Oncology Data Specialist (ODS) / Certified Tumor Registrar (CTR) Exam — Questions and Answers

Question 1: What is the PRIMARY purpose of continuing education requirements in Follow-Up & Survival Analysis for CTR professionals?

Fulfilling mandatory regulatory requirements only
Networking with other professionals in the field
Earning additional credentials for career advancement
Maintaining current knowledge and competency as the field evolves (Correct answer)

Correct answer: Maintaining current knowledge and competency as the field evolves

Continuing education in Follow-Up & Survival Analysis ensures professionals maintain current knowledge and skills as standards, technologies, and best practices evolve in the Certified Tumor Registrar field.

Question 2: Which standard within CoC accreditation specifically addresses the requirement for cancer registry staff to participate in continuing education?

Standard 1.1
Standard 5.3
Standard 3.1 (Correct answer)
Standard 6.1

Correct answer: Standard 3.1

Standard 3.1 addresses cancer registry qualifications and continuing education requirements for registry personnel.

Question 3: A patient with CML (chronic myelogenous leukemia) is diagnosed via bone marrow biopsy. Which topography code is correct?

C77.9 (lymph nodes)
C42.1 (bone marrow) (Correct answer)
C80.9 (unknown primary)
C42.0 (blood)

Correct answer: C42.1 (bone marrow)

CML originates in the bone marrow, so C42.1 is the correct primary topography code for this disease.

Question 4: In ICD-O-3, what does a behavior code of '/3' indicate?

Malignant, metastatic or secondary site
Benign neoplasm
Malignant, primary site (Correct answer)
Uncertain malignant potential

Correct answer: Malignant, primary site

Behavior code '/3' in ICD-O-3 designates a malignant primary site tumor, distinguishing it from benign ('/0'), borderline ('/1'), and metastatic ('/6') designations.

Question 5: When a cancer registry transitions to a new software system, which action should be performed FIRST before go-live?

Parallel testing by running both old and new systems simultaneously with the same cases (Correct answer)
Notifying the state registry of the planned system change
Training all staff on the new system before any data entry begins
Migrating all historical data to the new system and archiving the old one

Correct answer: Parallel testing by running both old and new systems simultaneously with the same cases

Parallel testing validates that the new system produces results consistent with the old system before fully committing to the transition.

Question 6: What is the recommended minimum follow-up rate for analytic cases in a CoC-accredited cancer program?

75%
95%
80%
90% (Correct answer)

Correct answer: 90%

The Commission on Cancer requires accredited programs to achieve at least a 90% follow-up rate for all living analytic cases.

Question 7: What is the primary purpose of the North American Association of Central Cancer Registries (NAACCR)?

To publish clinical treatment guidelines
To set data standards and certify central cancer registries in North America (Correct answer)
To fund individual hospital registry programs
To operate the national cancer screening programs

Correct answer: To set data standards and certify central cancer registries in North America

NAACCR develops and promotes uniform data standards, certifies central registries for data quality, and facilitates data sharing across U.S. and Canadian registries.

Question 8: The 'grade' data field in a cancer registry record reflects:

The extent of metastatic spread at diagnosis
The patient's performance status at time of treatment
The size of the primary tumor in centimeters
The degree of cellular differentiation or histologic aggressiveness of the tumor (Correct answer)

Correct answer: The degree of cellular differentiation or histologic aggressiveness of the tumor

Grade describes how differentiated (well, moderate, poorly, undifferentiated) the tumor cells are, reflecting biological aggressiveness.

Question 9: Under CoC standards, what is the maximum allowable time between diagnosis and completion of the cancer registry abstract?

18 months
30 days
12 months
6 months (Correct answer)

Correct answer: 6 months

CoC requires that abstracts be completed within 6 months of the patient's first contact with the facility for that diagnosis.

Question 10: A registry wants to assess whether survival has improved over three decades. Which analytical approach would be most appropriate?

Reviewing treatment records only
Comparing crude mortality rates
Calculating incidence-to-mortality ratios
Trend analysis of age-adjusted 5-year relative survival rates by diagnosis year cohort (Correct answer)

Correct answer: Trend analysis of age-adjusted 5-year relative survival rates by diagnosis year cohort

Trend analysis of age-adjusted relative survival rates across diagnosis year cohorts controls for age shifts and allows fair comparison of survival over time.

Question 11: What is the primary goal of casefinding in a cancer registry?

To audit cancer data accuracy
To identify reportable cancer cases (Correct answer)
To track cancer treatment responses
To analyze cancer trends over time

Correct answer: To identify reportable cancer cases

Casefinding is the systematic process employed by cancer registries to identify all eligible cases of cancer within a defined population or institution. Its primary goal is to ensure comprehensive and accurate data collection by finding every new cancer diagnosis that meets the registry's reporting criteria. This ensures a complete record of all reportable cases for statistical analysis and public health monitoring.

Question 12: The five-year relative survival rate compares observed survival of cancer patients to the survival of which comparison group?

A matched general population of the same age, sex, and race (Correct answer)
Patients with the same cancer who received no treatment
All cancer patients in the registry regardless of type
Hospital inpatients with chronic disease

Correct answer: A matched general population of the same age, sex, and race

Relative survival divides observed survival in cancer patients by expected survival in a demographically matched general population to isolate the cancer's impact.

Question 13: Why is data quality assurance essential in a cancer registry?

To ensure accurate and complete data (Correct answer)
To increase revenue
To streamline staff training
To satisfy patient requests

Correct answer: To ensure accurate and complete data

Data quality assurance is fundamental in a cancer registry because the reliability of the data directly impacts its utility for research, public health, and quality improvement. Ensuring accuracy and completeness means that analyses drawn from the registry are trustworthy and can effectively inform clinical decisions and policy-making. Poor data quality can lead to misleading conclusions and ineffective interventions.

Question 14: Under AJCC 8th edition, which biomarker is NOT part of the breast cancer prognostic stage grouping?

HER2 status
ER (estrogen receptor) status
Ki-67 proliferation index (Correct answer)
PR (progesterone receptor) status

Correct answer: Ki-67 proliferation index

Ki-67 is not included in AJCC 8th edition breast cancer prognostic staging; ER, PR, HER2, and Oncotype DX score are used.

Question 15: Which data quality measure specifically evaluates whether registry follow-up rates meet NPCR/SEER completeness benchmarks?

Stage distribution completeness
Percentage of microscopically confirmed cases
Mortality-to-incidence ratio
Percentage of cases with follow-up within the past 15 months (Correct answer)

Correct answer: Percentage of cases with follow-up within the past 15 months

Registries are evaluated on the percentage of living cases with documented contact within the past 15 months to ensure follow-up completeness.

Question 16: Under CoC standards, which committee is primarily responsible for reviewing cancer registry data quality and ensuring compliance with accreditation standards?

Tumor Board
Quality Assurance Committee
Credentials Committee
Cancer Committee (Correct answer)

Correct answer: Cancer Committee

The Cancer Committee is the governing body responsible for overseeing the cancer program, including registry data quality and accreditation compliance.

Question 17: What is the primary advantage of the National Cancer Database (NCDB) compared to SEER?

NCDB provides longer follow-up periods for survival analysis
NCDB covers a larger share of U.S. cancer cases from CoC-accredited hospitals (Correct answer)
NCDB is population-based and includes all patients in a geographic area
NCDB includes cases from non-hospital settings such as physician offices

Correct answer: NCDB covers a larger share of U.S. cancer cases from CoC-accredited hospitals

NCDB captures roughly 70% of newly diagnosed U.S. cancers from over 1,500 CoC-accredited facilities, giving it broader case volume than SEER's geographic samples.

Question 18: When should a tumor registrar use the 'autopsy only' class of case?

When the diagnosis is made from a biopsy performed after death
When the cancer is first diagnosed at autopsy and was not suspected ante-mortem (Correct answer)
When only a death certificate is available for the case
When the patient died before treatment could begin

Correct answer: When the cancer is first diagnosed at autopsy and was not suspected ante-mortem

Autopsy only (class of case 38) applies when a malignancy is discovered for the first time during autopsy and was not suspected during the patient's lifetime.

Question 19: Which cancer is currently the leading cause of cancer death among both men and women in the United States?

Breast cancer
Colorectal cancer
Prostate cancer
Lung and bronchus cancer (Correct answer)

Correct answer: Lung and bronchus cancer

Lung and bronchus cancer remains the leading cause of cancer mortality in both U.S. men and women, accounting for more deaths than the next several cancers combined.

Question 20: Under the HIPAA Privacy Rule, which of the following is a required element of a valid authorization for release of cancer registry information?

An expiration date or expiration event (Correct answer)
The name of the requesting facility's chief medical officer
A description of all other facilities that hold the patient's records
The patient's insurance policy number

Correct answer: An expiration date or expiration event

A valid HIPAA authorization must include an expiration date or event that relates to the individual or the purpose of the use or disclosure.

Question 21: What is the standard follow-up rate required by the Commission on Cancer (CoC)?

90% within the past five years (Correct answer)
100% for patients in treatment
70% for all time periods
80% for lifetime cases

Correct answer: 90% within the past five years

The Commission on Cancer (CoC) sets specific standards for accredited cancer programs to ensure comprehensive patient follow-up. A 90% follow-up rate within the past five years is required to accurately monitor patient outcomes, survival, and recurrence for recent cases. This standard ensures that current data is robust for research and quality improvement initiatives.

Question 22: What is the recommended frequency for reviewing pathology reports as part of a hospital cancer registry casefinding protocol?

Monthly
Daily (Correct answer)
Quarterly
Weekly

Correct answer: Daily

Daily review of pathology reports is the standard recommended practice to ensure timely case identification and minimize backlog.

Question 23: The STORE manual (Standards for Oncology Registry Entry) is published by which organization?

