Board Certified Oncology Pharmacist (BCOP®) Exam Prep
2026 Updated Practice Questions • Comprehensive Oncology
Pharmacotherapy Review Detailed Explanations • Verified
Answers • Complete Success Workbook
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING (Questions 1–28)
1A: Oncology Diagnosis
Question 1
A 55-year-old female presents with a painless, firm breast mass. Mammography
reveals a spiculated mass with microcalcifications. Core needle biopsy
demonstrates malignant cells that are estrogen receptor (ER) positive, progesterone
receptor (PR) positive, and HER2 negative. Which of the following is the most
appropriate next step in staging evaluation?
A) Proceed directly to surgical resection
B) Order HER2 testing by FISH or IHC
C) Obtain a bone scan and CT chest/abdomen/pelvis
D) Begin neoadjuvant endocrine therapy
Rationale: HER2 testing by FISH or IHC is essential for determining HER2
status, which guides treatment decisions. While the initial biopsy suggests HER2
negativity, the gold standard for HER2 determination is IHC and/or FISH testing.
Staging evaluation would be appropriate after HER2 status is confirmed.
Question 2
A 62-year-old male with a 40-pack-year smoking history presents with hemoptysis
and weight loss. CT scan reveals a 3.5 cm right upper lobe mass with mediastinal
lymphadenopathy. Biopsy shows adenocarcinoma. Which of the following
molecular markers should be tested to guide treatment selection?
A) KRAS mutation only
B) EGFR mutation, ALK rearrangement, ROS1 rearrangement, and PD-L1
expression
C) BRAF V600E mutation only
D) HER2 amplification only
,Rationale: In non-small cell lung cancer (NSCLC), comprehensive molecular
testing should include EGFR mutations, ALK rearrangements, ROS1
rearrangements, and PD-L1 expression. Other actionable targets include BRAF
V600E, MET exon 14 skipping, RET rearrangements, and NTRK fusions. KRAS
testing is less therapeutically actionable, though KRAS G12C inhibitors are now
available.
Question 3
A patient is diagnosed with chronic myeloid leukemia (CML) in chronic phase.
Cytogenetic analysis reveals the Philadelphia chromosome. Which of the following
best describes the molecular abnormality associated with CML?
A) t(8;21) resulting in AML1-ETO fusion
B) t(9;22) resulting in BCR-ABL1 fusion
C) t(15;17) resulting in PML-RARA fusion
D) t(11;14) resulting in CCND1 overexpression
Rationale: CML is characterized by the Philadelphia chromosome, a translocation
between chromosomes 9 and 22, resulting in the BCR-ABL1 fusion gene. This
fusion protein has constitutive tyrosine kinase activity, driving uncontrolled
proliferation. t(8;21) is associated with AML, t(15;17) with acute promyelocytic
leukemia, and t(11;14) with mantle cell lymphoma.
Question 4
A 45-year-old female is diagnosed with stage IIB melanoma. She has no known
mutations. Which of the following is the most appropriate next step in
management?
A) BRAF V600E mutation testing
B) Wide local excision with sentinel lymph node biopsy
C) Initiate pembrolizumab
D) Initiate dabrafenib/trametinib
Rationale: For stage IIB melanoma, wide local excision with sentinel lymph node
biopsy is the standard of care. BRAF V600E testing is important for patients with
stage III or IV disease who may benefit from targeted therapy. Adjuvant
,immunotherapy is considered for patients with high-risk stage IIB disease but is
not the initial step.
Question 5
A 70-year-old male presents with lower urinary tract symptoms and an elevated
PSA of 12 ng/mL. Digital rectal examination reveals a hard, nodular prostate.
Biopsy demonstrates Gleason 4+3=7 adenocarcinoma in 4 of 12 cores. Which of
the following is the most appropriate next step?
A) Immediate androgen deprivation therapy
B) Bone scan or PSMA PET/CT for staging
C) Radical prostatectomy
D) Active surveillance
Rationale: For a patient with newly diagnosed prostate cancer and Gleason 4+3=7
(intermediate risk), staging with bone scan or PSMA PET/CT is appropriate to
evaluate for metastatic disease. Treatment decisions depend on the extent of
disease. Active surveillance is not appropriate for intermediate-risk disease.
Question 6
A 48-year-old female with a BRCA1 mutation is diagnosed with triple-negative
breast cancer (TNBC). Which of the following is the most appropriate first-line
treatment?
