ABGC BOARDS TEST PAPER 2025/2026 QUESTIONS WITH
ANSWERS GRADED A+
✔✔B-ALL - ✔✔recurrent cytogenetic abnormalities associated with this type of ca
✔✔Acute-Promyletoic leukemia - ✔✔PML/RARA fusion involved with this type of
cytogenetic cancer
✔✔CML - ✔✔What cancer is the philadelphia chromosome responsible for creating
t(9;22) present in 95% that has BCR/ABL fusion
✔✔Oncogene - ✔✔Arise from proto-oncogenes, which regulate cell signalling;
Constitutive activation of these proto-oncogenes leads to tumors;
Most often point mutations, but may be gene amplification, chromosome rearrangement
(ex. BCR-ABL), viral insertion (ex. HPV);
Ex. RET (MEN2)
✔✔Tumor suppressor gene - ✔✔Responsible for halting growth of damaged cells;
Inactivation of these genes may lead to tumors (two-hit hypothesis);
Ex. most hereditary cancer genes (BRCA1/2, NF1, APC)
✔✔Mismatch repair gene - ✔✔Identifies and repairs DNA errors made during
replication;
Gatekeepers and caretakers;
Ex. Xeroderma pigmentosum, ATM, Lynch genes
✔✔Incidence - ✔✔Number of new cases of a disease per year
✔✔Prevalance - ✔✔Total number of cases in the population
✔✔Mortality rate - ✔✔Number of deaths per year per 100,000 people
✔✔Survival rate - ✔✔Proportion of people alive at some point subsequent to their
diagnosis
✔✔Relative survival rate - ✔✔Survival rate adjusted for expected mortality (factor out
those who were/are expected to die from other causes)
✔✔Carcinogenesis (4 steps) - ✔✔1. Initiation;
2. Promotion (clonal expansion mediated by growth factors);
3. Progression (develop neoplastic characteristics, increased growth, invasive
potential);
4. Metastasis
,✔✔TNM staging - ✔✔T indicates size of the primary tumor (T1-T4, T0 indicates in situ);
N indicates regional lymph node involvement (N0 no nodes, N1-N3 regional to distant
involvement);
M indicates metastasis (M0 none, M1 yes)
✔✔Chronic myeloid leukemia (CML) - ✔✔Caused by Philadelphia chromosome (t(9;22))
creating BCR-ABL fusion protein (constitutively active tyrosine kinase);
Targeted therapy Imatinib inhibits tyrosine kinase activity
✔✔Burkitt lymphoma - ✔✔B-cell tumor of the jaw (common childhood tumor in Africa);
Most cases caused by t(8;14) activating MYC proto-oncogene
✔✔Breast cancer (risk factors) - ✔✔Age, gender;
Race/ethnicity (Caucasian);
Benign breast disease (atypical hyperplasia, LCIS);
Obesity, poor diet, excessive EtOH use;
Early menarche, late menopause, nulliparity, HRT;
Ionizing and chest radiation;
Family/personal history
✔✔Tamoxifen (and arimidex) - ✔✔Selective estrogen receptor modulators for ER/PR+
tumors;
Reduces risk of recurrence/second primary by ~50%;
Increases risk of endometrial cancer;
May be used as chemoprevention
✔✔Gail model - ✔✔Breast cancer risk model;
Includes personal risk factors, FDR only;
Underestimates hereditary risk, ignores paternal fhx/age of onset
✔✔Claus model - ✔✔Breast cancer risk model;
Includes FDR and SDR as well as age of onset;
Ignores personal risk factors;
Underestimates hereditary risk
✔✔IBIS (Tyrer-Cusick) - ✔✔Breast cancer risk model;
Includes FDR/SDR, bilateral breast ca, age of onset;
