NLE Oncology Nursing — Cancer Pathophysiology, Prevention and DetectionExam Answer Templates

Marks

1

Topic

Pathophysiology — Carcinogenesis

Difficulty

easy

Template Id

T1

Examiner Tip

A one-sentence definition that includes the words 'multistep,' 'normal to malignant,' and 'mutation' will always earn this mark. You do not need to list the three stages for a 1-mark item — save that depth for 2- or 3-mark questions.

Model Answer

Carcinogenesis is the multistep process by which normal cells are transformed into malignant (cancer) cells through irreversible genetic mutations caused by carcinogens.

Question Type

very_short_answer

Answer Structure

• One sentence: name the process + describe it as multistep transformation of normal cells into malignant cells through genetic mutation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'cancer is caused by carcinogen' without mentioning the transformation of cells or mutation — too vague for a definition mark.
• Confusing carcinogenesis with metastasis.
• Leaving the answer blank because the student tried to memorize a longer definition and panicked.

Key Phrases To Include

• multistep process
• normal cells transformed into malignant cells
• genetic mutations
• carcinogens

Marks

1

Topic

Pathophysiology — Gene Regulation

Difficulty

easy

Template Id

T2

Examiner Tip

Use the analogy of a car: oncogene = accelerator stuck in 'on' position; tumor suppressor = brakes that fail. Examiners recognize this analogy from standard textbooks and reward it.

Model Answer

Proto-oncogenes normally promote healthy cell growth; when mutated into oncogenes, they drive uncontrolled proliferation. Tumor suppressor genes (e.g., p53) normally halt cell division and trigger apoptosis; when inactivated, cell division becomes unregulated.

Question Type

very_short_answer

Answer Structure

• Sentence 1: Define proto-oncogene/oncogene role — accelerator function [½ mark]
• Sentence 2: Define tumor suppressor gene role — brake function [½ mark]

Scoring Breakdown

Common Mark Deductions

• Mentioning only one gene type and ignoring the other — the question asks for the difference, so both must appear.
• Saying 'oncogene causes cancer' without explaining the mechanism (mutation of proto-oncogene).
• Omitting p53 or any example, which weakens the answer.

Key Phrases To Include

• proto-oncogene
• oncogene
• uncontrolled proliferation
• tumor suppressor gene
• p53
• apoptosis
• cell division

Marks

3

Topic

Pathophysiology — Carcinogenesis

Difficulty

medium

Template Id

T3

Examiner Tip

The word 'reversible' in promotion is a classic NLE discriminator. Students who include it demonstrate higher-order understanding and score the full mark. Always write it.

Model Answer

The three stages of carcinogenesis are: 1. Initiation — A carcinogen causes an irreversible mutation in the cell's DNA. The cell is permanently altered but not yet proliferating abnormally. 2. Promotion — Repeated exposure to promoting agents (e.g., tobacco, alcohol, hormones, chronic inflammation) stimulates the mutated cell to proliferate. This stage is reversible, making it the most important window for prevention. 3. Progression — The tumor grows rapidly, develops its own blood supply (angiogenesis), becomes increasingly malignant, invades surrounding tissue, and gains the ability to metastasize to distant organs.

Question Type

short_answer

Answer Structure

• Stage 1 — Initiation: irreversible DNA mutation by carcinogen [1 mark]
• Stage 2 — Promotion: reversible proliferation by promoting agents; prevention window [1 mark]
• Stage 3 — Progression: tumor growth, angiogenesis, invasion, metastasis [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing all three names but failing to describe each — the question says 'briefly describe each,' so a name alone earns no mark.
• Missing the key word 'reversible' for promotion — this is the distinguishing feature that earns the mark.
• Confusing progression with promotion (e.g., writing that progression is still reversible).

Key Phrases To Include

• initiation
• irreversible mutation
• carcinogen
• promotion
• reversible
• proliferation
• progression
• angiogenesis
• metastasis
• invasion

Marks

2

Topic

Warning Signs of Cancer

Difficulty

easy

Template Id

T4

Examiner Tip

Memorize CAUTION as a complete phrase, not just letters. In the exam, write the letter, a dash, and the full warning sign. This organized format shows mastery and is easy for the examiner to mark.

Model Answer

The seven warning signs of cancer (CAUTION): C — Change in bowel or bladder habits A — A sore that does not heal U — Unusual bleeding or discharge T — Thickening or a lump in the breast or elsewhere I — Indigestion or difficulty swallowing (dysphagia) O — Obvious change in a wart or mole N — Nagging cough or hoarseness

Question Type

short_answer

Answer Structure

• Mnemonic CAUTION written out with each letter correctly expanded — any 4–5 correct = 1 mark; all 7 correct = 2 marks [2 marks total]

Scoring Breakdown

Common Mark Deductions

• Writing the letters C-A-U-T-I-O-N without expanding what each letter stands for.
• Substituting incorrect expansions (e.g., writing 'Cancer' for C instead of 'Change in bowel or bladder habits').
• Missing 3 or more warning signs.

Key Phrases To Include

• CAUTION
• change in bowel or bladder habits
• sore that does not heal
• unusual bleeding or discharge
• thickening or lump
• indigestion or difficulty swallowing
• obvious change in a wart or mole
• nagging cough or hoarseness

Marks

2

Topic

Benign vs. Malignant Tumors

Difficulty

easy

Template Id

T5

Examiner Tip

A table is worth more than a paragraph for comparison questions. Even a simple hand-drawn 3-column table (Characteristic | Benign | Malignant) impresses examiners and keeps you from accidentally writing only one side.

Model Answer

| Characteristic | Benign | Malignant | |---|---|---| | Growth rate | Slow, controlled | Rapid, uncontrolled | | Cell differentiation | Well differentiated; resembles normal tissue | Poorly differentiated or anaplastic | | Capsule/Borders | Encapsulated; well-defined borders | Non-encapsulated; invasive, irregular borders | | Metastasis | Does NOT metastasize | DOES metastasize to distant organs | | Recurrence | Rare after removal | Common after removal | | Effect on host | Usually harmless (unless compressing vital structures) | Often life-threatening |

Question Type

short_answer

Answer Structure

• Table or parallel list format with a heading for each category (Benign vs. Malignant) [organizes answer clearly]
• At least 4 characteristics correctly stated for both benign and malignant — 2 characteristics = 1 mark; 4+ characteristics = 2 marks

Scoring Breakdown

Common Mark Deductions

• Writing only about benign OR only about malignant — comparison requires BOTH sides for each characteristic.
• Using only 2 characteristics when 4 are asked — reading the question carefully prevents this.
• Stating benign tumors 'are always harmless' — this is incorrect because benign tumors can compress vital structures.

Key Phrases To Include

• well differentiated
• encapsulated
• does not metastasize
• poorly differentiated
• anaplastic
• invasive
• metastasizes
• slow vs. rapid growth

Marks

3

Topic

Grading and Staging — TNM System

Difficulty

medium

Template Id

T6

Examiner Tip

Write T, N, and M as three clear, separate paragraphs or bullet points. The examiner is marking in real time and appreciates structure. Including 'Tis' for carcinoma in situ and 'M1' for distant metastasis shows command of clinical detail.

Model Answer

The TNM staging system is the international standard for describing the extent of cancer spread in the body. It has three components: T (Tumor) — describes the size and local extent of the primary tumor. T1–T4 indicates increasing size or local invasion. 'Tis' (carcinoma in situ) means the tumor is confined to the layer of origin and has not invaded deeper tissue. N (Nodes) — describes the degree of regional lymph node involvement. N0 means no lymph node spread; N1–N3 indicates increasing nodal involvement. M (Metastasis) — indicates whether distant metastasis is present. M0 means no distant spread; M1 means cancer has spread to distant organs. The T, N, and M values are combined to assign an overall Stage from Stage 0 (carcinoma in situ, most curable) to Stage IV (distant metastasis, most advanced and least curable). A lower stage number generally indicates earlier, more treatable disease.

