AOCNP Exam Study Guide – 300+ Review
Questions & Terms for Advanced
Oncology Certified Nurse Practitioner
(2026) Board Exam Prep (PDF)
Section 1: Cancer Continuum (35% of Exam)
Question 1
A 52-year-old female with no family history of breast cancer asks about breast cancer screening.
According to current guidelines, which of the following is the recommended screening approach?
• A) Annual mammography starting at age 40
• B) Mammography every 2 years starting at age 50
• C) Annual mammography starting at age 45 with option to begin at 40
• D) Clinical breast examination only until age 50
Rationale: Current NCCN and USPSTF guidelines recommend initiating annual mammography at age 45
for average-risk women, with the option to begin at age 40. Screening every 2 years at age 50 was a
previous recommendation that has been updated. Clinical breast examination alone is insufficient for
screening purposes.
Question 2
According to current USPSTF guidelines, at what age should average-risk individuals begin colorectal
cancer screening?
• A) Age 40
• B) Age 45
• C) Age 50
• D) Age 55
,Rationale: The USPSTF and NCCN recommend initiating colorectal cancer screening at age 45 for
average-risk individuals. This was updated from age 50 in 2021. Options include colonoscopy, FIT, or stool
DNA testing.
Question 3
Which of the following is considered the gold standard for colorectal cancer screening?
• A) Fecal immunochemical test (FIT)
• B) Colonoscopy
• C) Carcinoembryonic antigen (CEA) blood test
• D) CT colonography
Rationale: Colonoscopy is the gold standard because it allows for direct visualization and
biopsy/polypectomy of lesions throughout the entire colon. CEA is used for monitoring, not screening.
FIT and CT colonography are alternatives but not the gold standard.
Question 4
A 55-year-old male with a 30-pack-year smoking history presents for lung cancer screening. Which
screening modality is recommended for high-risk individuals?
• A) Chest X-ray
• B) Low-dose CT (LDCT)
• C) PET/CT
• D) Sputum cytology
Rationale: The USPSTF recommends annual low-dose CT screening for adults aged 50-80 with a 20+
pack-year smoking history who currently smoke or quit within the last 15 years. Chest X-ray and sputum
cytology have not been shown to reduce mortality.
Question 5
Which HPV types are most strongly associated with cervical cancer?
• A) HPV 6 and 11
• B) HPV 16 and 18
• C) HPV 31 and 33
• D) HPV 45 and 52
,Rationale: High-risk HPV types 16 and 18 are responsible for approximately 70% of cervical cancers
worldwide. Types 6 and 11 are associated with genital warts (low-risk types). The HPV vaccine covers
high-risk types 16 and 18.
Question 6
The BRCA1 gene is located on which chromosome?
• A) Chromosome 13
• B) Chromosome 17
• C) Chromosome 11
• D) Chromosome 9
Rationale: BRCA1 is located on chromosome 17q21. BRCA2 is on chromosome 13q12.3. BRCA1
mutations are associated with increased risk of breast, ovarian, pancreatic, and prostate cancers. The
lifetime breast cancer risk with BRCA1 mutation is approximately 60-70%.
Question 7
A 68-year-old male with a history of non-small cell lung cancer treated with definitive chemoradiation
2 years ago presents with new-onset seizures. A brain MRI shows multiple enhancing lesions. What is
the MOST likely diagnosis?
• A) Brain metastases
• B) Primary brain tumor
• C) Stroke
• D) Infectious process
Rationale: Lung cancer is the most common primary tumor to metastasize to the brain. Multiple
enhancing brain lesions in a patient with a history of lung cancer are most consistent with brain
metastases.
Question 8
A 70-year-old female with a new diagnosis of pancreatic cancer presents with jaundice, weight loss,
and abdominal pain. Her CA 19-9 level is significantly elevated. What is the MOST important
prognostic factor?
• A) CA 19-9 level
• B) Patient age
, • C) Tumor resectability
• D) Weight loss
Rationale: Tumor resectability is the most important prognostic factor in pancreatic cancer. Only 15-20%
of patients present with resectable disease, and these patients have significantly better survival
outcomes.
Question 9
A 48-year-old female with a BRCA1 mutation is considering risk-reducing salpingo-oophorectomy
(RRSO). At what age is RRSO MOST recommended for BRCA1 mutation carriers?
• A) Age 35-40
• B) Age 40-45
• C) Age 45-50
• D) Age 50-55
Rationale: For BRCA1 mutation carriers, RRSO is recommended between ages 40-45, or when
childbearing is complete. For BRCA2 carriers, the recommendation is ages 45-50. Bilateral prophylactic
mastectomy reduces breast cancer risk by approximately 90-95% in BRCA mutation carriers.
Question 10
A 45-year-old female with a new diagnosis of early-stage breast cancer asks about the role of genetic
testing. Which of the following is NOT an indication for genetic testing for hereditary breast and
ovarian cancer?
• A) Breast cancer diagnosed at age 45 or younger
• B) Triple-negative breast cancer at age 60
• C) Two primary breast cancers in the same patient
• D) Ashkenazi Jewish ancestry with breast cancer
Rationale: Triple-negative breast cancer diagnosed at age 60 would not typically meet criteria for genetic
testing unless there are other risk factors. Indications include breast cancer at age ≤ 50, triple-negative
breast cancer at age ≤ 60, two primary breast cancers, and Ashkenazi Jewish ancestry.
Question 11
A patient with cirrhosis and a liver lesion has an AFP level of 250 ng/mL. What is the MOST likely
diagnosis?