Includes personal risk factors;
May overestimate risk if fhx of bilateral disease
✔✔HBOC (genetics and founder muts) - ✔✔BRCA1: Ch. 17, 185delAG, 5382insC;
BRCA2: Ch. 13, 6174delT
✔✔BRCA1 risks - ✔✔Breast: 56-87%, may be triple negative;
Second breast: 40-60%
,Ovarian: 25-40%;
Male breast: increased;
Prostate: slightly increased;
Pancreatic: 2-4%;
Melanoma: none
✔✔BRCA2 risks - ✔✔Breast: 56-87%;
Second breast: 40-60%
Ovarian: 10-27%;
Male breast: increased;
Prostate: 20-30;
Pancreatic: 2-4%;
Melanoma: increased
✔✔HBOC management - ✔✔25-29yo: annual breast MRI;
>30yo: annual breast MRI and mammogram, pelvic exam/transvaginal u/s, CA-125,
consider prophylactic mastectomy;
~40yo: consider BSO;
Tamoxifen has unclear effects, OCPs >5yrs may reduce ovarian risk by 50%
✔✔Cowden syndrome (symptoms/risks) - ✔✔PTEN;
Lhermitte-Duclos disease, hair follicle tumors, macrocephaly, autism, ID, fibromas,
fibroids, penile macular pigmentation;
Breast: 25-50%;
Follicular thyroid: 3-10%;
Endometrial: 5-10%;
Clear cell RCC, melanoma, colon: increased
✔✔Cowden syndrome (management) - ✔✔ASAP: annual thyroid u/s
30-35yo: annual mammogram, breast MRI, endometrial bx, colonoscopy every 5 years,
consider prophylaxis (mastectomy and TAH)
40yo: annual renal u/s
✔✔Li-Fraumeni syndrome (risks) - ✔✔TP53;
Lifetime cancer risk: 90% women, 70% men (50% by 35yo);
Sarcoma, breast, brain, leukemia, adrenocortical tumors
✔✔Li-Fraumeni syndrome (criteria) - ✔✔LFS tumor <46yo AND F/SDR with LFS cancer
<56yo or multiple primaries;
OR LFS tumor <46yo and multiple LFS-related primaries;
OR breast cancer <31yo
✔✔HBOC (criteria) - ✔✔Phx of breast dx <45yo;
Phx of breast dx <50yo and another relative with breast;
Phx of breast and fhx ovarian/panc/male breast;
, Phx male breast;
Phx ovarian;
Phx metastatic prostate
✔✔Li-Fraumeni syndrome (management) - ✔✔20yo: breast MRI, derm eval;
25yo: colonoscopy and EGD;
30: breast MRI, mammogram, consider mastectomy;
Whole-body and brain MRI
✔✔Peutz-Jeghers syndrome (symptoms/risks) - ✔✔STK11;
Multiple GI hamartomas, hyperpigmentation of mouth/lips/nose/eyes/genitalia/fingers;
Lifetime cancer risk: 85%;
Breast: 45-50%;
Colon: 39%;
Pancreatic: 11-36%;
Stomach: 29%;
Ovarian: 21%;
Sex cord tumors, small bowel, uterine: increased
✔✔Peutz-Jeghers syndrome (management) - ✔✔8-10yo: CT/MRI of small bowel,
testicular exam;
Teens: colonoscopy and EGD;
25yo: breast MRI and mammogram;
Can consider endoscopic u/s of pancreas
✔✔Hereditary diffuse gastric cancer (criteria) - ✔✔2 or more gastric cancers, at least
one diffuse, dx <50yo;
Phx diffuse gastric ca <45yo;
1 diffuse gastric and 1 lobular breast;
1 diffuse gastric and 1 signet ring colon
✔✔Hereditary diffuse gastric cancer (risks) - ✔✔CDH1;
Gastric: 67% men, 83% women;
Lobular breast: 39-52%;
Ductal breast, signet ring colon, islet cell pancreatic
✔✔Hereditary diffuse gastric cancer (management) - ✔✔30yo: breast MRI,
mammogram, EGD with random biopsies, consider prophylactic mastectomy and
gastrectomy;
40yo: colonoscopy
✔✔Familial adenomatous polyposis (symptoms/risks) - ✔✔FAP;
>100 polyps before 40yo;
