MY AOCNP STUDY GUIDE
AOCNP
EXAM STUDY GUIDE
400+ Review Qs & Terms
Board-Exam Preparation
Main Features:
• Focused AOCNP board-exam review
• Board-Prep Questions and Review Terms
• Extensive collection of Review questions and answers
• Helpful for identifying knowledge gaps
• Covers high-yield concepts
• Supports structured study and final revision
My AOCNP Study Guide | Page 1
, MY AOCNP STUDY GUIDE
1. what is primary prevention
consists of interventions aimed at keeping the carcinogenic process from beginning.
2. secondary prevention and what is an example
is the discovery of cancerous of precancerous conditions while still in their earliest stage,
when the disease is most likely to be treated successfully. Mammography
3. Tertiary prevention
applied to those individuals who has already been diagnosed with a malignancy with the
intent of keeping the original disease in remission as long as possible.
4. Examples of primary prevention
tobacco cessation, sun exposure, diet and exercise,
5. What are the 5 A's in smoking cessation?
Ask, Advise, Assess, Assist and arrange
6. What are the 5 r's in smoking cessation
Relevance, risk, rewards, roadblocks, repetition
7. What is the first and second major risk factor for cancer
smoking and obesity
8. Define chemoprevention
the use of natural, synthetic, or biologic agents to reverse, suppress, or prevent carcinogenic
progression.
9. What two drugs are used for chemoprevention in women for breast cancer-
Tamoxifen/Raloxifene
10. What should I know about Tamoxifen for chemoprevention (4)
• selective Estrogen Receptor modulator (SERM)
• approved for prevention of invasive breast cancer in women with hx of non-invasive breast
cancer.
• Higher incidence of thrombolytic events/endometrial cancer
My AOCNP Study Guide | Page 2
, MY AOCNP STUDY GUIDE
• Premenopausal Women
11. What should I know about Raloxifine (3)
• 2nd gen SERM
• reduces invasive breast cancer in high risk postmenopausal
• Fewer cases of uterine cancer, thrombolytic events and cataracts
12. What medication is used for chemoprevention for colon cancer
Celecoxib
13. What should I know about Celecoxib (3)
• COX-2 inhibitor
• FDA approved for prevention of adenomatous polyps in patients with familial
adenomatous polyposis (FAP) Hereditary colon cancer syndrome ONLY
• Not approved for gen pop
14. What is COX-2
enzyme seen in prostaglandin synthesis inducted in inflammatory conditions, including tumor
proliferation. This overexpression is seen in numerous adenocarcinomas
15. Recommended dosage of Celecoxib for FAP
400 mg BID
16. HPV vaccine is an example of what
chemoprevention
17. What are the three types of HPV vaccines
Gardasil, Cervarix and Gardasil 9
18. Describe Gardasil (2)
• approved in 2006
• works on HPV types 6, 11, 16 and 18
19. Describe Cervarix (2)
• approved in 2009
• works on HPV 16 and 18
My AOCNP Study Guide | Page 3
, MY AOCNP STUDY GUIDE
20. Describe Gardasil 9 (2)
• approved 2014 given for older patients
21. What does sensitivity mean (3)
• the ability to rule OUT disease if the test is negative
• the proportion of people with cancer that are found to have a positive test
• higher sensitivity means fewer false-negative results
22. What does specificity mean (3)
• the ability to rule IN disease if the test is positive
• the proportion of people without cancer that have negative results
• higher specificity, the fewer false-positive results
23. Recommendations on mammography
Age of 40 to start unless it there is a first degree relative that had breast cancer screening
would then start 10 years younger than the age the first degree relative was diagnosed.