American College of Surgeons Commission on Cancer (Correct answer)
SEER Program / NCI
CDC National Program of Cancer Registries
NAACCR

Correct answer: American College of Surgeons Commission on Cancer

STORE is published by the American College of Surgeons CoC and provides coding and data standards specifically for CoC-accredited hospital registry programs.

Question 24: Under AJCC 8th edition, which prefix is applied to the T, N, or M category to indicate staging performed after neoadjuvant therapy?

yp or yc (Correct answer)
p (pathologic)
r (recurrence)
c (clinical)

Correct answer: yp or yc

The 'y' prefix (yc or yp) is applied to TNM categories when staging is performed after neoadjuvant (preoperative) systemic or radiation therapy.

Question 25: Under AJCC staging, what does the 'c' prefix before TNM elements (e.g., cT2) indicate?

Completed staging after all workup
Corroborated by a second physician
Confirmed by cytology only
Clinical classification based on pre-treatment evaluation (Correct answer)

Correct answer: Clinical classification based on pre-treatment evaluation

The 'c' prefix designates clinical stage determined from physical exam, imaging, and other non-surgical findings before treatment.

Question 26: Which coding system is used to classify the primary site of cancer in the tumor registry abstract?

ICD-O-3 topography codes (Correct answer)
SNOMED-CT codes
CPT procedure codes
ICD-10-CM

Correct answer: ICD-O-3 topography codes

ICD-O-3 topography codes (C00-C80) are used to specify the anatomic site of origin of the primary tumor.

Question 27: What is the PRIMARY purpose of continuing education requirements in Cancer Registry Data Collection for CTR professionals?

Maintaining current knowledge and competency as the field evolves (Correct answer)
Fulfilling mandatory regulatory requirements only
Networking with other professionals in the field
Earning additional credentials for career advancement

Correct answer: Maintaining current knowledge and competency as the field evolves

Continuing education in Cancer Registry Data Collection ensures professionals maintain current knowledge and skills as standards, technologies, and best practices evolve in the Certified Tumor Registrar field.

Question 28: Which of the following is the correct behavior when a cancer registry abstract is missing the date of diagnosis because no documentation provides a specific date?

Estimate based on symptom onset noted in the history
Leave the field blank permanently
Use the date of first treatment as a proxy per coding guidelines (Correct answer)
Default to January 1 of the diagnosis year

Correct answer: Use the date of first treatment as a proxy per coding guidelines

When an exact diagnosis date is unavailable, registrars follow STORE/FORDS rules allowing the date of first treatment to be used as a proxy.

Question 29: When the medical record documents that chemotherapy was recommended but the patient never started treatment, the RX Summ–Chemo field should be coded as:

0 – None; chemotherapy was not administered (Correct answer)
8 – Recommended, unknown if administered
9 – Unknown
1 – Chemotherapy administered

Correct answer: 0 – None; chemotherapy was not administered

If documentation confirms chemotherapy was recommended but never started, code 0 (none administered) is correct since no treatment actually occurred.

Question 30: A registrar encounters a pathology report for 'squamous cell carcinoma in situ of the skin.' Which ICD-O-3 morphology code is most appropriate?

8070/3
8010/2
8070/2 (Correct answer)
8071/3

Correct answer: 8070/2

Squamous cell carcinoma in situ is coded 8070/2, where /2 indicates the in situ behavior.

Question 31: The NAACCR standard version used for data submission is important because it determines:

The reimbursement rates applicable to cancer cases
The staging system required for that submission cycle
The specific field positions and valid values accepted by the receiving registry (Correct answer)
Which ICD codes are valid for that submission year

Correct answer: The specific field positions and valid values accepted by the receiving registry

Each NAACCR version defines exact record layouts, field positions, and valid code sets that submitting registries must follow.

Question 32: The multi-step process by which normal cells accumulate genetic alterations and transform into malignant cells is called:

Angiogenesis
Metaplasia
Apoptosis
Carcinogenesis (Correct answer)

Correct answer: Carcinogenesis

Carcinogenesis is the process through which normal cells undergo sequential genetic mutations — often involving oncogene activation and tumor suppressor inactivation — ultimately resulting in malignant transformation.

Question 33: Cancer incidence rate is calculated per how many persons in standard epidemiologic reporting?

1,000 persons
100,000 persons (Correct answer)
1,000,000 persons
10,000 persons

Correct answer: 100,000 persons

Cancer incidence and mortality rates are conventionally expressed per 100,000 persons in the population to allow meaningful comparison across groups.

Question 34: What action is required when a cancer registrar discovers that a previously submitted case was incorrectly classified as reportable?

Change the histology code to a non-reportable code without flagging
Archive the case without notifying the state
Delete the case from the registry and submit a correction to the state (Correct answer)
Leave the case in the registry as submitted

Correct answer: Delete the case from the registry and submit a correction to the state

Incorrectly reported cases must be deleted from the registry and a correction or deletion notice submitted to the state central registry to maintain data integrity.

Question 35: What is the purpose of casefinding audits in a cancer registry program?

To generate survival statistics
To update treatment information for analytic cases
To remove duplicate cases from the database
To verify completeness and identify missed reportable cases (Correct answer)

Correct answer: To verify completeness and identify missed reportable cases

Casefinding audits assess whether all reportable cases are being captured and identify gaps in the casefinding process.

Question 36: In a Cox proportional hazards model applied to registry survival data, what does a hazard ratio of 2.0 for stage IV versus stage I indicate?

Stage IV patients survive twice as long as stage I patients
Stage IV patients are twice as likely to be diagnosed
Stage IV patients have twice the instantaneous risk of death compared to stage I patients (Correct answer)
Stage IV patients receive twice as many treatments

Correct answer: Stage IV patients have twice the instantaneous risk of death compared to stage I patients

A hazard ratio of 2.0 means stage IV patients experience the event (death) at twice the rate of stage I patients at any given time point.

Question 37: When the primary site of a tumor cannot be determined after thorough workup, which ICD-O-3 topography code is assigned?

C80.9 (Correct answer)
C26.9
C77.9
C76.0

Correct answer: C80.9

C80.9 is assigned for unknown primary site when no primary site can be identified despite workup.

Question 38: Which of the following best describes 'passive follow-up' as used in cancer registry practice?

Sending letters to patients requesting self-reported health updates
Reviewing inpatient records annually for return visits
Contacting patients directly by phone to determine vital status
Using linkage to death certificates or other administrative databases to update vital status (Correct answer)

Correct answer: Using linkage to death certificates or other administrative databases to update vital status

Passive follow-up uses database linkages—such as state death files or NDI—to update patient vital status without direct contact.

Question 39: A physician documents 'probable lymphoma' in a patient's chart but no biopsy is performed. Under standard reporting rules, this case is:

Not reportable because histology is absent
Reportable only after 3 months of watchful waiting
Reportable based on the physician's clinical impression (Correct answer)
Reportable only if chemotherapy is initiated

Correct answer: Reportable based on the physician's clinical impression

A physician's clinical statement of 'probable' malignancy is sufficient for reportability under SEER and most state registry rules.

Question 40: Which field in the cancer abstract specifically documents whether the patient was part of a cancer-directed clinical trial?

Comorbidity index
Tumor marker field
Treatment modality code
Protocol participation / research flag (Correct answer)

Correct answer: Protocol participation / research flag

The protocol participation or research field records whether the patient was enrolled in a cancer-related clinical trial during first-course treatment.

Question 41: Which data item should the tumor registrar record as the starting point for calculating survival time?

Date of diagnosis (Correct answer)
Date of hospital admission
Date of first pathology report
Date of first treatment

Correct answer: Date of diagnosis

Per SEER and NAACCR standards, survival time is calculated from the date of diagnosis (incidence date) to the event or censoring date.

Question 42: A patient has two simultaneous primary cancers—one in each breast. How many abstracts should be created?

One abstract combining both tumors
Two abstracts, one for each primary tumor (Correct answer)
The number depends on whether treatment is the same for both
One abstract for the dominant tumor only

Correct answer: Two abstracts, one for each primary tumor

Each reportable primary tumor requires a separate abstract regardless of simultaneous occurrence.

Question 43: Under HIPAA, which of the following is considered a 'covered entity' with obligations to protect cancer registry data?

A public health researcher receiving de-identified data
A state cancer registry funded solely by federal grants
A tumor registry vendor providing only software
A healthcare provider that transmits health information electronically (Correct answer)

Correct answer: A healthcare provider that transmits health information electronically

Covered entities under HIPAA include health plans, healthcare clearinghouses, and healthcare providers that transmit protected health information electronically.

Question 44: When should a tumor registrar assign a 'Stage Unknown' rather than 'Unstaged' in SEER summary staging?

When the patient was diagnosed at autopsy
When the patient refused all workup
When enough information exists to stage but details are missing (Correct answer)
When staging was performed but results are conflicting

Correct answer: When enough information exists to stage but details are missing

'Stage Unknown' is used when sufficient information to assign a SEER stage exists in principle but the specific data needed are not documented in the record.

Question 45: What is the purpose of a 'suspense file' in cancer registry operations?

To archive cases older than five years
To flag cases requiring physician review for staging
To store cases that have been deleted from the database
To hold cases with incomplete information pending follow-up (Correct answer)

Correct answer: To hold cases with incomplete information pending follow-up

A suspense file (or pending file) temporarily holds cases lacking sufficient information to complete the abstract until the missing data is obtained.

Question 46: A hospital treats an out-of-state patient for a newly diagnosed colon cancer. For CoC accreditation purposes, how should this case be counted?

It is an analytic case and must be included in the registry (Correct answer)
It is not reportable because the patient does not reside in the state
It is a non-analytic case only if the patient had prior treatment elsewhere
It is counted only for the state where the patient resides

Correct answer: It is an analytic case and must be included in the registry

A patient who receives their first course of treatment at a CoC-accredited facility is an analytic case regardless of state of residence.