Question Type

short_answer

Answer Structure

• Opening sentence: name and purpose of TNM system [sets context, not scored separately]
• T component: define with T1–T4 range and Tis [1 mark]
• N component: define with N0 and N1–N3 range [1 mark]
• M component: define with M0 and M1 [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'T, N, M' as letters without explaining what each means — the examiner cannot award a mark for unexplained abbreviations.
• Confusing 'staging' with 'grading' in the opening sentence — this signals conceptual confusion.
• Omitting Tis or M1, which are classic NLE discriminators.

Key Phrases To Include

• TNM
• T = Tumor size and extent
• N = regional lymph node involvement
• M = distant metastasis
• Tis = carcinoma in situ
• M0 = no metastasis
• M1 = distant spread
• Stage 0 to Stage IV

Marks

2

Topic

Grading and Staging

Difficulty

medium

Template Id

T7

Examiner Tip

Memory trick: Grading = G = 'Guts of the cell' (how it looks under microscope). Staging = S = 'Spread' (where it is in the body). Using this distinction in your answer language will prevent the reversal error.

Model Answer

Grading describes the cellular appearance of a tumor — how closely the cancer cells resemble normal cells (degree of differentiation). Grades range from Grade 1 (well differentiated, least aggressive) to Grade 4 (undifferentiated/anaplastic, most aggressive). A higher grade means a more aggressive tumor. Staging describes the anatomical extent of the disease — how far the cancer has spread in the body. The international standard is the TNM system (Tumor, Nodes, Metastasis), producing an overall Stage 0 (carcinoma in situ) through Stage IV (distant metastasis). A higher stage means more widespread disease.

Question Type

short_answer

Answer Structure

• Grading: define as cellular differentiation + Grade 1–4 scale [1 mark]
• Staging: define as extent of spread + TNM or Stage 0–IV reference [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the definitions (writing that staging = cellular appearance) — this is the most common error for this topic.
• Not mentioning the Grade 1–4 scale or Stage 0–IV scale — using numbers shows precision.
• Writing only one definition without comparing both.

Key Phrases To Include

• grading
• cellular differentiation
• Grade 1 to Grade 4
• anaplastic
• staging
• extent of spread
• TNM
• Stage 0 to Stage IV

Marks

2

Topic

Diagnosis — Biopsy and Tumor Markers

Difficulty

medium

Template Id

T8

Examiner Tip

The distinction that tumor markers monitor treatment and recurrence rather than make an initial diagnosis is a classic NLE trap. Include this note in your answer to demonstrate clinical precision.

Model Answer

The definitive diagnostic test for cancer is a biopsy — the surgical removal of tissue for histologic (microscopic) examination by a pathologist. Three tumor markers and their associated cancers: 1. PSA (Prostate-Specific Antigen) — used to monitor prostate cancer 2. CA-125 — used to monitor ovarian cancer 3. CEA (Carcinoembryonic Antigen) — used to monitor colorectal cancer Note: Tumor markers are primarily used to monitor treatment response and detect recurrence, NOT as the first-line diagnostic test.

Question Type

short_answer

Answer Structure

• Definitive test = biopsy (must use the word 'biopsy' and briefly describe it) [1 mark]
• Three tumor markers correctly paired with their associated cancer [1 mark — award for at least 2 correct pairs]

Scoring Breakdown

Common Mark Deductions

• Writing 'CT scan' or 'PET scan' as the definitive test — imaging supports diagnosis but biopsy confirms it.
• Listing tumor markers without stating what cancer each monitors.
• Stating tumor markers are used for initial diagnosis — they are primarily used to monitor treatment and recurrence.

Key Phrases To Include

• biopsy
• histologic examination
• PSA
• prostate cancer
• CA-125
• ovarian cancer
• CEA
• colorectal cancer
• AFP
• liver/testicular cancer
• monitor treatment response

Marks

2

Topic

Pathophysiology — Carcinogens

Difficulty

medium

Template Id

T9

Examiner Tip

Philippine-context examples strengthen your answer. Mentioning aflatoxin (from improperly stored rice or corn) is culturally relevant and shows applied knowledge. HPV causing cervical cancer is also high-yield given DOH's national HPV vaccination program.

