NLE Oncology Nursing Reviewer 2026

Answer: B. Contact inhibition

Step 1 – Understand the question: We are looking for the term that describes normal cells stopping division upon contact with neighbors. Step 2 – Evaluate each option: Apoptosis is programmed cell death, not a contact-related stop signal. Contact inhibition is exactly the mechanism where normal cells stop proliferating when they physically touch adjacent cells – this is the correct answer. Angiogenesis refers to new blood vessel formation inside a tumor. Metastasis is the spread of cancer to distant sites. Step 3 – Key teaching point: Cancer cells lose contact inhibition, which is one reason they keep dividing uncontrollably and form a mass (neoplasm). Think of it like a traffic light – normal cells stop at the red light (contact), cancer cells run the red light.

Answer: C. Promotion

Step 1 – Recall the three stages of carcinogenesis: Initiation → Promotion → Progression. Step 2 – Define each stage: Initiation is when a carcinogen causes an irreversible DNA mutation – the first hit. Promotion is the stage where repeated exposure to promoting agents (tobacco, alcohol, hormones) causes the already-mutated cell to proliferate. This stage is REVERSIBLE, making it the most important stage for prevention. Progression is when the tumor grows, develops its own blood supply (angiogenesis), and gains the ability to invade and spread. Step 3 – Angiogenesis is a feature of the progression stage, not a separate carcinogenesis stage. Step 4 – NLE tip: Remember that promotion is the prevention window – if you remove the promoting agent (e.g., stop smoking), you may stop the cancer from developing further.

Answer: C. p53

Step 1 – Understand the two gene families involved in cancer: proto-oncogenes (accelerators) and tumor suppressor genes (brakes). Step 2 – p53 is the most important tumor suppressor gene. It acts as the 'guardian of the genome' – when DNA damage is detected, p53 either triggers repair or, if the damage is too great, initiates apoptosis (programmed death of that cell). Step 3 – A proto-oncogene is the normal version of an oncogene; when mutated, it becomes an oncogene that drives uncontrolled growth. An oncogene is the already-mutated, cancer-promoting version. Step 4 – HPV gene is a viral gene, not a human tumor suppressor. Step 5 – Key point: When p53 is lost or inactivated (as in many cancers), the brakes fail – damaged cells survive and proliferate instead of dying.

Answer: D. The tumor is capable of metastasizing to distant organs

Step 1 – The key distinguishing feature of malignancy is the ability to METASTASIZE (spread to distant sites). Step 2 – Analyze the wrong options: 'Encapsulated and well-defined' describes BENIGN tumors – they are usually contained in a capsule. 'Well differentiated' also describes benign tumors – their cells look close to normal tissue. 'Grows slowly and does not recur' describes benign tumors – malignant tumors grow rapidly and frequently recur. Step 3 – Malignant tumors are: NOT encapsulated (invasive), poorly differentiated or anaplastic, grow rapidly, and DO metastasize. Step 4 – NLE memory tool: Malignant = Metastasizes, invasive, Malevolent (dangerous). Benign = Bordered (capsule), Better differentiated, usually Benign in behavior.

Answer: C. N – Nagging cough or hoarseness

Step 1 – Recall the CAUTION mnemonic: C=Change in bowel/bladder habits, A=A sore that does not heal, U=Unusual bleeding or discharge, T=Thickening or lump, I=Indigestion or difficulty swallowing, O=Obvious change in a wart or mole, N=Nagging cough or hoarseness. Step 2 – The patient's symptom is a persistent (nagging) cough of 6 weeks, which matches 'N.' Step 3 – Wrong options explained: 'C' refers to changes in defecation or urination patterns. 'I' refers to stomach discomfort or trouble swallowing. 'U' refers to abnormal discharge or unexplained bleeding. Step 4 – Clinical relevance: In the Philippines, lung cancer is strongly linked to smoking and is a leading cancer in men. A persistent cough in a middle-aged male smoker is a red flag that warrants further workup including chest X-ray.

Answer: B. The tumor cells are poorly differentiated

Step 1 – Distinguish grading from staging: GRADING describes how abnormal the tumor cells look under the microscope (cellular differentiation). STAGING describes how far the cancer has spread in the body. Step 2 – The grading scale: Grade 1 = well differentiated (looks most like normal tissue, least aggressive). Grade 2 = moderately differentiated. Grade 3 = poorly differentiated (looks less like normal tissue, more aggressive). Grade 4 = undifferentiated/anaplastic (looks nothing like normal tissue, most aggressive). Step 3 – Wrong options: 'Spread to lymph nodes' and 'metastasized to three organs' are staging descriptions (N and M in TNM), not grading. 'Well differentiated, least aggressive' describes Grade 1, not Grade 3. Step 4 – Memory trick: Higher grade number = WORSE = more aggressive = less differentiated.