Question 47: A cancer registrar is coding a case where the patient received neoadjuvant chemotherapy before surgical resection. Which staging system captures extent of disease AFTER neoadjuvant treatment?

Pathologic TNM (pTNM)
Post-therapy TNM (ypTNM) (Correct answer)
Recurrence TNM (rTNM)
Clinical TNM (cTNM)

Correct answer: Post-therapy TNM (ypTNM)

The ypTNM prefix designates pathologic staging performed on a surgical specimen after neoadjuvant (pre-surgical) systemic or radiation therapy.

Question 48: A registrar is calculating the follow-up rate for a CoC annual report. Which cases are EXCLUDED from the follow-up rate denominator?

Cases with a date of last contact within the past 15 months
Non-analytic cases (class of case 00) (Correct answer)
Cases lost to follow-up for more than five years
Cases diagnosed and first treated at the facility (class of case 10–14)

Correct answer: Non-analytic cases (class of case 00)

Non-analytic cases (class of case 00) are excluded from follow-up rate calculations because they were not initially diagnosed or treated at the reporting facility.

Question 49: A patient with colorectal cancer receives bevacizumab along with FOLFOX. How should bevacizumab be classified?

Chemotherapy
Targeted therapy (Correct answer)
Immunotherapy
Hormone therapy

Correct answer: Targeted therapy

Bevacizumab is a monoclonal antibody targeting VEGF, classifying it as targeted therapy rather than conventional chemotherapy.

Question 50: A researcher requests identified cancer data from a state registry but does not have IRB approval. The registry should:

Provide de-identified data instead to meet the researcher's needs
Deny the request until proper IRB approval or waiver documentation is provided (Correct answer)
Supply the data under a verbal confidentiality agreement
Report the researcher to the NCDB for attempting to bypass review

Correct answer: Deny the request until proper IRB approval or waiver documentation is provided

Research using identifiable cancer registry data generally requires IRB approval or a formal waiver; the registry should not provide the data without it.

Question 51: Which of the following best describes the 'laterality' field in a cancer abstract?

Whether the tumor is central or peripheral within the organ
The patient's dominant hand relative to the tumor
Which side of a paired organ contains the primary tumor (Correct answer)
Whether the tumor spread to the contralateral side

Correct answer: Which side of a paired organ contains the primary tumor

Laterality identifies which side (right, left, bilateral, or midline) of a paired organ the primary tumor arises from.

Question 52: In the AJCC 8th edition, which site introduced anatomically based prognostic stage groups that incorporate non-anatomic factors such as grade and biomarkers?

Prostate cancer
Breast cancer (Correct answer)
Colorectal cancer
Thyroid cancer

Correct answer: Breast cancer

The AJCC 8th edition breast cancer chapter introduced Prognostic Stage Groups that incorporate ER, PR, HER2, and grade alongside TNM anatomy.

Question 53: A tumor registrar discovers that a coworker has been accessing patient records for cases outside their assigned abstracting workload. This MOST likely violates which policy?

Business associate agreement terms
Mandatory reporting requirements
Data retention schedules
Minimum necessary use provisions (Correct answer)

Correct answer: Minimum necessary use provisions

Accessing more patient information than is necessary for one's duties violates the HIPAA minimum necessary standard.

Question 54: The 'Class of Case' field in a cancer registry distinguishes between:

Invasive and in-situ cancers
Analytic and non-analytic cases (Correct answer)
Benign and malignant histologies
Primary and metastatic tumors

Correct answer: Analytic and non-analytic cases

Class of Case separates analytic cases (diagnosed and/or treated at the facility) from non-analytic cases (treated elsewhere, diagnosis only confirmed here).

Question 55: In a reabstraction study comparing original abstractions to a gold standard, which statistic is calculated to measure inter-rater reliability for categorical data fields?

Standard deviation
Pearson correlation coefficient
P-value
Cohen's Kappa statistic (Correct answer)

Correct answer: Cohen's Kappa statistic

Cohen's Kappa measures agreement between raters beyond chance for categorical variables, making it the standard inter-rater reliability statistic for registry audits.

Question 56: A physician documents 'metastatic adenocarcinoma, consistent with colonic primary' in the record. How should the registrar code the primary site?

Code primary site as unknown (C80.9)
Defer until pathology confirms with immunohistochemistry
Code primary site as colon based on physician statement (Correct answer)
Code primary site as the metastatic site

Correct answer: Code primary site as colon based on physician statement

Registrars follow physician statements of primary site even when expressed as 'consistent with,' per FORDS/STORE coding rules.

Question 57: Which NAACCR data item captures the extent of disease at the time of initial diagnosis and is required for central registry submissions?

TNM Pathologic Stage Group
SEER Combined Summary Stage
Collaborative Stage
Summary Stage (Correct answer)

Correct answer: Summary Stage

NAACCR Summary Stage (derived from SEER Summary Staging) is a required data item for central registry submissions representing extent of disease at diagnosis.

Question 58: Which histologic type of lung cancer is most commonly diagnosed in non-smokers and women?

Small cell carcinoma
Adenocarcinoma (Correct answer)
Large cell undifferentiated carcinoma
Squamous cell carcinoma

Correct answer: Adenocarcinoma

Adenocarcinoma is the most frequent lung cancer subtype in non-smokers and women, often arising peripherally in the lung and associated with EGFR mutations.

Question 59: In cancer registry epidemiology, 'denominator data' refers to:

Population counts used to calculate incidence and mortality rates (Correct answer)
The total number of cancer cases in the numerator
The number of registry-certified hospitals in a region
Pathology-confirmed cases only

Correct answer: Population counts used to calculate incidence and mortality rates

Denominator data are the population figures (usually from census estimates) that serve as the base for calculating rates per 100,000 persons.

Question 60: A CTR is asked to produce a 5-year relative survival rate for breast cancer patients. Which additional data is required beyond observed survival?

Expected survival of a comparable general population (Correct answer)
National average insurance coverage rates
Treatment response rates from clinical trials
Hospital length-of-stay averages

Correct answer: Expected survival of a comparable general population

Relative survival is calculated by dividing observed survival by the expected survival of a matched general population to remove the effect of other-cause mortality.

Question 61: When abstracting a case of non-Hodgkin lymphoma, which staging system is preferred over AJCC TNM?

FIGO staging
Binet staging
Ann Arbor staging (Correct answer)
Durie-Salmon staging

Correct answer: Ann Arbor staging

The Ann Arbor staging system (Lugano modification) is the standard staging system for Hodgkin and non-Hodgkin lymphomas.

Question 62: Which data quality measure evaluates whether cases diagnosed at the reporting facility were reported within the required timeframe?

Accuracy rate
Completeness rate
Duplicate rate
Timeliness rate (Correct answer)

Correct answer: Timeliness rate

The timeliness rate measures whether cases are abstracted and submitted within established deadlines set by state or accrediting bodies.

Question 63: When abstracting a case with multiple primaries, which SEER rule determines whether two tumors in the same site are counted as one or two primaries?

The Multiple Primary and Histology (MP/H) rules (Correct answer)
The rule of two-thirds
The ICD-O-3 topography rules
The AJCC staging guidelines

Correct answer: The Multiple Primary and Histology (MP/H) rules

SEER's Multiple Primary and Histology (MP/H) rules govern whether tumors at the same site constitute one or multiple primaries.

Question 64: Which of the following is considered a 'non-analytic' case in a hospital cancer registry?

A patient diagnosed and treated entirely at the reporting facility
A patient who had a diagnostic biopsy at the reporting facility
A patient who received chemotherapy at the reporting facility only
A patient diagnosed at the reporting facility but treated elsewhere (Correct answer)

Correct answer: A patient diagnosed at the reporting facility but treated elsewhere

Non-analytic cases include patients for whom the facility provided only part of the diagnostic workup or treatment, not the primary managing institution.

Question 65: Which NAACCR standard item is used to flag a data element that was reviewed and confirmed as correct, even if it appears unusual?

Sequence number
Reporting facility code
Quality index
Over-ride flag (Correct answer)

Correct answer: Over-ride flag

Over-ride flags are used to suppress edit errors for records where the data has been verified as correct despite triggering a warning.

Question 66: A patient is diagnosed with a borderline ovarian tumor. Under current SEER reportability rules, this case is:

Reportable only if the patient is under age 50
Reportable as a malignant neoplasm (Correct answer)
Reportable only if it recurs as invasive cancer
Not reportable because it is benign

Correct answer: Reportable as a malignant neoplasm

Borderline ovarian tumors (behavior code /1 per ICD-O-3) are reportable to SEER because the ovary is a site where borderline tumors are collected.

Question 67: Under NPCR (National Program of Cancer Registries) requirements, states must submit cancer incidence data to the CDC by what deadline each year?

June 1
March 1
September 1 (Correct answer)
December 31

Correct answer: September 1

NPCR states are required to submit their data to CDC by September 1 of each year for the prior diagnosis year.

Question 68: Which ICD-O-3 grade code is assigned when the pathology report states 'poorly differentiated'?

Grade III (Correct answer)
Grade IV
Grade II
Grade I

Correct answer: Grade III

Grade III (poorly differentiated) corresponds to high-grade tumors with significantly abnormal cell appearance.

Question 69: Which ICD-O-3 topography code should be assigned to a malignant mesothelioma arising from the pleura?

C34.9
C38.4
C45.0 (Correct answer)
C76.1

Correct answer: C45.0

Malignant mesothelioma of the pleura is coded to C45.0 in ICD-O-3, which is the specific topography for pleural mesothelioma.

Question 70: In AJCC 8th edition staging for colorectal cancer, which N category indicates metastasis in 7 or more regional lymph nodes?

N2b (Correct answer)
N1c
N2a
N1a

Correct answer: N2b

N2b in AJCC 8th edition colorectal staging indicates metastasis in 7 or more regional lymph nodes.