24. what is considered a increased risk of breast cancer where the consideration of
breast MRI would be added in addition to mammography (6)
• chest radiation
• life time risk score > 20%
• pedigree suggestive of known genetic predisposition
• BRCA1/BRCA2 carriers
• PTEN mutation
• Li-Frameniu
25. when do you start screening for breast cancer if the first degree relative had breast
cancer
10 years younger than the diagnosis date of the first degree relative
26. MRI of the breast in addition to mammography has not been found to do what
reduce mortality rate in women
27. what are the guidelines to recommend LDLCT for screening for lung cancer
• 50 and above
My AOCNP Study Guide | Page 4
, MY AOCNP STUDY GUIDE
• 20 pack years of smoking
28. What are the guidelines to indicate a patient is high-risk and prostate cancer
screening needs to be implemented (4)
• start screening at age 40-75 for high risk patients
• african american
• germline mutation that increases cancer risk
• those with concerning family history
29. what is the absolute risk of cancer definition
the occurance of cancer in a general population
30. MRI screening recommendations as an adjunct to MMG in high risk screening. (6)
• women with > 20% lifetime risk
• BRCA1/BRCA2 carriers
• Li-fraumeni
• PTEN mutation
• family hx of BCA
• hx of chest XRT ex. Hodgkin lymphoma
31. MRI screening has not been found to reduce what
mortality in any group of women
32. Cervical cancer screening recommendations
• screen every 3 years in women age 21-29
• 30-65 yrs screen every 3 years with cervical cytology and every 5 years with high risk
HPV testing alone, or every 5 years with both
33. What age does colorectal screening start and end for a regular risk pt
45-75
34. when do we recommend lung cancer screening? (2)
• age 50 and greater
• pt with at least 20 pack years
My AOCNP Study Guide | Page 5
, MY AOCNP STUDY GUIDE
35. What screening age is used for prostate in patients with high-risk features-
40-75
36. What screening age is used for patients with average risk features for prostate
45-75
37. what does absolute risk mean
the occurrence of cancer in the general population
38. Define attributable risk
the number of cancer cases that could be prevented with the manipulation of the known risk
factor.
39. Incidence
the number of cancer cases that develop in a define population in a specific period
40. population
number of people in a defined group who can develop cancer
41. prevalence
the actual number of cancer and is defined as the number of cases per 100,000
42. relative risk
statistical estimate that compares the likelihood of a person with risk factors developing
cancer compared to those that does not have risk factors developing cancer
43. risk factor
your trait, your characteristics, your lifestyle all things that increase your chances of
developing cancer
44. define somatic genes
occurs during growth and development of a tissue or organ
45. germ line gene
occurs at conception in the ova or sperm
46. proto oncogenes
regulate normal cell growth
My AOCNP Study Guide | Page 6
, MY AOCNP STUDY GUIDE
47. oncogenes
associated with abnormal cell growth - leading to increase cellular proliferation and
uncontrolled growth
48. Mismatch repair MMR
repair mistakes that occur during DNA replication
49. Tumor supressor genes (2)
Caretaker genes: maintain integrity of genetic material Gatekeeper genes: regulate
proliferation and cell life
50. What are examples of somatic mutations (2)
HER2 neu amplification Philedelphia chromosome in chronic leukemia
51. What are some things that I need to know about somatic genes (4)
• occurs after conception
• estimated 85% of cancer is from somatic mutations
• sporatic cancer
• cannot be passsed to subsequent generations
52. What genes are responsible for hereditary breast cancer (5)
BRCA 1/2, pten, cdh1, palb2, and TP53
53. what percent of breast cancer is caused by BRCA 1/2 gene mutation
5-10%
54. what is the risk of breast cancer development by the age of 50 with patients with
BRCA 1/2 gene mutation
33 - 50%
55. what is the cumulative risk of developing breast caner by the age of 70 with the
BRCA 1/2 mutation
87%
56. what other cancers does BRCA 1/2 associated with
melanoma, prostate, gastric, pancreatic and male breast cancer
My AOCNP Study Guide | Page 7
, MY AOCNP STUDY GUIDE
57. What are three characteristics of BRCA 1 cancers
• medullary histopathology
• more likely to be triple negative
• higher histologic grade
58. what are the high risk populations for hereditary breast cancer (3)
• ashkenazi jewish
• Dutch
• icelandic decent
59. what is the other name for hereditary nonpolyposis colorectal cancer syndrome
Lynch syndrome
60. What gene mutations are associated with hereditary nonpolyposis colorectal cancer
(lynch) - (5)
MSH2, MLH1, PMS2, MSH6, EPCAM
61. Lynch or hereditary nonpolyposis colorectal cancer is associated with what percent
of colorectal cancer
3-5%
62. what other caners is Lynch syndrome associated with (7)
endometrial, ovarian, gastric, bile duct, sm bowell, renal pelvis, and ureter
63. if you test positive for lynch syndrome, what is the percentage of risk you have to
develop colon cancer in a lifetime
80% lifetime risk
64. if you test positive for lynch syndrome, what is the lifetime risk of developing
endometrial cancer and ovarian cancer
60% endometrial and 12% ovarian cancer
65. if you have lynch syndrome, what is the lifetime risk of developing gastric or
stomach cancer compared to the gen pop of 1%
1-12%
My AOCNP Study Guide | Page 8
, MY AOCNP STUDY GUIDE
66. what side of colon cancer is lynch syndrome associated with
right sided
67. what type of tumors is lynch syndrome associated with? histology....