Desmoid tumors, dental anomalies, CHRPE;
ANSWERS GRADED A+
✔✔B-ALL - ✔✔recurrent cytogenetic abnormalities associated with this type of ca
✔✔Acute-Promyletoic leukemia - ✔✔PML/RARA fusion involved with this type of
cytogenetic cancer
✔✔CML - ✔✔What cancer is the philadelphia chromosome responsible for creating
t(9;22) present in 95% that has BCR/ABL fusion
✔✔Oncogene - ✔✔Arise from proto-oncogenes, which regulate cell signalling;
Constitutive activation of these proto-oncogenes leads to tumors;
Most often point mutations, but may be gene amplification, chromosome rearrangement
(ex. BCR-ABL), viral insertion (ex. HPV);
Ex. RET (MEN2)
✔✔Tumor suppressor gene - ✔✔Responsible for halting growth of damaged cells;
Inactivation of these genes may lead to tumors (two-hit hypothesis);
Ex. most hereditary cancer genes (BRCA1/2, NF1, APC)
✔✔Mismatch repair gene - ✔✔Identifies and repairs DNA errors made during
replication;
Gatekeepers and caretakers;
Ex. Xeroderma pigmentosum, ATM, Lynch genes
✔✔Incidence - ✔✔Number of new cases of a disease per year
✔✔Prevalance - ✔✔Total number of cases in the population
✔✔Mortality rate - ✔✔Number of deaths per year per 100,000 people
✔✔Survival rate - ✔✔Proportion of people alive at some point subsequent to their
diagnosis
✔✔Relative survival rate - ✔✔Survival rate adjusted for expected mortality (factor out
those who were/are expected to die from other causes)
✔✔Carcinogenesis (4 steps) - ✔✔1. Initiation;
2. Promotion (clonal expansion mediated by growth factors);
3. Progression (develop neoplastic characteristics, increased growth, invasive
potential);
4. Metastasis
,✔✔TNM staging - ✔✔T indicates size of the primary tumor (T1-T4, T0 indicates in situ);
N indicates regional lymph node involvement (N0 no nodes, N1-N3 regional to distant
involvement);
M indicates metastasis (M0 none, M1 yes)
✔✔Chronic myeloid leukemia (CML) - ✔✔Caused by Philadelphia chromosome (t(9;22))
creating BCR-ABL fusion protein (constitutively active tyrosine kinase);
Targeted therapy Imatinib inhibits tyrosine kinase activity
✔✔Burkitt lymphoma - ✔✔B-cell tumor of the jaw (common childhood tumor in Africa);
Most cases caused by t(8;14) activating MYC proto-oncogene
✔✔Breast cancer (risk factors) - ✔✔Age, gender;
Race/ethnicity (Caucasian);
Benign breast disease (atypical hyperplasia, LCIS);
Obesity, poor diet, excessive EtOH use;
Early menarche, late menopause, nulliparity, HRT;
Ionizing and chest radiation;
Family/personal history
✔✔Tamoxifen (and arimidex) - ✔✔Selective estrogen receptor modulators for ER/PR+
tumors;
Reduces risk of recurrence/second primary by ~50%;
Increases risk of endometrial cancer;
May be used as chemoprevention
✔✔Gail model - ✔✔Breast cancer risk model;
Includes personal risk factors, FDR only;
Underestimates hereditary risk, ignores paternal fhx/age of onset
✔✔Claus model - ✔✔Breast cancer risk model;
Includes FDR and SDR as well as age of onset;
Ignores personal risk factors;
Underestimates hereditary risk
✔✔IBIS (Tyrer-Cusick) - ✔✔Breast cancer risk model;
Includes FDR/SDR, bilateral breast ca, age of onset;
Includes personal risk factors;