Question 71: What does age-adjusted (age-standardized) cancer rate allow researchers to do?

Estimate a patient's individual cancer risk
Compare rates across populations with different age distributions (Correct answer)
Calculate the number of new cases in one year
Determine the stage distribution of a cancer type

Correct answer: Compare rates across populations with different age distributions

Age-adjustment removes the confounding effect of age so that rates in populations with different age structures can be validly compared.

Question 72: Which of the following passwords would be considered MOST secure for a cancer registry database account according to current best practices?

cancerdata
John_Registry_2026
Tr@8#mK!29vLqZ (Correct answer)
Password1234

Correct answer: Tr@8#mK!29vLqZ

Strong passwords use a mix of uppercase, lowercase, numbers, and special characters and are not based on dictionary words or predictable patterns.

Question 73: Which standard of practice is MOST important for ensuring quality in Data Quality & Completeness?

Using the most advanced technology available regardless of need
Strictly adhering to the same procedure in every situation
Minimizing documentation to focus on practical work
Following evidence-based protocols while adapting to specific circumstances (Correct answer)

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Evidence-based protocols provide a foundation of proven practices, but effective Certified Tumor Registrar professionals must also adapt their approach based on specific circumstances and individual case needs within Data Quality & Completeness.

Question 74: When a patient is diagnosed with two separate primary cancers simultaneously, the registrar should:

Combine both primaries into one abstract using the higher stage
Abstract only the first diagnosed primary
Abstract each primary as a separate case following multiple primary rules (Correct answer)
Abstract only the more advanced cancer

Correct answer: Abstract each primary as a separate case following multiple primary rules

Multiple primary rules (MP/H rules) govern when separate primaries must each be abstracted independently, ensuring both cases are counted in incidence data.

Question 75: Which type of cancer registry collects data from an entire defined geographic population regardless of where treatment occurs?

Disease registry
Hospital-based registry
Population-based registry (Correct answer)
Special purpose registry

Correct answer: Population-based registry

Population-based registries capture all cancer cases occurring within a defined geographic area, providing incidence data representative of that population.

Question 76: Under STORE rules, when a patient has a single histologic diagnosis of 'adenosquamous carcinoma,' how many primaries should be abstracted?

One primary using the combined histology code for adenosquamous carcinoma (Correct answer)
One primary, coded to the dominant histologic component
Two primaries only if they arise in different anatomic sites
Two primaries — one for each component histology

Correct answer: One primary using the combined histology code for adenosquamous carcinoma

Adenosquamous carcinoma is a single combined histologic entity with its own ICD-O-3 code, and should be abstracted as one primary using that specific code.

Question 77: Which NAACCR data item is used to assess whether a case was identified through active or passive case-finding methods?

Primary Site
Sequence Number
Basis of Diagnosis
Type of Reporting Source (Correct answer)

Correct answer: Type of Reporting Source

Type of Reporting Source identifies how a case came to the registry's attention, which helps evaluate completeness of case-finding.

Question 78: Which standard of practice is MOST important for ensuring quality in Coding & Classification Systems?

Following evidence-based protocols while adapting to specific circumstances (Correct answer)
Minimizing documentation to focus on practical work
Strictly adhering to the same procedure in every situation
Using the most advanced technology available regardless of need

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Question 79: A hospital registry's re-abstraction audit reveals that treatment data accuracy for radiation therapy is only 78%. Which action would MOST directly address this deficiency?

Increase casefinding frequency
Submit a corrected file to the state registry
Expand the casefinding sources list
Conduct targeted training on radiation therapy documentation sources (Correct answer)

Correct answer: Conduct targeted training on radiation therapy documentation sources

Targeted training on the relevant documentation sources (radiation oncology records, treatment summaries) directly addresses abstractor knowledge gaps in that specific data element.

Question 80: Which metric best measures a registry's ability to capture all reportable cases within a defined population?

Case completeness rate (Correct answer)
Error rate
Edit failure rate
Timeliness rate

Correct answer: Case completeness rate

Case completeness rate, often estimated through death certificate linkage or independent case-finding audits, measures how well a registry captures all eligible cases.

Question 81: When a patient is diagnosed with two separate primary cancers simultaneously, how should a tumor registrar abstract the case?

Abstract only the more advanced cancer
Abstract both as separate accession records (Correct answer)
Abstract only the first diagnosed cancer
Combine them into one record with dual primaries noted

Correct answer: Abstract both as separate accession records

Each separate primary cancer requires its own accession record per SEER multiple primary rules.

Question 82: Which of the following BEST describes the purpose of an Institutional Review Board (IRB) in relation to cancer registry research?

To develop cancer staging guidelines for registrars
To review and approve research protocols to protect the rights and welfare of human subjects (Correct answer)
To audit the registry's financial accounts for compliance
To manage the day-to-day operations of the cancer registry

Correct answer: To review and approve research protocols to protect the rights and welfare of human subjects

An IRB reviews research protocols involving human subjects to ensure ethical standards are met and participant rights are protected before data are shared.

Question 83: What is the primary purpose of the NAACCR Inter-rater Reliability Study in data quality assessment?

To validate facility reporting rates against state benchmarks
To confirm accuracy of follow-up information
To audit timeliness of case submission
To measure consistency of abstraction decisions between different registrars (Correct answer)

Correct answer: To measure consistency of abstraction decisions between different registrars

Inter-rater reliability studies compare abstraction decisions across multiple registrars to identify inconsistencies in data interpretation and coding.

Question 84: Which coding manual provides the rules for assigning histology codes in a cancer registry abstract?

SEER Program Coding and Staging Manual
ICD-10-CM
ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition) (Correct answer)
TNM Staging Manual

Correct answer: ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition)

ICD-O-3 is the standard reference for assigning both topography and morphology (histology) codes to cancer diagnoses in registry abstracts.

Question 85: A patient receives neoadjuvant chemotherapy followed by surgery. How should sequence of systemic therapy and surgery be coded?

Systemic only
Systemic before surgery (Correct answer)
Surgery before systemic
Surgery only

Correct answer: Systemic before surgery

When chemotherapy precedes surgery, the sequence is coded as systemic therapy before surgery, reflecting actual treatment order.

Question 86: Which organization certifies the accuracy and completeness of state cancer registry data through a data quality audit process called the 'Gold Standard'?

NAACCR (Correct answer)
American College of Pathologists
SEER
CoC

Correct answer: NAACCR

NAACCR administers the data certification program that sets gold-standard thresholds for completeness, timeliness, and data quality.

Question 87: The annual analytic case rate is calculated by dividing the number of analytic cases by:

Total cases abstracted that year, multiplied by 100 (Correct answer)
Number of new staff trained that year
Number of reportable cases received from outside facilities
Total inpatient discharges

Correct answer: Total cases abstracted that year, multiplied by 100

The analytic case rate expresses the proportion of analytic cases among all abstracted cases, supporting program benchmarking.

Question 88: In Cancer Registry Data Collection, what is the FIRST step a CTR professional should take when encountering a new case or situation?

Conduct a comprehensive assessment and gather all relevant information (Correct answer)
Implement an immediate solution based on past experience
Document the situation and wait for further instructions
Consult with a supervisor before taking any action

Correct answer: Conduct a comprehensive assessment and gather all relevant information

In Cancer Registry Data Collection, a thorough initial assessment ensures all relevant factors are identified before deciding on an appropriate course of action. This systematic approach is fundamental to Certified Tumor Registrar practice.

Question 89: In cancer registry operations, a 'death clearance' procedure is used to:

Update survival status for cases lost to follow-up
Remove deceased patients from the active follow-up list
Identify unreported cancer cases by matching death certificates to registry files (Correct answer)
Verify cause of death for quality reporting purposes

Correct answer: Identify unreported cancer cases by matching death certificates to registry files

Death clearance compares death certificate data with registry records to identify cancer deaths not yet captured as registry cases, improving completeness.

Question 90: Which NCDB standard requires that a cancer program perform a minimum number of analytic cases per year to maintain accreditation?

Standard 2.3
Standard 1.1 (Correct answer)
Standard 4.6
Standard 5.2

Correct answer: Standard 1.1

Standard 1.1 specifies the minimum analytic caseload requirement a program must meet annually for CoC accreditation.

Question 91: When coding histology in ICD-O-3, what does the fifth digit (behavior code) of '/3' indicate?

Benign
Uncertain whether benign or malignant
Malignant, primary site (Correct answer)
Malignant, metastatic site

Correct answer: Malignant, primary site

In ICD-O-3, behavior code /3 denotes a malignant neoplasm at the primary site.

Question 92: Observed survival differs from relative survival in that observed survival:

Applies only to localized-stage cancers
Excludes non-cancer deaths from the calculation
Uses life table comparisons
Counts all deaths regardless of cause (Correct answer)

Correct answer: Counts all deaths regardless of cause

Observed (or overall) survival counts all deaths from any cause, while relative survival compares to expected mortality in a matched population.

Question 93: A Certified Tumor Registrar reviewing follow-up data finds that 12% of analytic cases have no vital status update in the past 5 years. This primarily affects which quality dimension?

Data completeness (Correct answer)
Data accuracy
Data timeliness
Data comparability

Correct answer: Data completeness

Missing vital status updates represent incomplete data, reducing the registry's ability to calculate survival statistics.

Question 94: For pancreatic exocrine cancer, which vessel involvement upgrades the tumor to T4 in AJCC 8th edition?

Portal vein encasement
Superior mesenteric vein abutment
Splenic artery abutment
Celiac axis or superior mesenteric artery involvement (Correct answer)

Correct answer: Celiac axis or superior mesenteric artery involvement

Pancreatic T4 is defined by involvement of the celiac axis, common hepatic artery, or superior mesenteric artery, rendering the tumor surgically unresectable.