Questions & Terms for Advanced
Oncology Certified Nurse Practitioner
(2026) Board Exam Prep (PDF)
Section 1: Cancer Continuum (35% of Exam)
Question 1
A 52-year-old female with no family history of breast cancer asks about breast cancer screening.
According to current guidelines, which of the following is the recommended screening approach?
• A) Annual mammography starting at age 40
• B) Mammography every 2 years starting at age 50
• C) Annual mammography starting at age 45 with option to begin at 40
• D) Clinical breast examination only until age 50
Rationale: Current NCCN and USPSTF guidelines recommend initiating annual mammography at age 45
for average-risk women, with the option to begin at age 40. Screening every 2 years at age 50 was a
previous recommendation that has been updated. Clinical breast examination alone is insufficient for
screening purposes.
Question 2
According to current USPSTF guidelines, at what age should average-risk individuals begin colorectal
cancer screening?
• A) Age 40
• B) Age 45
• C) Age 50
• D) Age 55
,Rationale: The USPSTF and NCCN recommend initiating colorectal cancer screening at age 45 for
average-risk individuals. This was updated from age 50 in 2021. Options include colonoscopy, FIT, or stool
DNA testing.
Question 3
Which of the following is considered the gold standard for colorectal cancer screening?
• A) Fecal immunochemical test (FIT)
• B) Colonoscopy
• C) Carcinoembryonic antigen (CEA) blood test
• D) CT colonography
Rationale: Colonoscopy is the gold standard because it allows for direct visualization and
biopsy/polypectomy of lesions throughout the entire colon. CEA is used for monitoring, not screening.
FIT and CT colonography are alternatives but not the gold standard.
Question 4
A 55-year-old male with a 30-pack-year smoking history presents for lung cancer screening. Which
screening modality is recommended for high-risk individuals?
• A) Chest X-ray
• B) Low-dose CT (LDCT)
• C) PET/CT
• D) Sputum cytology
Rationale: The USPSTF recommends annual low-dose CT screening for adults aged 50-80 with a 20+
pack-year smoking history who currently smoke or quit within the last 15 years. Chest X-ray and sputum
cytology have not been shown to reduce mortality.
Question 5
Which HPV types are most strongly associated with cervical cancer?
• A) HPV 6 and 11
• B) HPV 16 and 18
• C) HPV 31 and 33
• D) HPV 45 and 52
,Rationale: High-risk HPV types 16 and 18 are responsible for approximately 70% of cervical cancers
worldwide. Types 6 and 11 are associated with genital warts (low-risk types). The HPV vaccine covers
high-risk types 16 and 18.
Question 6
The BRCA1 gene is located on which chromosome?
• A) Chromosome 13
• B) Chromosome 17
• C) Chromosome 11
• D) Chromosome 9
Rationale: BRCA1 is located on chromosome 17q21. BRCA2 is on chromosome 13q12.3. BRCA1
mutations are associated with increased risk of breast, ovarian, pancreatic, and prostate cancers. The
lifetime breast cancer risk with BRCA1 mutation is approximately 60-70%.
Question 7
A 68-year-old male with a history of non-small cell lung cancer treated with definitive chemoradiation
2 years ago presents with new-onset seizures. A brain MRI shows multiple enhancing lesions. What is
the MOST likely diagnosis?
• A) Brain metastases
• B) Primary brain tumor
• C) Stroke
• D) Infectious process
Rationale: Lung cancer is the most common primary tumor to metastasize to the brain. Multiple
enhancing brain lesions in a patient with a history of lung cancer are most consistent with brain
metastases.
Question 8
A 70-year-old female with a new diagnosis of pancreatic cancer presents with jaundice, weight loss,
and abdominal pain. Her CA 19-9 level is significantly elevated. What is the MOST important
prognostic factor?
• A) CA 19-9 level
• B) Patient age
, • C) Tumor resectability
• D) Weight loss
Rationale: Tumor resectability is the most important prognostic factor in pancreatic cancer. Only 15-20%
of patients present with resectable disease, and these patients have significantly better survival
outcomes.
Question 9
A 48-year-old female with a BRCA1 mutation is considering risk-reducing salpingo-oophorectomy
(RRSO). At what age is RRSO MOST recommended for BRCA1 mutation carriers?
• A) Age 35-40
• B) Age 40-45
• C) Age 45-50
• D) Age 50-55
Rationale: For BRCA1 mutation carriers, RRSO is recommended between ages 40-45, or when
childbearing is complete. For BRCA2 carriers, the recommendation is ages 45-50. Bilateral prophylactic
mastectomy reduces breast cancer risk by approximately 90-95% in BRCA mutation carriers.
Question 10
A 45-year-old female with a new diagnosis of early-stage breast cancer asks about the role of genetic
testing. Which of the following is NOT an indication for genetic testing for hereditary breast and
ovarian cancer?
• A) Breast cancer diagnosed at age 45 or younger
• B) Triple-negative breast cancer at age 60
• C) Two primary breast cancers in the same patient
• D) Ashkenazi Jewish ancestry with breast cancer
Rationale: Triple-negative breast cancer diagnosed at age 60 would not typically meet criteria for genetic
testing unless there are other risk factors. Indications include breast cancer at age ≤ 50, triple-negative
breast cancer at age ≤ 60, two primary breast cancers, and Ashkenazi Jewish ancestry.
Question 11
A patient with cirrhosis and a liver lesion has an AFP level of 250 ng/mL. What is the MOST likely
diagnosis?