May overestimate risk if fhx of bilateral disease
✔✔HBOC (genetics and founder muts) - ✔✔BRCA1: Ch. 17, 185delAG, 5382insC;
BRCA2: Ch. 13, 6174delT
✔✔BRCA1 risks - ✔✔Breast: 56-87%, may be triple negative;
Second breast: 40-60%
,Ovarian: 25-40%;
Male breast: increased;
Prostate: slightly increased;
Pancreatic: 2-4%;
Melanoma: none
✔✔BRCA2 risks - ✔✔Breast: 56-87%;
Second breast: 40-60%
Ovarian: 10-27%;
Male breast: increased;
Prostate: 20-30;
Pancreatic: 2-4%;
Melanoma: increased
✔✔HBOC management - ✔✔25-29yo: annual breast MRI;
>30yo: annual breast MRI and mammogram, pelvic exam/transvaginal u/s, CA-125,
consider prophylactic mastectomy;
~40yo: consider BSO;
Tamoxifen has unclear effects, OCPs >5yrs may reduce ovarian risk by 50%
✔✔Cowden syndrome (symptoms/risks) - ✔✔PTEN;
Lhermitte-Duclos disease, hair follicle tumors, macrocephaly, autism, ID, fibromas,
fibroids, penile macular pigmentation;
Breast: 25-50%;
Follicular thyroid: 3-10%;
Endometrial: 5-10%;
Clear cell RCC, melanoma, colon: increased
✔✔Cowden syndrome (management) - ✔✔ASAP: annual thyroid u/s
30-35yo: annual mammogram, breast MRI, endometrial bx, colonoscopy every 5 years,
consider prophylaxis (mastectomy and TAH)
40yo: annual renal u/s
✔✔Li-Fraumeni syndrome (risks) - ✔✔TP53;
Lifetime cancer risk: 90% women, 70% men (50% by 35yo);
Sarcoma, breast, brain, leukemia, adrenocortical tumors
✔✔Li-Fraumeni syndrome (criteria) - ✔✔LFS tumor <46yo AND F/SDR with LFS cancer
<56yo or multiple primaries;
OR LFS tumor <46yo and multiple LFS-related primaries;
OR breast cancer <31yo
✔✔HBOC (criteria) - ✔✔Phx of breast dx <45yo;
Phx of breast dx <50yo and another relative with breast;
Phx of breast and fhx ovarian/panc/male breast;
, Phx male breast;
Phx ovarian;
Phx metastatic prostate
✔✔Li-Fraumeni syndrome (management) - ✔✔20yo: breast MRI, derm eval;
25yo: colonoscopy and EGD;
30: breast MRI, mammogram, consider mastectomy;
Whole-body and brain MRI
✔✔Peutz-Jeghers syndrome (symptoms/risks) - ✔✔STK11;
Multiple GI hamartomas, hyperpigmentation of mouth/lips/nose/eyes/genitalia/fingers;
Lifetime cancer risk: 85%;
Breast: 45-50%;
Colon: 39%;
Pancreatic: 11-36%;
Stomach: 29%;
Ovarian: 21%;
Sex cord tumors, small bowel, uterine: increased
✔✔Peutz-Jeghers syndrome (management) - ✔✔8-10yo: CT/MRI of small bowel,
testicular exam;
Teens: colonoscopy and EGD;
25yo: breast MRI and mammogram;
Can consider endoscopic u/s of pancreas
✔✔Hereditary diffuse gastric cancer (criteria) - ✔✔2 or more gastric cancers, at least
one diffuse, dx <50yo;
Phx diffuse gastric ca <45yo;
1 diffuse gastric and 1 lobular breast;
1 diffuse gastric and 1 signet ring colon
✔✔Hereditary diffuse gastric cancer (risks) - ✔✔CDH1;
Gastric: 67% men, 83% women;
Lobular breast: 39-52%;
Ductal breast, signet ring colon, islet cell pancreatic
✔✔Hereditary diffuse gastric cancer (management) - ✔✔30yo: breast MRI,
mammogram, EGD with random biopsies, consider prophylactic mastectomy and
gastrectomy;
40yo: colonoscopy
✔✔Familial adenomatous polyposis (symptoms/risks) - ✔✔FAP;
>100 polyps before 40yo;
Desmoid tumors, dental anomalies, CHRPE;