Question 95: How does risk management apply to daily practice in Staging & Prognostic Factors for Certified Tumor Registrar professionals?

Through proactive identification of potential hazards and implementation of preventive measures (Correct answer)
Only through responding to incidents after they occur
Through annual safety audits exclusively
By avoiding high-risk situations entirely

Correct answer: Through proactive identification of potential hazards and implementation of preventive measures

Effective risk management in Staging & Prognostic Factors requires proactive hazard identification and preventive measures, not just reactive responses. This approach reduces incidents, improves outcomes, and protects both professionals and clients.

Question 96: What is the purpose of the NAACCR Call for Data in the context of data quality?

To collect standardized, quality-checked data from state registries for national analytic databases (Correct answer)
To audit individual hospital registries for accreditation
To notify registries of new ICD-O-3 coding updates
To request follow-up information from patients

Correct answer: To collect standardized, quality-checked data from state registries for national analytic databases

The NAACCR Call for Data is an annual request for standardized submissions to build national datasets, requiring data that has passed quality edits.

Question 97: Which histologic type does ICD-O-3 code 9732/3 represent?

Acute myeloid leukemia
Diffuse large B-cell lymphoma
Multiple myeloma (Correct answer)
Hodgkin lymphoma

Correct answer: Multiple myeloma

ICD-O-3 code 9732/3 represents multiple myeloma (plasma cell myeloma).

Question 98: A state central registry receives data from a hospital that routinely under-reports cases. The best metric to identify this problem is:

Percentage of cases with unknown stage
Number of cases flagged for physician review
Observed-to-expected (O/E) case ratio compared to regional incidence rates (Correct answer)
Average time from diagnosis to abstraction

Correct answer: Observed-to-expected (O/E) case ratio compared to regional incidence rates

Comparing observed case counts to expected counts based on regional population incidence rates reveals facilities with systematic under-reporting.

Question 99: Under CoC standards, what is the maximum number of days from date of first contact at a facility to the date a case must be abstracted?

3 months
1 year
30 days
6 months (Correct answer)

Correct answer: 6 months

CoC Standard 4.1 requires that cases be abstracted within 6 months of the date of first contact for analytic cases.

Question 100: Which accreditation body sets standards for hospital-based cancer registries in the United States?

American College of Surgeons (ACoS) Commission on Cancer (Correct answer)
National Institutes of Health (NIH)
Centers for Medicare & Medicaid Services (CMS)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Correct answer: American College of Surgeons (ACoS) Commission on Cancer

The American College of Surgeons Commission on Cancer (CoC) establishes standards for hospital cancer programs, including registry operations.

Question 101: How often should casefinding be performed in a hospital-based registry?

Only during audits
Annually
Quarterly
Weekly or monthly (Correct answer)

Correct answer: Weekly or monthly

Casefinding should be performed regularly and frequently, typically on a weekly or monthly basis, in a hospital-based cancer registry. This consistent schedule ensures that new cancer diagnoses are identified promptly, preventing backlogs and allowing for timely data abstraction. Regular casefinding also helps maintain the accuracy and completeness of the registry data by capturing cases as they are diagnosed.

Question 102: When a conflict arises between standard procedures and a unique situation in Coding & Classification Systems, what should a CTR professional prioritize?

Strict adherence to written procedures without exception
The most cost-effective solution available
The preference of the client or stakeholder
Safety and ethical obligations while seeking expert consultation (Correct answer)

Correct answer: Safety and ethical obligations while seeking expert consultation

Safety and ethics always take priority in Coding & Classification Systems. When standard procedures don't adequately address a unique situation, consulting with experienced colleagues or supervisors ensures both safety and professional standards are maintained.

Question 103: Which standard of practice is MOST important for ensuring quality in Follow-Up & Survival Analysis?

Strictly adhering to the same procedure in every situation
Using the most advanced technology available regardless of need
Following evidence-based protocols while adapting to specific circumstances (Correct answer)
Minimizing documentation to focus on practical work

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Question 104: A cancer registrar accidentally sends a report containing patient identifiers to the wrong email address. Under HIPAA, this event is INITIALLY classified as:

A minor incident with no reporting obligations
A business associate violation requiring immediate termination of the vendor
A potential breach requiring a risk assessment to determine reportability (Correct answer)
An intentional breach requiring criminal referral

Correct answer: A potential breach requiring a risk assessment to determine reportability

A misdirected email containing PHI is presumed to be a reportable breach unless a risk assessment demonstrates a low probability that the PHI was compromised.

Question 105: A hospital's cancer committee is reviewing a case where the abstract was completed 10 months after the patient's first contact. This case would:

Be reclassified as a non-analytic case
Be excluded from CoC accreditation case counts
Automatically trigger a corrective action plan
Count against the facility's timeliness standard (Correct answer)

Correct answer: Count against the facility's timeliness standard

Cases abstracted beyond 6 months reduce the facility's compliance rate with CoC's timeliness standard.

Question 106: When auditing the 'diagnostic confirmation' data field, which code is assigned to a case confirmed by cytology only, without histologic tissue?

Code 1
Code 6
Code 2
Code 4 (Correct answer)

Correct answer: Code 4

NAACCR/SEER code 4 is used when diagnostic confirmation is by cytology only, without a histologic (biopsy) confirmation.

Question 107: What does the term 'completeness' mean in the context of a central cancer registry's data quality?

The timeliness of case submission to the registry
The proportion of all cancer cases in the catchment area that are captured by the registry (Correct answer)
The percentage of cases with complete treatment information
The accuracy of stage data for abstracted cases

Correct answer: The proportion of all cancer cases in the catchment area that are captured by the registry

Completeness refers to the registry's case ascertainment rate — how well it captures all incident cancer cases occurring in its defined geographic population.

Question 108: A hospital registry's reabstraction audit shows a 15% discrepancy rate in T category coding. This rate exceeds the acceptable benchmark. The MOST appropriate response is to:

Conduct root cause analysis, retrain staff, and correct affected records (Correct answer)
Report the discrepancy to the state registry without correction
Switch to a different staging system to reset baseline
Suppress the T category field until the error rate drops

Correct answer: Conduct root cause analysis, retrain staff, and correct affected records

Root cause analysis identifies whether errors stem from unclear guidelines, training gaps, or documentation issues, enabling targeted corrective action.

Question 109: Stage grouping of 'Stage 0' in most AJCC cancer sites refers to which condition?

Occult primary tumor
In situ carcinoma with no invasion (Correct answer)
Microinvasive disease
Tumor with unknown nodal status

Correct answer: In situ carcinoma with no invasion

Stage 0 represents carcinoma in situ, where abnormal cells are present but have not invaded surrounding tissue.

Question 110: A hospital registrar is reviewing the hematology/oncology clinic schedules for casefinding. A new patient has a diagnosis of 'myelodysplastic syndrome.' Is this reportable?

No, it is a benign blood disorder
Yes, MDS is a reportable hematopoietic neoplasm (Correct answer)
Only if chemotherapy is given
Only if it transforms to acute leukemia

Correct answer: Yes, MDS is a reportable hematopoietic neoplasm

Myelodysplastic syndrome (MDS) is a reportable hematopoietic neoplasm per SEER and ACOS CoC guidelines.

Question 111: A patient with lung cancer has a PET scan showing uptake in mediastinal lymph nodes but no biopsy of those nodes. How should the registrar handle lymph node involvement for staging?

Assign clinical N stage based on imaging findings per AJCC rules (Correct answer)
Code lymph nodes as negative since no biopsy was done
Code lymph nodes as positive based on PET findings
Leave lymph node field blank until biopsy is performed

Correct answer: Assign clinical N stage based on imaging findings per AJCC rules

Clinical staging incorporates imaging results such as PET scans to assign N category even without biopsy confirmation.

Question 112: Which of the following is an advantage of passive follow-up over active follow-up in a hospital cancer registry?

Better compliance with HIPAA requirements
More accurate date-of-last-contact documentation
Higher contact rates with living patients
Lower resource expenditure through linkage with existing databases (Correct answer)

Correct answer: Lower resource expenditure through linkage with existing databases

Passive follow-up uses database linkages (NDI, vital statistics) to determine vital status without direct patient contact, reducing staff workload and cost.

Question 113: MSI-H (microsatellite instability-high) status in colorectal cancer is associated with which prognostic and treatment implication?

Worse prognosis and resistance to immunotherapy
Better prognosis and response to immune checkpoint inhibitors (Correct answer)
Worse prognosis but good response to FOLFOX
No prognostic significance but predicts fluorouracil benefit

Correct answer: Better prognosis and response to immune checkpoint inhibitors

MSI-H colorectal cancers have better stage-for-stage prognosis and are highly responsive to immune checkpoint inhibitor therapy such as pembrolizumab.

Question 114: What documentation practice is considered essential in Follow-Up & Survival Analysis within the Certified Tumor Registrar field?

Using shorthand notes that can be expanded later if needed
Completing all documentation at the end of the workday
Only documenting unusual events or complications
Recording actions, observations, and outcomes in real-time or as close to the event as possible (Correct answer)

Correct answer: Recording actions, observations, and outcomes in real-time or as close to the event as possible

Real-time or near-real-time documentation in Follow-Up & Survival Analysis ensures accuracy, provides a contemporaneous record, and is considered the gold standard for professional accountability and legal defensibility.

Question 115: When a cancer registry receives a casefinding audit, what is the primary goal of the audit?

To assess the timeliness of data submissions to the state registry
To review staff credentialing and training records
To verify that all reportable cases have been identified and abstracted (Correct answer)
To evaluate the accuracy of staging information

Correct answer: To verify that all reportable cases have been identified and abstracted

Casefinding audits assess completeness by verifying that every reportable case from all source documents has been captured by the registry.