Answer: C. Distant metastasis is present

Step 1 – Recall the TNM system: T = Tumor (size and local extent), N = Nodes (regional lymph node involvement), M = Metastasis (distant spread). Step 2 – For the M component: M0 = no distant metastasis. M1 = distant metastasis IS present. This is the most advanced finding and typically corresponds to Stage IV disease. Step 3 – Wrong options explained: '1 cm in size' would be described in the T component (e.g., T1), not M. 'One lymph node involved' would be in the N component (e.g., N1). 'Confined to layer of origin' is described as Tis (carcinoma in situ), part of the T component. Step 4 – NLE tip: M1 = worst news = Stage IV = distant spread present. M0 = no spread yet = better prognosis.

Answer: C. Biopsy with histologic examination of tissue

Step 1 – Understand that many tests can suggest cancer, but only a biopsy provides a definitive (confirmed) diagnosis. A biopsy removes actual tissue for microscopic (histologic) examination by a pathologist. Step 2 – Why the other options are incorrect: CT scan and PET scan are imaging studies – they can show a mass or abnormal activity but cannot definitively confirm cancer without tissue examination. Tumor markers (PSA, CEA, CA-125, AFP) are useful for monitoring treatment response and recurrence, but they are NOT used to make a first (initial) cancer diagnosis because they lack specificity. Step 3 – Types of biopsy: Needle biopsy (uses a needle to extract cells or tissue), Incisional biopsy (removes a part of the lesion), Excisional biopsy (removes the entire lesion). Step 4 – Key NLE point: BIOPSY = DEFINITIVE DIAGNOSIS. Always.

Answer: C. Administering the HPV vaccine to a 13-year-old girl

Step 1 – Distinguish primary from secondary prevention: PRIMARY prevention = PREVENT the disease from occurring (remove/reduce the cause). SECONDARY prevention = DETECT disease early before it causes harm (screening). Step 2 – Evaluate the options: HPV vaccine prevents HPV infection, which prevents cervical cancer from ever developing – this is primary prevention because it targets the causative agent (HPV virus) before disease occurs. Breast self-examination, Pap smear, and mammography are all forms of SECONDARY prevention (screening) – they detect existing disease early, but do not prevent it from starting. Step 3 – Other primary prevention examples: smoking cessation counseling, hepatitis B vaccination, sun protection education, promoting healthy diet and exercise. Step 4 – Philippine context: The DOH promotes HPV vaccination as part of the national cancer control program under RA 11215 (NICCA).

Answer: B. Republic Act No. 11215

Step 1 – RA 11215, the National Integrated Cancer Control Act (NICCA), was signed in 2019. It established a comprehensive national cancer control program covering prevention, early detection, treatment, survivorship, and financial protection for cancer patients. It also created the Cancer Assistance Fund to help Filipinos afford cancer care. Step 2 – Why the other options are wrong: RA 9173 is the Philippine Nursing Act of 2002, which governs the nursing profession – not cancer control. RA 10354 is the Responsible Parenthood and Reproductive Health Act. RA 7305 is the Magna Carta of Public Health Workers. Step 3 – Nursing implication: As nurses practicing under RA 9173, we support the goals of RA 11215 by educating communities, promoting screening programs, and facilitating access to DOH cancer services. Step 4 – Philippine cancer priorities: Breast, lung, colorectal, liver, and cervical cancers are the leading cancers in the Philippines.

Answer: B. Methotrexate

Step 1 – Understand the concept: Cell-cycle-specific drugs act only during a particular phase of the cell cycle. Step 2 – Identify S-phase agents: Antimetabolites such as methotrexate and fluorouracil act during the S (synthesis/DNA replication) phase. Step 3 – Eliminate the wrong options: Cyclophosphamide is an alkylating agent and is cell-cycle-NONspecific (acts in any phase). Doxorubicin is an antitumor antibiotic and is also cell-cycle-nonspecific. Vincristine is a plant alkaloid that acts in the M (mitosis) phase – it IS cell-cycle-specific, but acts in the M phase, NOT the S phase. Step 4 – Conclusion: Methotrexate (antimetabolite, S phase) is the correct answer.

Answer: B. Nadir

Step 1 – Define the nadir: The nadir is the point of the lowest blood cell counts (neutrophils, platelets, RBCs) after a chemotherapy dose. Step 2 – Recall the timing: The nadir typically occurs 7 to 14 days after chemotherapy administration. Day 10 falls squarely within this window. Step 3 – Understand the risk: At the nadir, the patient has the least ability to fight infection (low neutrophils), is most prone to bleeding (low platelets), and may feel most fatigued (low RBCs). Step 4 – Eliminate wrong options: The recovery phase comes after the nadir (day 14–21). Proliferation and induction are not standard terms used to describe post-chemo blood count phases. Step 5 – Conclusion: Day 10 = nadir = highest vulnerability.