poorly differentiated tumors like mucoid and signet cell features
68. What is the Bethesida criteria
method to further determine MSI or IHC testing
69. what risk factors would make you screen for hereditary nonpolyposis coloretal
cancer or Lynch syndrome (6)
• personal history of colorectal or endometrial cancer diagnosis < age 50
• 1st degree relative with colorectal < age 50
• 2 or more relatives with colorectal cancer or HNPPC
• colorectal cancer in 2 or more relatives occuring on the same side of the family
• personal hx of colorectal ca and a 1st degree relative with adenomas dx < age 40
• relative known with HPCC dx
70. What gene mutations are associated with familial adenomatous polyposis syndrome
(2)
MUTH, APC
71. FAPS is usually characterized by how many polyps
100+
72. FAPS is seen in how many colorectal cases
1%
73. 75% of patients with FAPS will develop polyps by the age of what
20
74. what is the less severe form of FAPS
attenuating familial polyposis syndrome AFPS
75. how many mutations are seen in the APC gene seen in FAPS
800
My AOCNP Study Guide | Page 9
, MY AOCNP STUDY GUIDE
76. characteristics of MUTYH associated polyposis (MAP)v -v(3)
• autosomal recessive
• 0.5-1% colorectal cancer
• risk of colon cancer 19% by age 50 and 43% by age 60
77. what 4 factors are concerning for FAP/AFAP
• patient with clinical dx of FAP (100+ polyps)
• suspected FAP (15-99 polyps)
• 1st degree relative with known FAP or MYH mutation
• patient with any number of adenomas in family with FAP
78. what is the average age of development for FAP/AFAP
39
79. what genes are associated with heradatery melanoma (2)
p16/CDK5
80. herediatery melanoma is what type of gene mutation
autosomal recessive
81. herditary melanomas make up what percentage of all melanomas
10%
82. what 4 factors is suggestive of hereditary melanoma
• 3 or more primary melanomas in one individual
• patient with melanoma with 3 or more melanomas in the family
• melanoma or pancreatic cancer in a individual or family
• 1st degree relative of p16 carrier
83. what two gene mutations are associated with pancreatic cancer
PALB2/BRCA2
84. what are the 4 characteristics suggestive of hereditary pancreatic cancer: -
• patient with at least one close relative of pancreatic cancer
My AOCNP Study Guide | Page 10
AOCNP
EXAM STUDY GUIDE
400+ Review Qs & Terms
Board-Exam Preparation
Main Features:
• Focused AOCNP board-exam review
• Board-Prep Questions and Review Terms
• Extensive collection of Review questions and answers
• Helpful for identifying knowledge gaps
• Covers high-yield concepts
• Supports structured study and final revision
My AOCNP Study Guide | Page 1
, MY AOCNP STUDY GUIDE
1. what is primary prevention
consists of interventions aimed at keeping the carcinogenic process from beginning.
2. secondary prevention and what is an example
is the discovery of cancerous of precancerous conditions while still in their earliest stage,
when the disease is most likely to be treated successfully. Mammography
3. Tertiary prevention
applied to those individuals who has already been diagnosed with a malignancy with the
intent of keeping the original disease in remission as long as possible.
4. Examples of primary prevention
tobacco cessation, sun exposure, diet and exercise,
5. What are the 5 A's in smoking cessation?
Ask, Advise, Assess, Assist and arrange
6. What are the 5 r's in smoking cessation
Relevance, risk, rewards, roadblocks, repetition
7. What is the first and second major risk factor for cancer
smoking and obesity
8. Define chemoprevention
the use of natural, synthetic, or biologic agents to reverse, suppress, or prevent carcinogenic
progression.
9. What two drugs are used for chemoprevention in women for breast cancer-
Tamoxifen/Raloxifene
10. What should I know about Tamoxifen for chemoprevention (4)
• selective Estrogen Receptor modulator (SERM)
• approved for prevention of invasive breast cancer in women with hx of non-invasive breast
cancer.
• Higher incidence of thrombolytic events/endometrial cancer
My AOCNP Study Guide | Page 2
, MY AOCNP STUDY GUIDE
• Premenopausal Women
11. What should I know about Raloxifine (3)
• 2nd gen SERM
• reduces invasive breast cancer in high risk postmenopausal
• Fewer cases of uterine cancer, thrombolytic events and cataracts
12. What medication is used for chemoprevention for colon cancer
Celecoxib
13. What should I know about Celecoxib (3)
• COX-2 inhibitor
• FDA approved for prevention of adenomatous polyps in patients with familial
adenomatous polyposis (FAP) Hereditary colon cancer syndrome ONLY
• Not approved for gen pop
14. What is COX-2
enzyme seen in prostaglandin synthesis inducted in inflammatory conditions, including tumor
proliferation. This overexpression is seen in numerous adenocarcinomas
15. Recommended dosage of Celecoxib for FAP
400 mg BID
16. HPV vaccine is an example of what
chemoprevention
17. What are the three types of HPV vaccines
Gardasil, Cervarix and Gardasil 9
18. Describe Gardasil (2)
• approved in 2006
• works on HPV types 6, 11, 16 and 18
19. Describe Cervarix (2)
• approved in 2009
• works on HPV 16 and 18
My AOCNP Study Guide | Page 3
, MY AOCNP STUDY GUIDE
20. Describe Gardasil 9 (2)
• approved 2014 given for older patients
21. What does sensitivity mean (3)
• the ability to rule OUT disease if the test is negative
• the proportion of people with cancer that are found to have a positive test
• higher sensitivity means fewer false-negative results
22. What does specificity mean (3)
• the ability to rule IN disease if the test is positive
• the proportion of people without cancer that have negative results
• higher specificity, the fewer false-positive results
23. Recommendations on mammography
Age of 40 to start unless it there is a first degree relative that had breast cancer screening
would then start 10 years younger than the age the first degree relative was diagnosed.
24. what is considered a increased risk of breast cancer where the consideration of
breast MRI would be added in addition to mammography (6)
• chest radiation
• life time risk score > 20%
• pedigree suggestive of known genetic predisposition
• BRCA1/BRCA2 carriers
• PTEN mutation
• Li-Frameniu
25. when do you start screening for breast cancer if the first degree relative had breast
cancer
10 years younger than the diagnosis date of the first degree relative
26. MRI of the breast in addition to mammography has not been found to do what
reduce mortality rate in women
27. what are the guidelines to recommend LDLCT for screening for lung cancer
• 50 and above
My AOCNP Study Guide | Page 4
, MY AOCNP STUDY GUIDE
• 20 pack years of smoking
28. What are the guidelines to indicate a patient is high-risk and prostate cancer
screening needs to be implemented (4)
• start screening at age 40-75 for high risk patients
• african american
• germline mutation that increases cancer risk
• those with concerning family history
29. what is the absolute risk of cancer definition
the occurance of cancer in a general population
30. MRI screening recommendations as an adjunct to MMG in high risk screening. (6)
• women with > 20% lifetime risk
• BRCA1/BRCA2 carriers
• Li-fraumeni
• PTEN mutation
• family hx of BCA
• hx of chest XRT ex. Hodgkin lymphoma
31. MRI screening has not been found to reduce what
mortality in any group of women
32. Cervical cancer screening recommendations
• screen every 3 years in women age 21-29
• 30-65 yrs screen every 3 years with cervical cytology and every 5 years with high risk
HPV testing alone, or every 5 years with both
33. What age does colorectal screening start and end for a regular risk pt
45-75
34. when do we recommend lung cancer screening? (2)
• age 50 and greater
• pt with at least 20 pack years
My AOCNP Study Guide | Page 5
, MY AOCNP STUDY GUIDE
35. What screening age is used for prostate in patients with high-risk features-
40-75
36. What screening age is used for patients with average risk features for prostate
45-75
37. what does absolute risk mean
the occurrence of cancer in the general population
38. Define attributable risk
the number of cancer cases that could be prevented with the manipulation of the known risk
factor.
39. Incidence
the number of cancer cases that develop in a define population in a specific period
40. population
number of people in a defined group who can develop cancer
41. prevalence
the actual number of cancer and is defined as the number of cases per 100,000
42. relative risk
statistical estimate that compares the likelihood of a person with risk factors developing
cancer compared to those that does not have risk factors developing cancer
43. risk factor
your trait, your characteristics, your lifestyle all things that increase your chances of
developing cancer
44. define somatic genes
occurs during growth and development of a tissue or organ
45. germ line gene
occurs at conception in the ova or sperm
46. proto oncogenes
regulate normal cell growth
My AOCNP Study Guide | Page 6
, MY AOCNP STUDY GUIDE
47. oncogenes
associated with abnormal cell growth - leading to increase cellular proliferation and
uncontrolled growth
48. Mismatch repair MMR
repair mistakes that occur during DNA replication
49. Tumor supressor genes (2)
Caretaker genes: maintain integrity of genetic material Gatekeeper genes: regulate
proliferation and cell life
50. What are examples of somatic mutations (2)
HER2 neu amplification Philedelphia chromosome in chronic leukemia
51. What are some things that I need to know about somatic genes (4)
• occurs after conception
• estimated 85% of cancer is from somatic mutations
• sporatic cancer
• cannot be passsed to subsequent generations
52. What genes are responsible for hereditary breast cancer (5)
BRCA 1/2, pten, cdh1, palb2, and TP53
53. what percent of breast cancer is caused by BRCA 1/2 gene mutation
5-10%
54. what is the risk of breast cancer development by the age of 50 with patients with
BRCA 1/2 gene mutation
33 - 50%
55. what is the cumulative risk of developing breast caner by the age of 70 with the
BRCA 1/2 mutation
87%
56. what other cancers does BRCA 1/2 associated with
melanoma, prostate, gastric, pancreatic and male breast cancer
My AOCNP Study Guide | Page 7
, MY AOCNP STUDY GUIDE
57. What are three characteristics of BRCA 1 cancers
• medullary histopathology
• more likely to be triple negative
• higher histologic grade
58. what are the high risk populations for hereditary breast cancer (3)
• ashkenazi jewish
• Dutch
• icelandic decent
59. what is the other name for hereditary nonpolyposis colorectal cancer syndrome
Lynch syndrome
60. What gene mutations are associated with hereditary nonpolyposis colorectal cancer
(lynch) - (5)
MSH2, MLH1, PMS2, MSH6, EPCAM
61. Lynch or hereditary nonpolyposis colorectal cancer is associated with what percent
of colorectal cancer
3-5%
62. what other caners is Lynch syndrome associated with (7)
endometrial, ovarian, gastric, bile duct, sm bowell, renal pelvis, and ureter
63. if you test positive for lynch syndrome, what is the percentage of risk you have to
develop colon cancer in a lifetime
80% lifetime risk
64. if you test positive for lynch syndrome, what is the lifetime risk of developing
endometrial cancer and ovarian cancer
60% endometrial and 12% ovarian cancer
65. if you have lynch syndrome, what is the lifetime risk of developing gastric or
stomach cancer compared to the gen pop of 1%
1-12%
My AOCNP Study Guide | Page 8
, MY AOCNP STUDY GUIDE
66. what side of colon cancer is lynch syndrome associated with
right sided
67. what type of tumors is lynch syndrome associated with? histology....
poorly differentiated tumors like mucoid and signet cell features
68. What is the Bethesida criteria
method to further determine MSI or IHC testing
69. what risk factors would make you screen for hereditary nonpolyposis coloretal
cancer or Lynch syndrome (6)
• personal history of colorectal or endometrial cancer diagnosis < age 50
• 1st degree relative with colorectal < age 50
• 2 or more relatives with colorectal cancer or HNPPC
• colorectal cancer in 2 or more relatives occuring on the same side of the family
• personal hx of colorectal ca and a 1st degree relative with adenomas dx < age 40
• relative known with HPCC dx
70. What gene mutations are associated with familial adenomatous polyposis syndrome
(2)
MUTH, APC
71. FAPS is usually characterized by how many polyps
100+
72. FAPS is seen in how many colorectal cases
1%
73. 75% of patients with FAPS will develop polyps by the age of what
20
74. what is the less severe form of FAPS
attenuating familial polyposis syndrome AFPS
75. how many mutations are seen in the APC gene seen in FAPS
800
My AOCNP Study Guide | Page 9
, MY AOCNP STUDY GUIDE
76. characteristics of MUTYH associated polyposis (MAP)v -v(3)
• autosomal recessive
• 0.5-1% colorectal cancer
• risk of colon cancer 19% by age 50 and 43% by age 60
77. what 4 factors are concerning for FAP/AFAP
• patient with clinical dx of FAP (100+ polyps)
• suspected FAP (15-99 polyps)
• 1st degree relative with known FAP or MYH mutation
• patient with any number of adenomas in family with FAP
78. what is the average age of development for FAP/AFAP
39
79. what genes are associated with heradatery melanoma (2)
p16/CDK5
80. herediatery melanoma is what type of gene mutation
autosomal recessive
81. herditary melanomas make up what percentage of all melanomas
10%
82. what 4 factors is suggestive of hereditary melanoma
• 3 or more primary melanomas in one individual
• patient with melanoma with 3 or more melanomas in the family
• melanoma or pancreatic cancer in a individual or family
• 1st degree relative of p16 carrier
83. what two gene mutations are associated with pancreatic cancer
PALB2/BRCA2
84. what are the 4 characteristics suggestive of hereditary pancreatic cancer: -
• patient with at least one close relative of pancreatic cancer
My AOCNP Study Guide | Page 10