Model Answer

Carcinogens are agents that cause cancer by inducing irreversible genetic mutations. Four types with examples: 1. Chemical carcinogens — tobacco smoke, benzene, asbestos, aflatoxin (from mold in grains) 2. Physical carcinogens — ultraviolet (UV) radiation (from sun exposure), ionizing radiation (from X-rays or nuclear material) 3. Biological/Infectious agents — Human Papillomavirus (HPV) causes cervical cancer; Hepatitis B and C viruses cause liver cancer; Helicobacter pylori causes gastric cancer 4. Hormonal carcinogens — prolonged estrogen exposure linked to breast and endometrial cancer

Question Type

short_answer

Answer Structure

• Opening definition of carcinogen (optional, adds clarity)
• Type 1 with correct example [½ mark]
• Type 2 with correct example [½ mark]
• Type 3 with correct example [½ mark]
• Type 4 with correct example [½ mark — total 2 marks for 4 types with examples]

Scoring Breakdown

Common Mark Deductions

• Listing only examples (e.g., 'tobacco, asbestos, HPV') without categorizing them into type — the question asks for types with examples.
• Naming a carcinogen category twice (e.g., listing both asbestos and benzene as two separate types when both are chemical carcinogens).
• Confusing H. pylori (a bacterium) as a virus — specificity matters.

Key Phrases To Include

• chemical carcinogens
• tobacco
• physical carcinogens
• UV radiation
• ionizing radiation
• biological/infectious agents
• HPV
• Hepatitis B
• Helicobacter pylori
• hormonal factors
• estrogen

Marks

3

Topic

Pathophysiology — Invasion and Metastasis

Difficulty

medium

Template Id

T10

Examiner Tip

The statement that 'a metastasis keeps the cell type of its origin' is a classic discriminator item in NLE. Include it even if not explicitly asked — it demonstrates depth of understanding and earns bonus recognition.

Model Answer

Metastasis is the spread of cancer cells from the primary tumor site to distant organs or tissues, forming secondary tumors. It is the defining feature that distinguishes malignant from benign tumors. Metastasis occurs through four routes: 1. Direct extension — cancer cells invade and grow into adjacent tissues. 2. Lymphatic spread — cancer cells enter lymph vessels and travel to regional lymph nodes; this is the most common route for carcinomas. 3. Hematogenous (bloodstream) spread — cancer cells enter blood vessels and are carried to distant organs. 4. Transcoelomic (seeding) spread — cancer cells shed into body cavities (e.g., peritoneal, pleural) and implant on organ surfaces. The four most common sites of metastasis are: 1. Lungs 2. Liver 3. Bone 4. Brain Important note: A metastatic tumor retains the cell type of the primary tumor. For example, breast cancer that spreads to the bone is still breast cancer, not bone cancer.

Question Type

short_answer

Answer Structure

• Definition of metastasis [½ mark — earns mark when combined with routes]
• At least two routes of spread correctly described [1 mark]
• Four common sites of metastasis: lungs, liver, bone, brain [1 mark]
• Note that metastatic tumor retains cell type of origin [½ mark — bonus/discriminator]

Scoring Breakdown

Common Mark Deductions

• Naming only one route of spread — the question expects the student to know multiple mechanisms.
• Not naming all four metastatic sites — writing only 'lungs and liver' loses ½ mark.
• Stating a metastatic tumor takes on the character of the new site (e.g., 'bone cancer' when breast spreads to bone) — this is clinically wrong.

Key Phrases To Include

• metastasis
• spread from primary tumor
• lymphatic system — most common route for carcinomas
• hematogenous
• direct extension
• transcoelomic/seeding
• lungs, liver, bone, brain
• retains cell type of origin

Marks

5

Topic

Prevention and Early Detection

Difficulty

hard

Template Id

T11

Examiner Tip

For 5-mark long answers, use headings (I. PRIMARY PREVENTION / II. SECONDARY PREVENTION). Examiners follow a marking key that often assigns 1 mark per major point, and clear headings ensure your points are easy to identify. Referencing RA 9173 and the DOH demonstrates Philippine nursing professional context — this is uniquely rewarded in NLE-style exams.

Model Answer

Cancer prevention is classified into two levels based on the stage at which the nurse intervenes. I. PRIMARY PREVENTION Definition: Primary prevention aims to prevent cancer from developing by reducing or eliminating exposure to risk factors (carcinogens) before the disease begins. It targets the initiation and promotion stages of carcinogenesis. Key strategies: - Avoidance of tobacco (smoking cessation counseling) — tobacco is the single most important modifiable risk factor, linked to lung, oral, esophageal, and bladder cancers. - Vaccination: HPV vaccine (prevents cervical and other HPV-related cancers) and Hepatitis B vaccine (prevents liver cancer). In the Philippines, the DOH provides free HPV vaccination for Grade 4 girls as part of its national immunization program. - Healthy lifestyle promotion: balanced diet rich in fiber, fruits, and vegetables; limited alcohol; maintenance of healthy weight; regular physical activity. - Sun protection: sunscreen use, protective clothing, and avoiding prolonged UV exposure to prevent skin cancer. - Occupational safety: limiting exposure to asbestos, benzene, and ionizing radiation. Two nursing interventions for primary prevention: 1. Conduct community health education sessions on smoking cessation, healthy diet, and HPV/Hepatitis B vaccination, emphasizing the link between modifiable behaviors and cancer risk. 2. Administer or facilitate administration of the HPV vaccine and Hepatitis B vaccine to eligible clients, following the Philippine DOH immunization schedule, and document vaccination status accurately. II. SECONDARY PREVENTION Definition: Secondary prevention involves early detection of cancer or precancerous conditions before symptoms appear, so that treatment can begin when the disease is most curable. It targets the progression stage. Key screening strategies: - Breast: Monthly breast self-examination (BSE), clinical breast examination, and mammography. - Cervical: Pap smear (Papanicolaou smear) to detect precancerous cervical changes; HPV co-testing. - Colorectal: Fecal occult blood test (FOBT) and colonoscopy. - Prostate: PSA testing and digital rectal examination. - Testicular: Monthly testicular self-examination in young men. - Skin: Self-inspection using the ABCDE rule (Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolving). Two nursing interventions for secondary prevention: 1. Teach and demonstrate breast self-examination (BSE) and testicular self-examination techniques to clients of appropriate age, explaining the correct monthly timing and what findings to report (e.g., a lump, discharge, or any CAUTION warning sign). 2. Refer female clients for regular Pap smear screening and mammography, explaining the purpose, procedure, and schedule; advocate for access to DOH-provided free cervical cancer screening available at rural health units (RHUs) and health centers. Nursing note: Cultural barriers common in Filipino clients — including fatalism ('bahala na'), privacy concerns, and fear of diagnosis — must be acknowledged and addressed through therapeutic communication and family involvement to promote adherence to screening programs. Under RA 9173 (Philippine Nursing Act of 2002), nurses are mandated to provide health education and community health services, which encompasses both levels of cancer prevention.

Question Type

long_answer

Answer Structure

• Part I — Primary Prevention: clear definition distinguishing it from secondary prevention [1 mark]
• Key strategies for primary prevention listed with at least 3 examples [1 mark]
• Two specific, actionable nursing interventions for primary prevention [1 mark]
• Part II — Secondary Prevention: clear definition with examples of screening tests by body system [1 mark]
• Two specific, actionable nursing interventions for secondary prevention; Philippine context (DOH, RHU, RA 9173) mentioned [1 mark]

Scoring Breakdown

Common Mark Deductions

• Failing to define either primary or secondary prevention — just listing interventions without context loses 2 marks.
• Giving interventions that are the same for both levels — each section must have distinct, level-appropriate interventions.
• Not mentioning any Philippine context in a 5-mark answer — the examiner expects local clinical relevance.
• Listing general nursing actions (e.g., 'provide emotional support') that are not specific to cancer prevention.
• Writing in paragraph form without clear Part I / Part II structure — makes the answer hard to score and risks missing elements.

Key Phrases To Include

• primary prevention
• reduce or eliminate carcinogen exposure
• HPV vaccine
• Hepatitis B vaccine
• smoking cessation
• secondary prevention
• early detection
• Pap smear
• mammography
• breast self-examination
• ABCDE rule
• fecal occult blood test
• DOH
• RA 9173
• RHU
• CAUTION warning signs

Marks

5

Topic

Nursing Management — Prevention and Early Detection

Difficulty

hard

Template Id

T12

Examiner Tip

Case-study items reward the student who follows the nursing process sequence visibly: Assessment → Diagnosis → Intervention → Evaluation. Label each section. For oncology case studies, always link your interventions to the level of prevention (primary or secondary) — this demonstrates clinical reasoning beyond memorization.

Model Answer

ASSESSMENT — CUES: Subjective cue: 'Mayroon akong bukol sa kanang suso at may dugo na lumalabas sa utong ko.' (Patient reports a painless lump in the right breast and bloodstained nipple discharge for 3 weeks.) Objective cue: Palpable, painless mass in the right breast on clinical examination; presence of bloodstained nipple discharge noted; no Pap smear done in the last 5 years. PRIORITY NURSING DIAGNOSIS (NANDA): Anxiety related to perceived threat of cancer diagnosis and diagnostic workup as evidenced by patient's report of fear and concern over her breast lump and discharge (fear/anxiety is prioritized using Maslow's hierarchy — Love and Belonging and Safety needs are threatened; physiologic safety is also at risk). Alternative physiologic priority: Deficient Knowledge regarding breast cancer warning signs, screening, and the need for prompt diagnostic evaluation, as evidenced by delayed help-seeking (3-week history) and lapsed cervical cancer screening. PRIORITY NURSING INTERVENTIONS: 1. Facilitate immediate referral for diagnostic workup: Explain to the patient the importance of prompt evaluation. Coordinate referral to a physician for clinical breast examination, breast ultrasound or mammography, and biopsy if indicated. Reinforce that a definitive cancer diagnosis requires biopsy — histologic examination is the gold standard. This addresses the patient's physiologic safety need (Maslow's Level 2). 2. Provide targeted health education and emotional support: Explain the CAUTION warning signs and why this patient's symptoms (lump + unusual discharge) require immediate evaluation. Perform or teach correct technique for monthly breast self-examination (BSE). Address any cultural barriers (e.g., fatalism, reluctance to seek care, family decision-making) using therapeutic communication. Refer the patient for overdue Pap smear screening (available at RHU at no cost under DOH programs), consistent with secondary prevention. Document all teaching per RA 9173 standards for nursing documentation. EVALUATION CRITERIA: Patient verbalizes understanding of warning signs and agrees to follow through with referral and diagnostic workup. Patient demonstrates correct BSE technique. Referral for Pap smear is completed.

Question Type

case_study

Answer Structure

• One subjective cue correctly identified from the scenario [½ mark]
• One objective cue correctly identified from the scenario [½ mark]
• Priority nursing diagnosis stated in correct NANDA format (Problem + Etiology + Signs/Symptoms) [1 mark]
• First nursing intervention: referral for diagnostic workup including mention of biopsy as definitive test [1 mark]
• Second nursing intervention: health education including BSE, CAUTION, Pap smear referral, and/or cultural considerations [1 mark]
• Philippine healthcare context (RHU, DOH, RA 9173, or free screening) mentioned [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the nursing diagnosis without the NANDA PES format (Problem + Etiology + Evidence) — partial credit at best.
• Listing only assessment data without proceeding to diagnosis and interventions — the question specifically asks for both.
• Providing generic interventions ('monitor vital signs,' 'provide comfort') that are not specific to the oncology/screening context.
• Failing to mention biopsy as the definitive test when the question scenario involves a suspected cancer — this is a major knowledge gap.
• Not referencing any Philippine healthcare delivery element in a case set in an RHU.

Key Phrases To Include

• NANDA nursing diagnosis
• Anxiety related to
• Deficient Knowledge
• subjective cue
• objective cue
• biopsy — definitive diagnostic test
• referral for diagnostic workup
• breast self-examination (BSE)
• CAUTION warning signs
• Pap smear
• RHU
• DOH
• RA 9173
• secondary prevention
• cultural barriers
• Maslow's hierarchy

Marks

2

Topic

Cancer Epidemiology in the Philippines

Difficulty

easy

Template Id

T13

Examiner Tip

Memorize 'RA 11215 = NICCA = 2019' as a fixed triple. In the Philippine nursing board exam, legislation questions reward exact recall of the law number and its common name. Do not confuse this with RA 9173 (Nursing Act of 2002).