Question 116: What documentation practice is considered essential in Coding & Classification Systems within the Certified Tumor Registrar field?

Recording actions, observations, and outcomes in real-time or as close to the event as possible (Correct answer)
Using shorthand notes that can be expanded later if needed
Completing all documentation at the end of the workday
Only documenting unusual events or complications

Correct answer: Recording actions, observations, and outcomes in real-time or as close to the event as possible

Real-time or near-real-time documentation in Coding & Classification Systems ensures accuracy, provides a contemporaneous record, and is considered the gold standard for professional accountability and legal defensibility.

Question 117: When immunotherapy such as pembrolizumab is part of first course treatment, it should be coded in which field?

RX Summ–Immunotherapy (Correct answer)
RX Summ–Hormone
RX Summ–Other
RX Summ–Chemo

Correct answer: RX Summ–Immunotherapy

Checkpoint inhibitors like pembrolizumab are coded in the RX Summ–Immunotherapy field, which captures biological response modifiers and immune checkpoint inhibitors.

Question 118: Which of the following is NOT a required component of the CoC's casefinding audit?

Review of social worker notes (Correct answer)
Review of radiation therapy logs
Review of pathology reports
Review of surgical logs

Correct answer: Review of social worker notes

Social worker notes are not a standard casefinding source; pathology, surgery, and radiation logs are reviewed to identify missed cases.

Question 119: When a hospital cancer registry submits data to the state central registry, which organization's standards govern the required data items and their coding?

Only SEER standards apply
Each hospital sets its own submission standards
Only CoC standards apply
NAACCR standards, which integrate CoC and SEER requirements (Correct answer)

Correct answer: NAACCR standards, which integrate CoC and SEER requirements

NAACCR standards serve as the umbrella framework that harmonizes CoC, SEER, and NPCR data items for state reporting.

Question 120: A central registry rejects a hospital's submission because 4% of records fail the 'Diagnosis Year vs. Date of Birth' edit. This is an example of which quality control mechanism?

Automated edit check at submission (Correct answer)
Manual reabstraction audit
Interagency data comparison
Case-finding completeness review

Correct answer: Automated edit check at submission

Automated edit checks run at submission validate logical relationships between fields, catching errors before data enters the central registry.

Question 121: A tumor registrar encounters the term 'Gleason score 7 (3+4)' on a prostate pathology report. Which grade group does this correspond to?

Grade Group 2 (Correct answer)
Grade Group 4
Grade Group 3
Grade Group 1

Correct answer: Grade Group 2

Gleason score 7 (3+4) corresponds to Grade Group 2 in the 2016 WHO/ISUP Grade Group system for prostate cancer.

Question 122: Under STORE manual guidelines, which condition would cause a case to be flagged as a potential duplicate?

Same patient name, date of birth, and primary site at different facilities (Correct answer)
Two primaries diagnosed in the same calendar year
Same histology reported by two different pathologists
A case reported by both pathology and radiology

Correct answer: Same patient name, date of birth, and primary site at different facilities

Potential duplicates are identified when the same patient demographic data and cancer site appear in multiple submissions, suggesting the same case was reported more than once.

Question 123: Adenocarcinoma is a malignancy arising from which tissue type?

Stratified squamous epithelium
Glandular epithelium (Correct answer)
Mesothelial lining cells
Transitional (urothelial) epithelium

Correct answer: Glandular epithelium

Adenocarcinoma (prefix 'adeno-') originates from glandular epithelial cells and is common in organs such as the colon, breast, lung, and prostate.

Question 124: What is the primary goal of patient follow-up in a cancer registry?

To collect tissue samples
To schedule future treatments
To evaluate disease recurrence and survival (Correct answer)
To confirm insurance coverage

Correct answer: To evaluate disease recurrence and survival

The primary goal of patient follow-up in a cancer registry is to monitor the long-term outcomes of cancer patients. This process is crucial for evaluating disease recurrence, tracking the patient's survival status, and assessing the effectiveness of various treatments. The collected data provides valuable insights for research, public health initiatives, and improving cancer care.

Question 125: Which laboratory technique uses antibodies to detect specific proteins expressed by tumor cells and is routinely reported on pathology reports?

Polymerase chain reaction (PCR)
Flow cytometry
Fluorescence in situ hybridization (FISH)
Immunohistochemistry (IHC) (Correct answer)

Correct answer: Immunohistochemistry (IHC)

Immunohistochemistry (IHC) applies labeled antibodies to tissue sections to visualize protein expression, commonly used to classify tumors and guide targeted therapy selection.

Question 126: Which electronic health record (EHR) tool is MOST effective for automated casefinding in a modern hospital registry?

Problem list alerts only
Pharmacy dispensing alerts alone
ICD-coded discharge diagnosis queries combined with pathology report text mining (Correct answer)
Appointment scheduling flags

Correct answer: ICD-coded discharge diagnosis queries combined with pathology report text mining

Combining ICD-coded diagnosis queries with pathology text mining provides the broadest and most accurate automated casefinding across multiple data sources.

Question 127: In NAACCR data quality assessment, what does a high 'unknown' rate for the 'method of diagnosis' field most likely indicate?

Excellent data abstraction
Accurate reflection of community demographics
High proportion of autopsy cases
Incomplete medical record review or abstractor training gaps (Correct answer)

Correct answer: Incomplete medical record review or abstractor training gaps

A high unknown rate in the method of diagnosis field typically signals gaps in abstractor training or incomplete review of source documents.

Question 128: Cancer registries submit data to SEER using which standard file exchange format?

XML HL7 v2
NAACCR flat file (fixed-width text format) (Correct answer)
HL7 FHIR JSON
CSV spreadsheet

Correct answer: NAACCR flat file (fixed-width text format)

SEER and all major central registries use the NAACCR fixed-width flat file format as the standard for data submission and exchange.

Question 129: Which prognostic factor is used specifically for breast cancer staging and reflects tumor cell proliferation rate?

Ki-67 index (Correct answer)
PSA level
CEA level
AFP level

Correct answer: Ki-67 index

Ki-67 index measures the proportion of actively dividing tumor cells and is a key proliferation marker in breast cancer prognosis.

Question 130: A pathology report describes a tumor as 'transitional cell carcinoma.' What is the preferred ICD-O-3 histology code?

8000/3
8120/3 (Correct answer)
8140/3
8010/3

Correct answer: 8120/3

Transitional cell carcinoma (also called urothelial carcinoma) is coded 8120/3 in ICD-O-3.

Question 131: Which term describes a malignant tumor of mesothelial cells, such as those lining the pleura, peritoneum, or pericardium?

Neuroendocrine carcinoma
Mesothelioma (Correct answer)
Squamous cell carcinoma
Adenocarcinoma

Correct answer: Mesothelioma

Mesothelioma is a rare malignancy arising from mesothelial cells that line the pleura and other serosal surfaces, strongly associated with asbestos exposure.

Question 132: A registrar finds a patient with a diagnosis of 'borderline ovarian tumor' on a surgical pathology report. How should this be handled for registry purposes?

Place in suspense until follow-up biopsy
Abstract as a benign tumor; not reportable
Abstract as a malignant tumor using the appropriate behavior code (Correct answer)
Report only if invasive elements are identified

Correct answer: Abstract as a malignant tumor using the appropriate behavior code

Borderline ovarian tumors are reportable and assigned a behavior code of /1 (uncertain behavior) or /3 depending on registry rules, but are generally abstracted.

Question 133: Which systemic therapy class includes drugs such as tamoxifen and anastrozole used in breast cancer treatment?

Targeted therapy
Immunotherapy
Chemotherapy
Hormone therapy (Correct answer)

Correct answer: Hormone therapy

Tamoxifen and anastrozole are hormone (endocrine) therapy agents that block or reduce estrogen's effect on breast cancer cells.

Question 134: In cancer epidemiology, what does a 'cohort study' examine?

A cross-sectional snapshot of cancer prevalence
A group followed over time to observe who develops cancer (Correct answer)
Randomized patients assigned to treatment or placebo
Cancer cases and matched controls interviewed about past exposures

Correct answer: A group followed over time to observe who develops cancer

A cohort study follows a defined population prospectively (or retrospectively) over time to measure cancer incidence and identify risk factors.

Question 135: Which U.S. national program collects population-based cancer incidence and survival data from registries across the country?

SEER (Surveillance, Epidemiology, and End Results) (Correct answer)
CoC (Commission on Cancer)
NCDB (National Cancer Database)
NPCR (National Program of Cancer Registries)

Correct answer: SEER (Surveillance, Epidemiology, and End Results)

SEER, maintained by NCI, is the premier population-based program collecting cancer incidence and survival data from geographically diverse U.S. registries.

Question 136: Which source document takes PRIORITY when there is a conflict between the operative report and the pathology report regarding tumor size?

Pathology report (Correct answer)
Operative report
Physician progress notes
Radiology report

Correct answer: Pathology report

The pathology report takes priority over the operative report for tumor size, as it provides the definitive microscopic measurement.

Question 137: In Registry Operations & Management, what is the FIRST step a CTR professional should take when encountering a new case or situation?

Consult with a supervisor before taking any action
Implement an immediate solution based on past experience
Document the situation and wait for further instructions
Conduct a comprehensive assessment and gather all relevant information (Correct answer)

Correct answer: Conduct a comprehensive assessment and gather all relevant information

In Registry Operations & Management, a thorough initial assessment ensures all relevant factors are identified before deciding on an appropriate course of action. This systematic approach is fundamental to Certified Tumor Registrar practice.

Question 138: A registry receives a death certificate for a patient with cancer diagnosed at an out-of-state facility. This case should be abstracted as a:

Death certificate only (DCO) case (Correct answer)
Non-analytic case
Autopsy only case
Duplicate case

Correct answer: Death certificate only (DCO) case

When the only source of information about a cancer diagnosis is the death certificate, the case is classified as a death certificate only (DCO) case.