A) Tamoxifen
B) Neoadjuvant chemotherapy with a platinum agent
C) Trastuzumab
D) Olaparib
Rationale: Neoadjuvant chemotherapy, often including a platinum agent, is the
standard of care for early-stage triple-negative breast cancer, particularly in BRCA
mutation carriers. PARP inhibitors (olaparib) are used in the adjuvant setting or for
metastatic disease. Endocrine therapy and trastuzumab are not effective in TNBC.
Question 7
A 38-year-old male presents with a painless testicular mass. Ultrasound reveals a
, solid intratesticular mass. Serum tumor markers show elevated AFP and hCG.
Which of the following is the most likely diagnosis?
A) Seminoma
B) Non-seminomatous germ cell tumor
C) Leydig cell tumor
D) Lymphoma
Rationale: Elevated AFP and hCG are characteristic of non-seminomatous germ
cell tumors. Pure seminomas rarely elevate AFP and may have mild hCG
elevation. Leydig cell tumors are generally non-secretory. Testicular lymphoma is
rare and typically occurs in older men.
Question 8
A 60-year-old female presents with abdominal pain, early satiety, and
unintentional weight loss. CT scan reveals a 4 cm gastric mass with invasion into
the muscularis propria. Biopsy shows gastric adenocarcinoma. HER2 testing is
positive (IHC 3+). Which of the following is the most appropriate treatment
approach?
A) Trastuzumab monotherapy
B) Trastuzumab plus chemotherapy (fluoropyrimidine and platinum)
C) Trastuzumab deruxtecan
D) Surgery alone
Rationale: For HER2-positive gastric adenocarcinoma, the standard first-line
treatment is trastuzumab combined with a fluoropyrimidine and platinum
chemotherapy. Trastuzumab deruxtecan is used in the second-line setting. Surgery
alone is insufficient for locally advanced disease.
Question 9
A 55-year-old female presents with a 2 cm breast mass and axillary
lymphadenopathy. Biopsy shows invasive ductal carcinoma, ER positive, PR
positive, HER2 positive (IHC 3+). Which of the following is the most appropriate
neoadjuvant regimen?
A) Docetaxel + cyclophosphamide
B) Paclitaxel + trastuzumab + pertuzumab
2026 Updated Practice Questions • Comprehensive Oncology
Pharmacotherapy Review Detailed Explanations • Verified
Answers • Complete Success Workbook
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING (Questions 1–28)
1A: Oncology Diagnosis
Question 1
A 55-year-old female presents with a painless, firm breast mass. Mammography
reveals a spiculated mass with microcalcifications. Core needle biopsy
demonstrates malignant cells that are estrogen receptor (ER) positive, progesterone
receptor (PR) positive, and HER2 negative. Which of the following is the most
appropriate next step in staging evaluation?
A) Proceed directly to surgical resection
B) Order HER2 testing by FISH or IHC
C) Obtain a bone scan and CT chest/abdomen/pelvis
D) Begin neoadjuvant endocrine therapy
Rationale: HER2 testing by FISH or IHC is essential for determining HER2
status, which guides treatment decisions. While the initial biopsy suggests HER2
negativity, the gold standard for HER2 determination is IHC and/or FISH testing.
Staging evaluation would be appropriate after HER2 status is confirmed.
Question 2
A 62-year-old male with a 40-pack-year smoking history presents with hemoptysis
and weight loss. CT scan reveals a 3.5 cm right upper lobe mass with mediastinal
lymphadenopathy. Biopsy shows adenocarcinoma. Which of the following
molecular markers should be tested to guide treatment selection?
A) KRAS mutation only
B) EGFR mutation, ALK rearrangement, ROS1 rearrangement, and PD-L1
expression
C) BRAF V600E mutation only
D) HER2 amplification only
,Rationale: In non-small cell lung cancer (NSCLC), comprehensive molecular
testing should include EGFR mutations, ALK rearrangements, ROS1
rearrangements, and PD-L1 expression. Other actionable targets include BRAF
V600E, MET exon 14 skipping, RET rearrangements, and NTRK fusions. KRAS
testing is less therapeutically actionable, though KRAS G12C inhibitors are now
available.
Question 3
A patient is diagnosed with chronic myeloid leukemia (CML) in chronic phase.
Cytogenetic analysis reveals the Philadelphia chromosome. Which of the following
best describes the molecular abnormality associated with CML?