Model Answer

The leading cancers in the Philippines (in order of frequency/mortality) are: 1. Breast cancer — the most common cancer among Filipino women and overall 2. Lung cancer — strongly linked to high smoking rates; leading cause of cancer death in men 3. Colorectal cancer 4. Liver cancer — associated with Hepatitis B virus infection, which is endemic in the Philippines 5. Cervical cancer — associated with Human Papillomavirus (HPV) 6. Prostate cancer The governing Philippine law for the national cancer control program is: Republic Act No. 11215, also known as the National Integrated Cancer Control Act (NICCA), signed into law in 2019. It established a comprehensive national cancer control program covering prevention, early detection, treatment, survivorship, and financial protection for cancer patients, and created the Cancer Assistance Fund.

Question Type

short_answer

Answer Structure

• At least 4 leading cancers in the Philippines correctly listed [1 mark]
• RA 11215 / NICCA named with year and brief description of its purpose [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing fewer than 4 cancers — the question implies a comprehensive list.
• Citing RA 9173 (Philippine Nursing Act) as the cancer law — RA 9173 governs nursing practice, not cancer control.
• Omitting the year (2019) or the full name of the law — NLE items often test the exact law name and number.

Key Phrases To Include

• breast cancer — most common among Filipino women
• lung cancer
• colorectal cancer
• liver cancer
• cervical cancer
• prostate cancer
• Republic Act 11215
• National Integrated Cancer Control Act (NICCA)
• 2019
• Cancer Assistance Fund
• DOH

Marks

1

Topic

Secondary Prevention — Skin Cancer Screening

Difficulty

easy

Template Id

T14

Examiner Tip

The E in ABCDE (Evolving) is the newest and most clinically significant addition — examiners frequently test whether students know all five. A changing mole is the most important warning sign of melanoma.

Model Answer

The ABCDE rule is a self-inspection guide for detecting potentially malignant skin lesions (moles): A — Asymmetry (one half does not match the other) B — Border irregularity (edges are ragged, notched, or blurred) C — Color variation (uneven color; multiple shades of tan, brown, or black) D — Diameter greater than 6 mm (about the size of a pencil eraser) E — Evolving (any change in size, shape, color, or new symptoms such as bleeding)

Question Type

very_short_answer

Answer Structure

• ABCDE expanded correctly with all 5 components described [1 mark — award if at least 4 of 5 are correct]

Scoring Breakdown

Common Mark Deductions

• Writing only the letters (A, B, C, D, E) without expanding what each stands for.
• Stating 'D = Depth' instead of 'D = Diameter >6 mm' — this is a common error.
• Missing the 'E = Evolving' component, which is the most recently added and clinically important criterion.

Key Phrases To Include

• Asymmetry
• Border irregularity
• Color variation
• Diameter greater than 6 mm
• Evolving
• mole
• skin cancer

Marks

1

Topic

Pathophysiology — Normal Cell Regulation

Difficulty

medium

Template Id

T15

Examiner Tip

Even in a 1-mark question, write a mini-chain of reasoning: apoptosis fails → abnormal cells survive → they proliferate → cancer grows. This chain demonstrates pathophysiologic understanding rather than rote recall.

Model Answer

Apoptosis is programmed cell death — the normal mechanism by which old, damaged, or abnormal cells are eliminated. In cancer, mutations (particularly in tumor suppressor genes such as p53) disable the apoptosis pathway, so abnormal cells that should die instead survive and continue to proliferate, accumulating genetic mutations and contributing to tumor growth.

Question Type

very_short_answer

Answer Structure

• Define apoptosis as programmed cell death [sets context]
• Explain that cancer cells escape apoptosis due to gene mutation (p53), allowing abnormal cells to survive and proliferate [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining apoptosis correctly but not connecting its failure to cancer development — the answer must link the two.
• Omitting any mention of the genetic mechanism (p53 or tumor suppressor genes) — vague answers score partial credit at best.

Key Phrases To Include

• apoptosis
• programmed cell death
• tumor suppressor gene
• p53
• abnormal cells survive
• proliferate
• mutation