Question 139: A cancer committee is reviewing quality metrics and finds the facility's DCO (Death Certificate Only) rate is 8%. What is the benchmark most registries strive to achieve?

Less than 20%
Less than 5% (Correct answer)
Less than 1%
Less than 15%

Correct answer: Less than 5%

A DCO rate below 5% is the generally accepted quality benchmark, indicating the registry is successfully obtaining clinical information before or beyond death certificate data.

Question 140: A hospital tumor registry is conducting a rapid case ascertainment (RCA) study. The PRIMARY purpose of RCA is to:

Identify newly diagnosed cancer patients quickly to enroll them in clinical trials or studies (Correct answer)
Accelerate reporting to the state registry for compliance deadlines
Improve follow-up rates for long-term survivors
Reduce the backlog of cases awaiting abstraction

Correct answer: Identify newly diagnosed cancer patients quickly to enroll them in clinical trials or studies

Rapid case ascertainment identifies newly diagnosed patients within days of diagnosis to facilitate timely enrollment in research studies or clinical trials.

Question 141: When abstracting a case from a facility that is part of a health system, the registrar should assign class of case 20 when:

The patient declined all treatment and was referred to hospice
The patient was diagnosed and received all first-course treatment at the reporting facility
The patient was initially diagnosed at another facility and received all treatment at the reporting facility (Correct answer)
The patient was only seen for a follow-up visit after treatment elsewhere

Correct answer: The patient was initially diagnosed at another facility and received all treatment at the reporting facility

Class of case 20 applies when the initial diagnosis was made elsewhere but all or part of first-course treatment was administered at the reporting facility.

Question 142: Under SEER program requirements, which tumors are reportable even when histology is not confirmed by biopsy?

Only carcinomas with imaging confirmation
Tumors must always have pathologic confirmation to be reportable
Only tumors staged as IV are reportable without biopsy
Clinical diagnoses made by a physician are reportable (Correct answer)

Correct answer: Clinical diagnoses made by a physician are reportable

SEER and most central registries accept physician clinical diagnoses as reportable even without tissue confirmation.

Question 143: Which survival calculation method accounts for patients who are lost to follow-up by censoring their data at the last known contact date?

Kaplan-Meier method (Correct answer)
Cause-specific survival
Relative survival
Observed survival

Correct answer: Kaplan-Meier method

The Kaplan-Meier method handles censored observations, including lost-to-follow-up cases, by removing them at the time of censoring.

Question 144: Which measure expresses the probability of dying FROM cancer (rather than with it) over a specified time period?

Disease-free survival rate
Cause-specific survival rate (Correct answer)
Overall survival rate
Relative survival rate

Correct answer: Cause-specific survival rate

Cause-specific survival counts only deaths attributed to the cancer of interest as events, excluding deaths from other causes.

Question 145: What role do re-abstracting audits play in quality assurance?

They identify late patient arrivals
They verify data accuracy and consistency (Correct answer)
They evaluate financial operations
They measure coding productivity

Correct answer: They verify data accuracy and consistency

Re-abstracting audits involve having a second, independent abstractor review a sample of cases to compare their abstracted data against the original abstract and source documents. This process helps identify errors, inconsistencies, and variations in coding practices. These audits are crucial for ensuring the overall accuracy and reliability of the data within the cancer registry.

Question 146: When a hospital cancer registry submits data to a state central registry, which process ensures that a case reported by two different hospitals for the same patient is counted only once?

Sequence number assignment
Casefinding audit
Record linkage and deduplication (Correct answer)
Edit validation

Correct answer: Record linkage and deduplication

Record linkage uses probabilistic or deterministic matching on patient identifiers to detect and merge or suppress duplicate submissions.

Question 147: Which factor most commonly introduces bias into registry-based survival estimates?

Including cases diagnosed at autopsy
Using monthly rather than annual follow-up intervals
Including pediatric cases
Lead-time bias from screening-detected cancers (Correct answer)

Correct answer: Lead-time bias from screening-detected cancers

Lead-time bias occurs when screening advances the diagnosis date without extending life, artificially inflating apparent survival time.

Question 148: What is the PRIMARY purpose of continuing education requirements in Reporting Requirements & Standards for CTR professionals?

Networking with other professionals in the field
Maintaining current knowledge and competency as the field evolves (Correct answer)
Earning additional credentials for career advancement
Fulfilling mandatory regulatory requirements only

Correct answer: Maintaining current knowledge and competency as the field evolves

Continuing education in Reporting Requirements & Standards ensures professionals maintain current knowledge and skills as standards, technologies, and best practices evolve in the Certified Tumor Registrar field.

Question 149: How does the NCDB use cancer registry data?

To assess registry staff performance
To support quality improvement and benchmarking (Correct answer)
To fund new hospitals
To track hospital expenses

Correct answer: To support quality improvement and benchmarking

The National Cancer Database (NCDB) collects and analyzes data from CoC-accredited cancer programs across the U.S. It uses this vast dataset to provide benchmarks for cancer care, allowing facilities to compare their outcomes and processes against national standards. This information is crucial for identifying areas for quality improvement and enhancing patient care.

Question 150: Why is it important to use multiple sources for casefinding?

To identify all reportable cases (Correct answer)
To monitor data quality
To prevent data duplication
To simplify abstracting tasks

Correct answer: To identify all reportable cases

Using multiple sources for casefinding is crucial to ensure that no reportable cancer cases are missed. Relying on a single source might lead to incomplete data, as different departments or systems may capture varying aspects of a patient's journey. By cross-referencing information from various sources like pathology, radiology, and discharge records, registries can achieve comprehensive identification of all eligible cancer cases, ensuring data completeness and accuracy.

Question 151: A registrar is conducting casefinding and finds a patient who had a positive fine needle aspiration (FNA) biopsy for malignancy performed at the facility but received all treatment elsewhere. Is this case reportable?

No, because treatment was not at the facility
No, FNA alone does not confirm malignancy
Yes, as an analytic case because diagnosis was made at the facility (Correct answer)
Yes, but only as a non-analytic case

Correct answer: Yes, as an analytic case because diagnosis was made at the facility

A case is analytic when the diagnosing facility is your own, even if treatment occurs elsewhere; diagnosis at the facility makes it a Class 1 analytic case.

Question 152: During casefinding, a registrar finds a case of CIN III (severe cervical dysplasia) on a pathology report. How should this be handled?

Do not abstract; CIN III is not reportable
Abstract as an invasive carcinoma
Abstract as carcinoma in situ of the cervix (Correct answer)
Place in suspense pending colposcopy results

Correct answer: Abstract as carcinoma in situ of the cervix

CIN III is equivalent to carcinoma in situ of the cervix and is a reportable condition that should be abstracted as in situ.

Question 153: According to SEER program guidelines, which of the following is NOT a reportable condition?

Carcinoma in situ of the cervix (CIN III)
Invasive adenocarcinoma of the colon
Malignant melanoma of the skin
Basal cell carcinoma of the skin (Correct answer)

Correct answer: Basal cell carcinoma of the skin

Basal cell carcinoma of the skin is specifically excluded from SEER and most cancer registry reporting requirements due to its extremely high incidence and low mortality.

Question 154: Which document typically serves as the primary source for identifying the class of case (e.g., analytic vs. non-analytic)?

Only the surgical pathology report
The patient's insurance claims
State cancer registry report
The complete medical record including all treatment documentation (Correct answer)

Correct answer: The complete medical record including all treatment documentation

Class of case is determined by reviewing the full medical record to identify where diagnosis was made and where first-course treatment was received.

Question 155: In Data Quality & Completeness, what is the FIRST step a CTR professional should take when encountering a new case or situation?

Implement an immediate solution based on past experience
Document the situation and wait for further instructions
Consult with a supervisor before taking any action
Conduct a comprehensive assessment and gather all relevant information (Correct answer)

Correct answer: Conduct a comprehensive assessment and gather all relevant information

In Data Quality & Completeness, a thorough initial assessment ensures all relevant factors are identified before deciding on an appropriate course of action. This systematic approach is fundamental to Certified Tumor Registrar practice.

Question 156: Which STORE field records whether chemotherapy was given as part of the first course of treatment?

RX Date–Chemo
RX Summ–Other
RX Summ–Chemo (Correct answer)
RX Summ–Systemic/Surgery Sequence

Correct answer: RX Summ–Chemo

The RX Summ–Chemo field uses standardized codes to indicate whether and what type of chemotherapy was administered in the first course.

Question 157: A CTR receives an email from an unknown sender requesting a list of patients diagnosed with leukemia for a 'national study.' What is the BEST course of action?

Delete the email and ignore the request
Reply with the requested list if the email appears professional
Ask the sender for their credentials and then fulfill the request
Forward the request to the privacy officer and do not respond directly (Correct answer)

Correct answer: Forward the request to the privacy officer and do not respond directly

Unsolicited data requests from unknown parties should be escalated to the privacy officer, who can verify legitimacy and determine the appropriate response.

Question 158: During a casefinding audit, a registrar compares the registry's case count to the facility's ICD-coded discharge data and finds a 12% discrepancy. What is the MOST likely explanation?

The registry database has duplicate entries
The ICD coders are overcoding cancer diagnoses
All discrepancies are due to non-analytic cases not being abstracted
Casefinding missed cases coded only as secondary diagnoses or seen in outpatient settings (Correct answer)

Correct answer: Casefinding missed cases coded only as secondary diagnoses or seen in outpatient settings

Discrepancies often arise when casefinding focuses on inpatient primary diagnoses but misses outpatient encounters or secondary diagnosis codes that indicate a new cancer.