A) t(8;21) resulting in AML1-ETO fusion
B) t(9;22) resulting in BCR-ABL1 fusion
C) t(15;17) resulting in PML-RARA fusion
D) t(11;14) resulting in CCND1 overexpression
Rationale: CML is characterized by the Philadelphia chromosome, a translocation
between chromosomes 9 and 22, resulting in the BCR-ABL1 fusion gene. This
fusion protein has constitutive tyrosine kinase activity, driving uncontrolled
proliferation. t(8;21) is associated with AML, t(15;17) with acute promyelocytic
leukemia, and t(11;14) with mantle cell lymphoma.
Question 4
A 45-year-old female is diagnosed with stage IIB melanoma. She has no known
mutations. Which of the following is the most appropriate next step in
management?
A) BRAF V600E mutation testing
B) Wide local excision with sentinel lymph node biopsy
C) Initiate pembrolizumab
D) Initiate dabrafenib/trametinib
Rationale: For stage IIB melanoma, wide local excision with sentinel lymph node
biopsy is the standard of care. BRAF V600E testing is important for patients with
stage III or IV disease who may benefit from targeted therapy. Adjuvant
,immunotherapy is considered for patients with high-risk stage IIB disease but is
not the initial step.
Question 5
A 70-year-old male presents with lower urinary tract symptoms and an elevated
PSA of 12 ng/mL. Digital rectal examination reveals a hard, nodular prostate.
Biopsy demonstrates Gleason 4+3=7 adenocarcinoma in 4 of 12 cores. Which of
the following is the most appropriate next step?
A) Immediate androgen deprivation therapy
B) Bone scan or PSMA PET/CT for staging
C) Radical prostatectomy
D) Active surveillance
Rationale: For a patient with newly diagnosed prostate cancer and Gleason 4+3=7
(intermediate risk), staging with bone scan or PSMA PET/CT is appropriate to
evaluate for metastatic disease. Treatment decisions depend on the extent of
disease. Active surveillance is not appropriate for intermediate-risk disease.
Question 6
A 48-year-old female with a BRCA1 mutation is diagnosed with triple-negative
breast cancer (TNBC). Which of the following is the most appropriate first-line
treatment?
A) Tamoxifen
B) Neoadjuvant chemotherapy with a platinum agent
C) Trastuzumab
D) Olaparib
Rationale: Neoadjuvant chemotherapy, often including a platinum agent, is the
standard of care for early-stage triple-negative breast cancer, particularly in BRCA
mutation carriers. PARP inhibitors (olaparib) are used in the adjuvant setting or for
metastatic disease. Endocrine therapy and trastuzumab are not effective in TNBC.
Question 7
A 38-year-old male presents with a painless testicular mass. Ultrasound reveals a
, solid intratesticular mass. Serum tumor markers show elevated AFP and hCG.
Which of the following is the most likely diagnosis?
A) Seminoma
B) Non-seminomatous germ cell tumor
C) Leydig cell tumor
D) Lymphoma
Rationale: Elevated AFP and hCG are characteristic of non-seminomatous germ
cell tumors. Pure seminomas rarely elevate AFP and may have mild hCG
elevation. Leydig cell tumors are generally non-secretory. Testicular lymphoma is
rare and typically occurs in older men.
Question 8
A 60-year-old female presents with abdominal pain, early satiety, and
unintentional weight loss. CT scan reveals a 4 cm gastric mass with invasion into
the muscularis propria. Biopsy shows gastric adenocarcinoma. HER2 testing is
positive (IHC 3+). Which of the following is the most appropriate treatment
approach?
A) Trastuzumab monotherapy
B) Trastuzumab plus chemotherapy (fluoropyrimidine and platinum)
C) Trastuzumab deruxtecan
D) Surgery alone
Rationale: For HER2-positive gastric adenocarcinoma, the standard first-line
treatment is trastuzumab combined with a fluoropyrimidine and platinum
chemotherapy. Trastuzumab deruxtecan is used in the second-line setting. Surgery
alone is insufficient for locally advanced disease.
Question 9
A 55-year-old female presents with a 2 cm breast mass and axillary
lymphadenopathy. Biopsy shows invasive ductal carcinoma, ER positive, PR
positive, HER2 positive (IHC 3+). Which of the following is the most appropriate
neoadjuvant regimen?
A) Docetaxel + cyclophosphamide
B) Paclitaxel + trastuzumab + pertuzumab
