most invasive and most accurate option because the whole nodule is removed rather than simply a sample of it. This is also called an excisional biopsy (excision meaning complete removal). The procedure is usually performed using a minimally invasive approach such as thoracoscopy (VATS) or robot-assisted surgery.
A preliminary result is obtained within a few minutes while the patient is still under general anesthesia. If the nodule is indeed a lung cancer, then the definitive cancer surgery is completed at that moment. A surgical biopsy is not only diagnostic (reveals if the nodule is cancerous), but it is also therapeutic because it is the definitive treatment for early-stage lung cancer that offers the best chance of a cure.
Lung Cancer Treatment Methods
The treatment options for non-small cell lung cancer (NSCLC) — the most common type of lung cancer — are based on the stage of the cancer when diagnosed. A person’s lung function and overall health also play a role in the treatment options. Other factors to consider: Side effects of the treatment and probability of curing the disease or extending life.
The next step after diagnosing a cancer involves determining its stage. Stage identifies how far the cancer has advanced. A combination of CT and PET scans, among other tests, determines lung cancer stage.
Stage I lung cancers are small cancers that have not spread to the lymph nodes. A cancer that traveled to the hilar lymph nodes, around the root of the lung, is considered stage II. Stage III cancers have usually spread to the mediastinal lymph nodes around the trachea (windpipe). If a cancer has metastasized to pleura (lining around lung) or to other organs, it is considered stage IV.
Lung Cancer Surgery
Stage I lung cancer only requires surgery. Chemotherapy and radiation are not necessary. Stage II and stage III lung cancers are best treated with a combination of surgery, chemotherapy and sometimes radiation therapy. Surgery is almost never helpful in treating metastatic disease.
The most common surgeries are a wedge resection or segmentectomy, where part of a lobe is removed; a lobectomy, where an entire lobe is removed; or a pneumonectomy, in which the entire lung is removed. The extent of lung to be removed is determined by a combination of the specific type of lung cancer, its size, location and overall health of the patient.
Some of these procedures can be accomplished through robotic techniques. Dr. Fontaine is the Program Director for Moffitt’s Robotic Thoracic Fellowship Program based in Tampa, Florida. In fact, surgeons at Moffitt perform more robotic lung surgeries than any other center in the U.S. This experience gives Tampa residents and those who travel to Moffitt the opportunity to have better results.
Minimally invasive or robotic surgery offers many advantages to cancer patients requiring surgery as part of their treatment. Through a few small cuts, with the aid of a magnifying 3-D camera and precise instruments, surgeons can perform surgery with a faster recovery and less trauma, blood loss and pain. This means patients can return to their hometown sooner, whether that’s here in Tampa or further away in other surrounding communities such as Sarasota, Clearwater or Ft. Myers.
Chemotherapy is a treatment involving anti-cancer medication taken orally (pill form) or intravenously. It can be used before surgery to help shrink a tumor, after surgery to decrease the chance of recurrence, or as the main treatment option for a patient who is not a candidate for surgery.
There are many different types of chemotherapy. Side effects, dosage and administration schedule may vary considerably. The side effects often depend on the type and dosage level of the drugs. Side effects usually are short term. Many of the newer oral cancer drugs have few, if any, side effects.
Each tumor has a specific genetic fingerprint. Knowing the genetic code of the patient’s tumor allows us to use more precise and targeted therapies.
Dr. Fontaine and his team at Moffitt work hard to maintain relationships with oncologists around the state of Florida, so patients can begin treatment in their hometown, travel to Moffitt for surgery and return to their home for the rest of their treatment. This makes it easier for patients from other major Florida cities – Sarasota, Miami, Ft. Myers, St. Petersburg, etc – to get the very best cancer care.
Radiation treatment can be used before surgery, after surgery or as the main treatment for lung cancer if surgery is not an option.
Radiation uses high-energy rays to burn and kill cancer cells. It is often used in conjunction with chemotherapy. Although there are different types, Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation (SBRT – also known as Cyberknife) are the ones most often performed in specialized centers today.
This technology uses a computer-aided machine that aims multiple beams from various angles at the tumors. It is much more precise and virtually eliminates the problem of damaging nearby healthy tissue. It is important to seek treatment from a radiation oncologist well experienced with this new technology. Successful treatment results depend as much on the quality of the machine as on the quality of the radiation oncologist.
The radiation oncologists at Moffitt’s Tampa campus are pioneers in this technology, and they treat more lung cancer patients every year than any other center in the Southeast.
Why Choose Moffitt and Dr. Fontaine for Your Lung Cancer?
Moffitt is successful for a number of reasons: The cancer center focuses solely on the treatment and prevention of cancer, and more than half of its Tampa-based staffers are researchers breaking new ground in the search for a better way to treat these cancers.
Innovation is also important. Moffitt takes a personalized approach to treatment that includes the latest immunotherapy drugs and clinical trials.
Fontaine provides lung cancer patients at Moffitt the best possible care. In fact, a report from the National Cancer Institute shows lung cancer patients treated at Moffitt have higher survival rates than the national average.
That’s why patients and their loved ones from cities across Florida, including St. Petersburg, Clearwater, Sarasota, Lakeland, Fort Myers, Naples and Lakeland, choose Fontaine and Moffitt over other specialists and cancer centers.
For people who travel from out of town, Moffitt’s approach works well.
In addition to innovative treatment options and a multidisciplinary approach to cancer care, Moffitt Cancer Center offers a variety of support resources, including weekly patient-specific and loved one-specific support groups. By connecting with other residents of Tampa and surrounding communities, patients can learn more about their disease from other survivors.
Fontaine and Moffitt have developed personal relationships with oncologists around the state, allowing for a seamless, well-coordinated treatment plan. Patients can start treatment in their hometown, travel to Moffitt for surgery and return home to continue that treatment.