Question 159: A state health department asks a hospital cancer registry for a monthly data file to fulfill mandatory reporting requirements. This disclosure is permissible PRIMARILY because:

The data are automatically de-identified before transmission
The hospital and state have a longstanding informal agreement
State mandatory reporting laws create a HIPAA-permitted public health disclosure exception (Correct answer)
The state pays for the data, making it a permissible healthcare transaction

Correct answer: State mandatory reporting laws create a HIPAA-permitted public health disclosure exception

HIPAA permits covered entities to disclose PHI to public health authorities authorized by law to collect such data for public health surveillance and reporting.

Question 160: In a population-based cancer registry, which source is typically most complete for ascertaining all cancer cases?

State vital records (death certificates) combined with pathology reports and hospital records (Correct answer)
Insurance claims data only
Physician office billing codes only
Hospital discharge records alone

Correct answer: State vital records (death certificates) combined with pathology reports and hospital records

Using multiple sources — vital records, pathology reports, and hospital records — through a process called multiple-source ascertainment maximizes case completeness.

Question 161: Which federal agency publishes the United States Cancer Statistics (USCS) report combining SEER and NPCR data?

National Cancer Institute (NCI)
Centers for Disease Control and Prevention (CDC) (Correct answer)
American Cancer Society (ACS)
Commission on Cancer (CoC)

Correct answer: Centers for Disease Control and Prevention (CDC)

The CDC publishes the USCS report, which combines data from NCI's SEER program and CDC's own NPCR to provide comprehensive national cancer statistics.

Question 162: The concept of 'lead time bias' in cancer screening studies refers to:

Overestimation of incidence due to improved case finding
The delay between symptom onset and diagnosis
The time lag between diagnosis and treatment initiation
The apparent increase in survival time due to earlier detection, without actual benefit (Correct answer)

Correct answer: The apparent increase in survival time due to earlier detection, without actual benefit

Lead time bias inflates apparent survival because screening detects disease earlier, but if the death date is unchanged, survival appears longer without true benefit.

Question 163: In prostate cancer staging, what Gleason score range indicates Grade Group 5 (the highest grade)?

Gleason 7 (4+3)
Gleason 6
Gleason 7 (3+4)
Gleason 9-10 (Correct answer)

Correct answer: Gleason 9-10

Grade Group 5 encompasses Gleason scores 9 and 10, representing the most poorly differentiated prostate tumors.

Question 164: Which field captures administration of bone marrow or stem cell transplant as part of first-course treatment?

RX Summ–Immunotherapy
RX Summ–Other
RX Summ–Chemo
RX Summ–Transplnt/Endocr (Correct answer)

Correct answer: RX Summ–Transplnt/Endocr

Bone marrow and stem cell transplants are recorded in the RX Summ–Transplnt/Endocr field alongside endocrine procedures.

Question 165: Which standard of practice is MOST important for ensuring quality in Registry Operations & Management?

Minimizing documentation to focus on practical work
Using the most advanced technology available regardless of need
Strictly adhering to the same procedure in every situation
Following evidence-based protocols while adapting to specific circumstances (Correct answer)

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Question 166: When a cancer registry shares data with an external researcher under a data use agreement, the DUA must specify which of the following?

The names of all patients whose data will be shared
The registry's internal quality control procedures
Permitted uses of the data and required safeguards (Correct answer)
The researcher's personal salary and funding source

Correct answer: Permitted uses of the data and required safeguards

A data use agreement must define the permitted uses and disclosures of the limited data set and required safeguards to protect it.

Question 167: Which field captures the method by which the cancer diagnosis was confirmed?

Type of reporting source
Diagnostic confirmation
Basis of diagnosis (Correct answer)
Primary payer at diagnosis

Correct answer: Basis of diagnosis

The 'basis of diagnosis' field records the most definitive method used to confirm the cancer diagnosis, such as histology, cytology, or clinical diagnosis.

Question 168: NPCR, managed by the CDC, primarily funds which type of cancer registries?

Hospital-based cancer registries only
Veterans Affairs registries
Private insurance cancer databases
State and territorial central cancer registries (Correct answer)

Correct answer: State and territorial central cancer registries

NPCR provides funding and standards to state and territorial central cancer registries to ensure complete, high-quality population-based cancer data nationwide.

Question 169: Which statistic is most useful for assessing whether cancer mortality rates are declining over time in a population?

Five-year relative survival rate
Annual percent change (APC) in age-adjusted mortality rate (Correct answer)
Crude incidence rate for a single year
Stage distribution at diagnosis

Correct answer: Annual percent change (APC) in age-adjusted mortality rate

Annual percent change (APC) in age-adjusted mortality quantifies the trend direction and magnitude over time, making it the standard metric for mortality trend analysis.

Question 170: In cause-specific survival analysis, which patients are censored?

Patients who complete the follow-up period alive
All patients lost to follow-up
Patients who die from the cancer under study
Patients who die from causes other than the cancer under study (Correct answer)

Correct answer: Patients who die from causes other than the cancer under study

In cause-specific survival, deaths from causes other than the cancer of interest are treated as censored observations.

Question 171: Which standard of practice is MOST important for ensuring quality in Cancer Registry Data Collection?

Minimizing documentation to focus on practical work
Strictly adhering to the same procedure in every situation
Following evidence-based protocols while adapting to specific circumstances (Correct answer)
Using the most advanced technology available regardless of need

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Question 172: A quality review reveals that a registrar consistently codes 'unknown' for Perineural Invasion when the pathology report does not explicitly mention it. The correct approach is to:

Continue coding 'unknown' as it is conservative
Code 'not applicable' or the appropriate 'not documented' code per SEER/STORE rules (Correct answer)
Leave the field blank
Query the pathologist to confirm absence before coding

Correct answer: Code 'not applicable' or the appropriate 'not documented' code per SEER/STORE rules

Current coding manuals provide specific 'not documented' codes distinct from 'unknown,' and registrars should apply these accurately per item-specific instructions.

Question 173: A registrar is reviewing a case where the operative report, pathology report, and physician's notes all document different primary sites. Which source should take priority for coding primary site?

The operative report, as it was written first
The pathology report, as it provides the most definitive tissue diagnosis (Correct answer)
The physician's notes, as the treating physician has final authority
The most recent document in the medical record

Correct answer: The pathology report, as it provides the most definitive tissue diagnosis

Pathology reports provide microscopic confirmation of the primary site and take precedence over clinical impression documents when there is a discrepancy.

Question 174: When must a cancer registry report a case of basal cell carcinoma (BCC) of the skin?

Only when BCC metastasizes to lymph nodes
Never, because BCC of the skin is excluded from most registry requirements (Correct answer)
Only when BCC occurs in patients over age 65
Always, because all skin cancers are reportable

Correct answer: Never, because BCC of the skin is excluded from most registry requirements

Basal cell carcinoma of the skin is universally excluded from standard cancer registry reporting requirements.

Question 175: A cancer registry receives a returned mail piece for a patient last seen 3 years ago. What is the FIRST recommended step to locate the patient?

Contact the patient's physician of record (Correct answer)
Send a follow-up letter to the patient's last known address
Search the Social Security Death Index
Request records from the state vital statistics office

Correct answer: Contact the patient's physician of record

Contacting the physician of record is the first recommended step because the provider may have current contact information or updated address details.

Question 176: When a conflict arises between standard procedures and a unique situation in Registry Operations & Management, what should a CTR professional prioritize?

Strict adherence to written procedures without exception
Safety and ethical obligations while seeking expert consultation (Correct answer)
The preference of the client or stakeholder
The most cost-effective solution available

Correct answer: Safety and ethical obligations while seeking expert consultation

Safety and ethics always take priority in Registry Operations & Management. When standard procedures don't adequately address a unique situation, consulting with experienced colleagues or supervisors ensures both safety and professional standards are maintained.

Question 177: A cancer registrar is reviewing a data quality report and notices a high proportion of cases coded with 'vital status unknown' persisting over multiple quarters. This MOST likely indicates:

An unusually healthy patient population
A data migration error from a software upgrade
Inadequate follow-up tracing procedures or insufficient resources (Correct answer)
Overcoding of the unknown category by staff

Correct answer: Inadequate follow-up tracing procedures or insufficient resources

A sustained high rate of unknown vital status typically signals that follow-up tracing processes are insufficiently resourced or systematically incomplete.

Question 178: Which of the following would NOT be reportable to a hospital cancer registry under standard ACOS CoC guidelines?

Metastatic colon cancer first diagnosed at the facility
In situ carcinoma of the cervix diagnosed and treated at the facility
Recurrent breast cancer treated at the facility
Basal cell carcinoma of the skin diagnosed at the facility (Correct answer)

Correct answer: Basal cell carcinoma of the skin diagnosed at the facility

Basal cell carcinoma of the skin is generally excluded from cancer registry reporting under ACOS CoC guidelines.

Question 179: A program receives its NCDB benchmark report showing that its lymph node examination rate for colon cancer is significantly below the national rate. The BEST next step is to:

Ignore the benchmark as it reflects national data, not local practice
Present findings to the Cancer Committee and initiate a clinical study (Correct answer)
Submit a variance report to the CoC
Recode the cases to improve the rate

Correct answer: Present findings to the Cancer Committee and initiate a clinical study

Benchmark discrepancies should be presented to the Cancer Committee, which may initiate a clinical study to investigate and improve clinical practice.

Question 180: Which term describes the total number of persons living with a cancer diagnosis at a given point in time?

Mortality
Incidence
Prevalence (Correct answer)
Case fatality rate

Correct answer: Prevalence

Prevalence measures the total existing cancer case burden in a population at a specific time, combining new and existing survivors.

Oncology Data Specialist (ODS) / Certified Tumor Registrar (CTR) Exam

The ODS (formerly CTR) certification exam tests competency in cancer registry operations, data identification, coding, abstraction, and legal/ethical standards for oncology data professionals. It is administered by the National Cancer Registrars Association (NCRA).

180

Questions

240 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds