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

Question 1: In survival analysis, what is a 'censored observation'?

A patient who refused treatment
A patient excluded due to incomplete staging data
A patient whose outcome is unknown or who left the study before the event occurred (Correct answer)
A patient who died from the cancer under study

Correct answer: A patient whose outcome is unknown or who left the study before the event occurred

A censored observation is one where the exact event time is unknown because the patient was lost to follow-up, withdrew, or the study ended before the event.

Question 2: A cancer registry is transitioning from paper-based to electronic abstracting. To comply with HIPAA, paper records containing PHI that are no longer needed must be:

Recycled in standard paper bins to reduce environmental impact
Disposed of by shredding, burning, or pulping to render the PHI unreadable (Correct answer)
Returned to the patient upon request before disposal
Stored indefinitely in case of future audits

Correct answer: Disposed of by shredding, burning, or pulping to render the PHI unreadable

HIPAA requires that PHI in paper form be disposed of in a manner that renders the information unreadable, indecipherable, and unable to be reconstructed.

Question 3: What is the PRIMARY purpose of continuing education requirements in Follow-Up & Survival Analysis for CTR professionals?

Maintaining current knowledge and competency as the field evolves (Correct answer)
Networking with other professionals in the field
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 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 4: Which hematologic malignancy is most classically associated with the Philadelphia chromosome (t(9;22) BCR-ABL translocation)?

Chronic myelogenous leukemia (CML) (Correct answer)
Acute lymphoblastic leukemia (ALL) in pediatric patients
Multiple myeloma
Hodgkin lymphoma

Correct answer: Chronic myelogenous leukemia (CML)

The Philadelphia chromosome, resulting from the t(9;22) translocation that creates the BCR-ABL fusion oncogene, is the defining genetic abnormality of chronic myelogenous leukemia (CML).

Question 5: Which NAACCR data item captures whether a case was identified through a non-hospital source such as a pathology laboratory or physician office?

Casefinding Source
Type of Reporting Source (Correct answer)
Reporting Facility
Class of Case

Correct answer: Type of Reporting Source

Type of Reporting Source documents the type of facility or source (e.g., hospital, laboratory, physician office) from which the case was identified.

Question 6: 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)
Recurrence TNM (rTNM)
Post-therapy TNM (ypTNM) (Correct answer)
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 7: In FIGO staging for gynecologic cancers, Stage IVB cervical cancer indicates:

Invasion of bladder or rectum
Parametrial invasion only
Extension to pelvic wall
Distant metastasis beyond the pelvis (Correct answer)

Correct answer: Distant metastasis beyond the pelvis

FIGO Stage IVB cervical cancer denotes spread to distant organs beyond the true pelvis, including distant lymph nodes.

Question 8: What documentation practice is considered essential in Coding & Classification Systems within the Certified Tumor Registrar field?

Using shorthand notes that can be expanded later if needed
Recording actions, observations, and outcomes in real-time or as close to the event as possible (Correct answer)
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 9: Which data quality concept refers to the registry capturing all required data fields for a reportable case, as opposed to capturing the case itself?

Item-level completeness (Correct answer)
Diagnostic verification
Submission timeliness
Case completeness

Correct answer: Item-level completeness

Item-level completeness measures the proportion of required fields that are coded versus missing within abstracted cases.

Question 10: 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?

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

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

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

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 12: A patient who was diagnosed at your facility emigrated to another country five years ago and cannot be traced. Per STORE data standards, this case should be coded as:

Alive — no follow-up required
Vital status unknown
Dead — cause unknown
Lost to follow-up (Correct answer)

Correct answer: Lost to follow-up

When all reasonable tracing efforts have been exhausted without determining vital status, the case is coded as lost to follow-up.

Question 13: In a reabstraction study comparing original abstractions to a gold standard, which statistic is calculated to measure inter-rater reliability for categorical data fields?

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

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 14: The Ki-67 index reported on a pathology report measures which tumor characteristic?

Proportion of actively proliferating cells within the tumor (Correct answer)
Tumor response to prior chemotherapy
Degree of tumor necrosis present
Extent of lymphovascular invasion

Correct answer: Proportion of actively proliferating cells within the tumor

Ki-67 is a nuclear protein expressed during active phases of the cell cycle; the Ki-67 index reflects the percentage of tumor cells actively dividing and is used as a proliferative marker.

Question 15: Which coding system is used to classify the primary site of cancer in the tumor registry abstract?

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

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 16: A state cancer registry is subject to a public records request under the state's open records law. The registry MOST likely:

Must release all requested records because public records laws override HIPAA
Has no legal basis to withhold any records from the public
Is exempt from disclosure because state cancer registry data is typically protected by state statute (Correct answer)
Must release aggregate data only after removing all geographic identifiers

Correct answer: Is exempt from disclosure because state cancer registry data is typically protected by state statute

Most states have enacted specific statutes exempting cancer registry data from public records laws to protect patient confidentiality.

Question 17: Which concept requires that cancer registry employees only access patient data necessary for their specific job functions?

Role-based access control
Data minimization
Need-to-know principle (Correct answer)
Least privilege

Correct answer: Need-to-know principle

The need-to-know principle restricts access to confidential information to only those individuals whose job duties require it.

Question 18: Which federal agency publishes the United States Cancer Statistics (USCS) report combining SEER and NPCR data?

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

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

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 Cancer Registry Data Collection.

Question 20: Under STORE manual guidelines, which condition would cause a case to be flagged as a potential duplicate?

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

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 21: Which NAACCR-defined data item records the facility where the patient was FIRST diagnosed with cancer, even if treatment occurred elsewhere?

Reporting Facility
Diagnostic Facility (Correct answer)
Managing Facility
Treating Facility

Correct answer: Diagnostic Facility

The Diagnostic Facility data item captures the institution where the initial cancer diagnosis was established, independent of where treatment was provided.

Question 22: A registrar is auditing cases and finds that 'race' is coded as unknown for 12% of cases. Which resource should be consulted to improve race coding accuracy?

ICD-O-3 Topography Index
AJCC Cancer Staging Manual
NAACCR Race and Ethnicity Code Set Volume II (Correct answer)
SEER Summary Staging Manual

Correct answer: NAACCR Race and Ethnicity Code Set Volume II

NAACCR publishes the Race and Ethnicity Code Set which provides standardized definitions and coding guidance for race data elements.

Question 23: Under STORE (Standards for Oncology Registry Entry) guidelines, how often should follow-up contact attempts be made for living patients?

Every 3 years
Every 2 years
Every 6 months
Annually (Correct answer)

Correct answer: Annually

STORE guidelines recommend annual follow-up contact attempts for all living registry patients to maintain current vital status.

Question 24: A new cancer registrar asks why the 'date of first contact' field is important for quality assurance. The BEST answer is:

It determines the patient's insurance coverage type
It identifies the pathologist who made the diagnosis
It determines the reporting deadline for the facility
It establishes the beginning of the follow-up timeline for the patient (Correct answer)

Correct answer: It establishes the beginning of the follow-up timeline for the patient

Date of first contact establishes when the patient first became known to the facility, which anchors the start of follow-up activity and survival calculations.

Question 25: A physician documents 'probable lymphoma' in a patient's chart but no biopsy is performed. Under standard reporting rules, this case is:

Reportable only after 3 months of watchful waiting
Not reportable because histology is absent
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 26: Which NAACCR standard level requires the most complete set of data items for a cancer registry abstract?

Gold Certified (Correct answer)
Silver Certified
Platinum Certified
Bronze Certified

Correct answer: Gold Certified

NAACCR Gold Certification represents the highest completeness standard, requiring the greatest number of fully populated required data items.

Question 27: Which NAACCR data item is used to assess whether a case was identified through active or passive case-finding methods?

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

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 28: A state central registry receives a death certificate listing 'carcinoma of the lung' as cause of death with no prior case record. The standard procedure is to:

Add it as a DCO case and attempt follow-back to find the treating facility (Correct answer)
Automatically code it as a non-analytic case
Report it immediately to CDC without further investigation
Discard it because no hospital record exists

Correct answer: Add it as a DCO case and attempt follow-back to find the treating facility

DCO cases undergo death certificate follow-back to locate treating facilities and obtain clinical details to complete the record.

Question 29: A state cancer registry finds that a specific hospital's submission has a 30% higher rate of 'unknown' stage compared to similar facilities. The BEST first investigative step is to:

Submit a correction to NAACCR
Conduct a targeted audit comparing the hospital's source records to its submitted data (Correct answer)
Recode 'unknown' to the most common stage for that site
Remove all 'unknown stage' cases from analysis

Correct answer: Conduct a targeted audit comparing the hospital's source records to its submitted data

A targeted audit identifies whether the high 'unknown' rate reflects true data limitations or a systematic coding or casefinding error at that facility.

Question 30: 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
CoC
SEER

Correct answer: NAACCR

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

Question 31: Which standard of practice is MOST important for ensuring quality in Confidentiality & Data Security?

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

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

Question 32: Which of the following is a defining feature that distinguishes malignant tumors from benign tumors?

Capacity to invade and metastasize to distant sites (Correct answer)
Presence of a well-defined fibrous capsule
Slow, expansile growth pattern
Close histological resemblance to tissue of origin

Correct answer: Capacity to invade and metastasize to distant sites

The hallmark of malignancy is the ability of tumor cells to invade surrounding tissue and spread (metastasize) to distant organs, which benign tumors cannot do.

Question 33: Which accreditation body sets standards for hospital-based cancer registries in the United States?

Centers for Medicare & Medicaid Services (CMS)
National Institutes of Health (NIH)
American College of Surgeons (ACoS) Commission on Cancer (Correct answer)
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 34: Under CoC standards, what is the maximum allowable time between diagnosis and completion of the cancer registry abstract?

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

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 35: 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?

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

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 36: In the context of cancer registry data management, 'edit checks' primarily serve to:

Authorize access to the registry database
Detect and flag inconsistent or out-of-range data values (Correct answer)
Calculate survival statistics automatically
Generate follow-up letters to patients

Correct answer: Detect and flag inconsistent or out-of-range data values

Edit checks are automated rules that identify data entries that are logically inconsistent, missing, or outside acceptable value ranges.

Question 37: 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 1%
Less than 20%
Less than 15%
Less than 5% (Correct answer)

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 38: 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 39: Which of the following scenarios would trigger a 'suspense' status in a cancer registry case?

The case is determined to be non-reportable after initial review
The case is a duplicate of a previously entered record
The case is identified but awaiting pathology or treatment information to complete abstraction (Correct answer)
The case is fully abstracted and submitted to the state

Correct answer: The case is identified but awaiting pathology or treatment information to complete abstraction

A suspense file holds cases that have been identified as reportable but cannot yet be fully abstracted because key information (pathology, treatment) is still pending.

Question 40: Adenocarcinoma is a malignancy arising from which tissue type?

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

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

HL7 FHIR JSON
XML HL7 v2
NAACCR flat file (fixed-width text format) (Correct answer)
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 42: A patient receives a diagnosis of carcinoma in situ of the cervix (CIN III). Under most state and central registry rules, this case is:

Not reportable because it is in situ (Correct answer)
Reportable as an invasive cancer
Reportable only if the patient subsequently develops invasive cancer
Reportable as a non-malignant tumor

Correct answer: Not reportable because it is in situ

Carcinoma in situ of the cervix (CIN III) is generally excluded from central cancer registry reporting because it is not invasive cancer.

Question 43: Which of the following methods is typically used for passive follow-up?

Physician interview
National Death Index search (Correct answer)
Phone call to the patient
Review of hospital records

Correct answer: National Death Index search

Passive follow-up methods involve obtaining patient status updates without direct contact with the patient or their physician. A National Death Index search is a prime example, as it allows Certified Tumor Registrars to ascertain a patient's vital status by cross-referencing their records with national death databases. This method efficiently provides crucial survival data without requiring direct communication.

Question 44: 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 percentage of cases with complete treatment information
The proportion of all cancer cases in the catchment area that are captured by the registry (Correct answer)
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 45: 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
Only documenting unusual events or complications
Recording actions, observations, and outcomes in real-time or as close to the event as possible (Correct answer)
Completing all documentation at the end of the workday

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 46: A tumor registry receives a diagnosis of 'carcinoma in situ of the cervix' (CIN III). What ICD-O-3 behavior code applies?

/3
/0
/1
/2 (Correct answer)

Correct answer: /2

Carcinoma in situ is assigned ICD-O-3 behavior code /2, indicating non-invasive (in situ) malignancy.

Question 47: A patient with CML (chronic myelogenous leukemia) is diagnosed via bone marrow biopsy. Which topography code is correct?

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

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 48: 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
Leave the field blank
Query the pathologist to confirm absence before coding
Code 'not applicable' or the appropriate 'not documented' code per SEER/STORE rules (Correct answer)

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 49: What information is typically abstracted in the 'first course of treatment' section?

All treatments given throughout life
Treatments unrelated to the diagnosis
Initial cancer-directed therapies (Correct answer)
Only experimental therapies

Correct answer: Initial cancer-directed therapies

The 'first course of treatment' section in a cancer abstract documents the initial therapies administered to a patient specifically to treat their cancer. This typically includes surgery, radiation, chemotherapy, hormone therapy, or immunotherapy given within a defined period after diagnosis. This data is crucial for understanding initial treatment patterns and evaluating their effectiveness.

Question 50: 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:

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

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 51: A registry quality control audit finds that 8% of cases are missing the Lymph-vascular Invasion data item. The BEST corrective action is to:

Submit the cases as-is to the state registry
Recode all missing values to 'unknown'
Remove the data item from the registry database
Implement targeted reabstracting of cases with missing data and retrain staff (Correct answer)

Correct answer: Implement targeted reabstracting of cases with missing data and retrain staff

Reabstracting and retraining address both the existing data gap and the root cause to prevent future missing data.

Question 52: Which coding system is typically used to determine if a case is reportable?

SNOMED
CPT
ICD-10-CM
ICD-O-3 (Correct answer)

Correct answer: ICD-O-3

The International Classification of Diseases for Oncology, Third Edition (ICD-O-3) is the standard coding system specifically used by cancer registries to classify the topography (site) and morphology (histology/behavior) of neoplasms. This system is essential for determining if a case meets the criteria for reportability to the cancer registry. While ICD-10-CM is used for general medical diagnoses, ICD-O-3 is specialized for cancer coding and reportability.

Question 53: Which standard-setter publishes the rules that define the 'casefinding' process used by hospital cancer registries accredited by the American College of Surgeons?

SEER
NAACCR
CoC (Commission on Cancer) (Correct answer)
CDC NPCR

Correct answer: CoC (Commission on Cancer)

The Commission on Cancer (CoC) sets casefinding standards for accredited hospital cancer registries through its STORE manual.

Question 54: Under CoC standards, what is the required turnaround time for completing an abstract after the patient's first contact at the facility?

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

Correct answer: 6 months

The Commission on Cancer requires that abstracts be completed within 6 months of a patient's first contact at the reporting facility.

Question 55: How does risk management apply to daily practice in Registry Operations & Management for Certified Tumor Registrar professionals?

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

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

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

Question 56: Which laboratory technique uses antibodies to detect specific proteins expressed by tumor cells and is routinely reported on pathology reports?

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

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

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

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 58: In the SEER program, what is the standard follow-up interval used to calculate 5-year relative survival rates?

10 years
5 years (Correct answer)
3 years
2 years

Correct answer: 5 years

SEER reports 5-year relative survival rates as the standard benchmark for comparing cancer survival across populations.

Question 59: Under STORE (Standards for Oncology Registry Entry), what is the rule for coding a synchronous primary when both tumors arise in paired organs?

Report only the higher-stage tumor
Combine into one record with bilateral site code
Each tumor is reported as a separate primary with its own accession number (Correct answer)
Report only if histologies differ

Correct answer: Each tumor is reported as a separate primary with its own accession number

STORE rules require that synchronous primaries in paired organs be reported as separate primaries, each with its own accession number.

Question 60: A registrar discovers two abstracts in the database for the same patient with different medical record numbers. What is this situation called?

Over-reporting error
Duplicate record (Correct answer)
Registry fragmentation
Benign data collision

Correct answer: Duplicate record

Two records for the same patient are called duplicates, and merging or deduplicating them is essential for data integrity.

Question 61: What documentation practice is considered essential in Registry Operations & Management within the Certified Tumor Registrar field?

Only documenting unusual events or complications
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

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 Registry Operations & Management ensures accuracy, provides a contemporaneous record, and is considered the gold standard for professional accountability and legal defensibility.

Question 62: A registrar reviews a case where surgery removed a colon tumor and 18 lymph nodes were examined, with 3 positive. How should the regional lymph node fields be coded?

Number examined: 0, number positive: 3
Number examined: 18, number positive: 3 (Correct answer)
Number examined: 3, number positive: 18
Number examined: 18, number positive: 0

Correct answer: Number examined: 18, number positive: 3

Both the total nodes examined and the number of positive nodes are recorded separately to support accurate N-category staging.

Question 63: Which measure expresses the probability of dying FROM cancer (rather than with it) over a specified time period?

Overall survival rate
Disease-free survival rate
Cause-specific survival rate (Correct answer)
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 64: When should a tumor registrar assign a 'Stage Unknown' rather than 'Unstaged' in SEER summary staging?

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

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 65: The term 'anaplastic' when describing a tumor indicates:

Tumor cells are well-differentiated and slow growing
Tumor is confined to the primary site without invasion
Tumor cells lack differentiation and typically behave aggressively (Correct answer)
Tumor cells are highly differentiated with favorable prognosis

Correct answer: Tumor cells lack differentiation and typically behave aggressively

Anaplastic tumors are characterized by a complete loss of differentiation, pleomorphic nuclei, and high mitotic activity, generally correlating with aggressive clinical behavior.

Question 66: In registry management, 'timeliness' is most commonly measured by tracking the time from:

Date of surgery to date of pathology report
Date of diagnosis to date of abstract completion (Correct answer)
Date of referral to date of first treatment
Date of admission to date of discharge

Correct answer: Date of diagnosis to date of abstract completion

Registry timeliness is standardly measured as the interval from the patient's date of diagnosis to the date the abstract is completed and entered into the database.

Question 67: In a population-based cancer registry, which source is typically most complete for ascertaining all cancer cases?

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

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

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

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 69: A hospital is completing its CoC survey and must demonstrate that the Cancer Committee reviewed registry data quality reports. What is the minimum meeting frequency required by CoC standards?

Monthly
Biannually (twice per year)
Quarterly (Correct answer)
Annually

Correct answer: Quarterly

CoC standards require the Cancer Committee to meet at least quarterly to review program activities including registry performance and quality data.

Question 70: Which data item in the NAACCR record layout captures the ICD-O-3 histology morphology code along with its behavior digit?

Grade (Item #440)
Morphology Code ICD-O-2 (Item #420)
Histologic Type ICD-O-3 (Item #522) (Correct answer)
Primary Site (Item #400)

Correct answer: Histologic Type ICD-O-3 (Item #522)

NAACCR Item #522 (Histologic Type ICD-O-3) records the 4-digit morphology code, and Item #523 captures the behavior digit.

Question 71: 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:

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

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 72: Which element is essential in follow-up data collection?

Physician's signature
Last date of contact (Correct answer)
Billing code
Insurance policy number

Correct answer: Last date of contact

The 'last date of contact' is a critical element in follow-up data collection because it establishes the most recent point at which a patient's vital status and disease status were known. This date is essential for accurately calculating survival rates and understanding the long-term outcomes of cancer patients. Without it, the registry cannot precisely track patient progress or determine follow-up compliance.

Question 73: When the medical record documents that chemotherapy was recommended but the patient never started treatment, the RX Summ–Chemo field should be coded as:

1 – Chemotherapy administered
0 – None; chemotherapy was not administered (Correct answer)
9 – Unknown
8 – Recommended, unknown if 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 74: Which STORE code is used when a patient receives radiation therapy as the first course of treatment?

Code 3
Code 1 (Correct answer)
Code 2
Code 0

Correct answer: Code 1

STORE Code 1 indicates that radiation therapy was administered as part of the first course of treatment.

Question 75: Which NAACCR standard item is used to flag a data element that was reviewed and confirmed as correct, even if it appears unusual?

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

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

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

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

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

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 78: In cancer registry epidemiology, 'denominator data' refers to:

The total number of cancer cases in the numerator
The number of registry-certified hospitals in a region
Population counts used to calculate incidence and mortality rates (Correct answer)
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 79: A cancer registrar discovers that a group of cases from the outpatient oncology clinic was never reported due to a breakdown in the casefinding process. What is the appropriate response?

Note the gap in the annual report and move forward
Perform a retrospective review and abstract all missed reportable cases (Correct answer)
Report only cases with active treatment
Abstract only the most recent cases to save time

Correct answer: Perform a retrospective review and abstract all missed reportable cases

All missed reportable cases should be identified and abstracted retrospectively to maintain database completeness and integrity.

Question 80: 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?

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

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 81: Which best describes the purpose of the 'Date of Death' field in a tumor registry abstract?

Records when the death certificate was issued
Captures the actual date the patient died for survival analysis (Correct answer)
Documents the date the registry was notified of the death
Indicates when the case was closed in the registry

Correct answer: Captures the actual date the patient died for survival analysis

Date of death is used in survival calculations and must reflect the actual date the patient died, not administrative dates.

Question 82: 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 83: A registrar is abstracting a case where the patient was diagnosed with breast cancer at an outside facility, had surgery there, and came to your hospital for post-mastectomy radiation only. What class of case is this?

Class 0 – Non-reportable
Class 1 – Analytic, diagnosed and treated at your facility
Class 3 – Non-analytic, consultation only
Class 2 – Analytic, treated at your facility after diagnosis elsewhere (Correct answer)

Correct answer: Class 2 – Analytic, treated at your facility after diagnosis elsewhere

A case diagnosed elsewhere but receiving a portion of first course treatment at your facility is classified as a Class 2 analytic case.

Question 84: In the context of tumor staging, what is the significance of 'extranodal extension' (ENE) in head and neck cancers?

It has no impact on AJCC staging but affects treatment planning only
It automatically assigns Stage IV disease
It upgrades the T category by one level
It upgrades regional node involvement to N3b in AJCC 8th edition (Correct answer)

Correct answer: It upgrades regional node involvement to N3b in AJCC 8th edition

In AJCC 8th edition head and neck cancers, pathologically confirmed extranodal extension upgrades nodal status to N3b, indicating aggressive disease.

Question 85: Under STORE manual guidelines, which scenario requires the registrar to submit a correction to a previously submitted case?

The treating physician retires
A subsequent pathology report changes the histology to a more specific code (Correct answer)
A patient moves to a different state
A follow-up letter is returned as undeliverable

Correct answer: A subsequent pathology report changes the histology to a more specific code

New pathologic information that changes a coded field requires the registry to update and resubmit the corrected record to maintain data accuracy.

Question 86: A CTR reviewing registry operations notices that the percentage of cases with 'unknown' race is 15%. The BEST corrective action is to:

Implement a more thorough review of all available source documents including face sheets and nursing notes (Correct answer)
Assign the most common race in the facility's population to unknown cases
Accept the rate as within normal limits and document it in the annual report
Request that the medical staff begin documenting race more consistently

Correct answer: Implement a more thorough review of all available source documents including face sheets and nursing notes

Thorough secondary source review — including registration face sheets, nursing notes, and other records — is the standard method for resolving unknown demographic data before defaulting to 'unknown.'

Question 87: Which survival calculation method accounts for patients who are lost to follow-up by censoring their data at the last known contact date?

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

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 88: Which of the following hematologic diagnoses is NOT reportable to a hospital cancer registry?

Iron deficiency anemia (Correct answer)
Chronic lymphocytic leukemia (CLL)
Hodgkin lymphoma
Multiple myeloma

Correct answer: Iron deficiency anemia

Iron deficiency anemia is a benign nutritional/hematologic condition, not a neoplasm, and is not reportable to the cancer registry.

Question 89: When performing casefinding, a registrar discovers a death certificate listing 'carcinoma of the pancreas' with no prior hospital record. What action is required?

Create a death certificate only (DCO) case (Correct answer)
Report to the state registry only
Ignore it since there is no hospital record
Contact the physician to obtain treatment records

Correct answer: Create a death certificate only (DCO) case

A death certificate only (DCO) case is created when the death certificate is the sole source of cancer information and no prior medical records can be obtained.

Question 90: When a patient is diagnosed with two separate primary cancers simultaneously, how should a tumor registrar abstract the case?

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

Correct answer: Abstract both as separate accession records

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

Question 91: A patient with colorectal cancer receives bevacizumab along with FOLFOX. How should bevacizumab be classified?

Hormone therapy
Targeted therapy (Correct answer)
Immunotherapy
Chemotherapy

Correct answer: Targeted therapy

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

Question 92: Which federal legislation most directly governs the sharing of patient follow-up information between cancer registries across state lines?

Affordable Care Act
Cancer Registries Amendment Act (CRAA) (Correct answer)
Clinical Laboratory Improvement Amendments (CLIA)
HIPAA Privacy Rule

Correct answer: Cancer Registries Amendment Act (CRAA)

The Cancer Registries Amendment Act (CRAA) specifically authorizes data sharing among central cancer registries for follow-up and research purposes.

Question 93: 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
State mandatory reporting laws create a HIPAA-permitted public health disclosure exception (Correct answer)
The hospital and state have a longstanding informal agreement
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 94: Which type of cancer registry collects data from an entire defined geographic population regardless of where treatment occurs?

Disease registry
Special purpose registry
Population-based registry (Correct answer)
Hospital-based 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 95: In cancer epidemiology, what does a 'cohort study' examine?

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

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

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
To assess the timeliness of data submissions to the state registry

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 97: 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 hold cases with incomplete information pending follow-up (Correct answer)
To store cases that have been deleted from the database

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

Squamous cell carcinoma
Adenocarcinoma (Correct answer)
Small cell carcinoma
Large cell undifferentiated 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 99: Which document serves as the primary source for verifying reportability and completeness in a hospital tumor registry?

Pathology report (Correct answer)
Discharge summary
Operative report
Radiology report

Correct answer: Pathology report

The pathology report is the gold-standard primary source for confirming diagnosis, histology, and reportability of a cancer case.

Question 100: When a tumor registrar identifies a discrepancy between the abstracted TNM stage and the stage documented by the physician in the medical record, the correct action is to:

Use the lower stage to avoid overstaging
Always defer to the physician's documented stage
Leave the field blank until the physician is consulted
Apply AJCC staging rules independently and document the discrepancy (Correct answer)

Correct answer: Apply AJCC staging rules independently and document the discrepancy

Registrars are trained to apply AJCC rules based on all available information and must document any discrepancy with the physician's stage in the record.

Question 101: In ICD-O-3 coding, which histology code is used for 'adenocarcinoma, NOS'?

8140/3 (Correct answer)
8000/3
8010/3
8500/3

Correct answer: 8140/3

Histology code 8140/3 represents adenocarcinoma, NOS (not otherwise specified) in ICD-O-3.

Question 102: Which registry item captures the extent of disease based on physical exam, imaging, and surgery BEFORE any treatment?

Post-therapy stage
Pathologic stage
Clinical stage (Correct answer)
Autopsy stage

Correct answer: Clinical stage

Clinical stage is assigned using all information available prior to the initiation of treatment.

Question 103: Which of the following BEST describes the term 'casefinding' as it relates to cancer registry data management?

The process of updating vital status through follow-up
The assignment of ICD-O topography and morphology codes
The review of data for coding accuracy
The systematic identification of all reportable cancer cases treated at a facility (Correct answer)

Correct answer: The systematic identification of all reportable cancer cases treated at a facility

Casefinding is the process of systematically identifying all reportable cancer cases seen at a facility to ensure registry completeness.

Question 104: How often should casefinding be performed in a hospital-based registry?

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

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 105: Under the SEER Program, 'complete dates' (month, day, and year) are preferred over partial dates. When only the year of diagnosis is known, the registrar should:

Record the date the pathology report was signed as the diagnosis date
Use January 1st of the diagnosis year as a default
Leave all date fields blank until the complete date is verified
Record the year with unknown month (99) and unknown day (99) flags (Correct answer)

Correct answer: Record the year with unknown month (99) and unknown day (99) flags

SEER coding rules specify that known date components should be recorded with unknown-value flags (e.g., 99) for missing month and day, preserving partial information.

Question 106: The STORE manual (Standards for Oncology Registry Entry) is published by which organization?

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

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 107: A CTR is preparing the annual follow-up report and calculates a follow-up rate of 79% for living patients. According to CoC standards, this rate is:

Below standard — CoC requires 90% follow-up
Acceptable — no minimum threshold exists
Acceptable — exceeds the 75% threshold
Below standard — CoC requires at least 80% for living patients (Correct answer)

Correct answer: Below standard — CoC requires at least 80% for living patients

CoC requires an 80% follow-up rate for living patients; a 79% rate falls below this standard.

Question 108: When should a tumor registrar use the 'autopsy only' class of case?

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

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 109: 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)
All cancer patients in the registry regardless of type
Patients with the same cancer who received no treatment
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 110: The concept of 'lead time bias' in cancer screening studies refers to:

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

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

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

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 112: Observed survival differs from relative survival in that observed survival:

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

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

Colorectal cancer
Prostate cancer
Breast 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 114: What is the primary purpose of the North American Association of Central Cancer Registries (NAACCR)?

To publish clinical treatment guidelines
To fund individual hospital registry programs
To set data standards and certify central cancer registries in North America (Correct answer)
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 115: How does the NCDB use cancer registry data?

To fund new hospitals
To assess registry staff performance
To support quality improvement and benchmarking (Correct answer)
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 116: When a conflict arises between standard procedures and a unique situation in Staging & Prognostic Factors, what should a CTR professional prioritize?

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

Correct answer: Safety and ethical obligations while seeking expert consultation

Safety and ethics always take priority in Staging & Prognostic Factors. 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 117: A mastectomy is performed, and a sentinel lymph node biopsy removes 2 nodes with 1 positive. What value goes in Regional Nodes Positive?

99
0
1 (Correct answer)
2

Correct answer: 1

Regional Nodes Positive records only the number of lymph nodes found to contain metastatic cancer, which is 1 in this case.

Question 118: Which follow-up method involves contacting the patient's physician to determine current vital status?

Passive follow-up
Obituary search
Active follow-up (Correct answer)
Death certificate linkage

Correct answer: Active follow-up

Active follow-up involves direct contact with physicians, patients, or family members to obtain current vital status.

Question 119: What is the primary purpose of abstracting in a cancer registry?

To generate treatment protocols
To analyze tumor registry finances
To extract and code cancer data (Correct answer)
To validate patient insurance details

Correct answer: To extract and code cancer data

Abstracting is the core process in a cancer registry where trained registrars review patient medical records to identify, extract, and code specific information related to a cancer diagnosis. This includes details about the tumor, patient demographics, treatment, and follow-up. The coded data forms the foundation for all registry analyses and reporting.

Question 120: When a conflict arises between standard procedures and a unique situation in Data Quality & Completeness, what should a CTR professional prioritize?

The most cost-effective solution available
Strict adherence to written procedures without exception
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 Data Quality & Completeness. 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 121: When a cancer registry performs a casefinding sweep of death certificates, what is the primary goal related to follow-up?

Identify new primary cancers not previously registered
Update vital status of existing registry cases to deceased (Correct answer)
Verify treatment information
Calculate cause-specific mortality rates

Correct answer: Update vital status of existing registry cases to deceased

Death certificate sweeps allow registries to update the vital status of previously registered patients who have since died.

Question 122: Under SEER program requirements, which tumors are reportable even when histology is not confirmed by biopsy?

Only tumors staged as IV are reportable without biopsy
Only carcinomas with imaging confirmation
Tumors must always have pathologic confirmation to be reportable
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 123: When abstracting a case with multiple tumors in the same organ, which set of rules governs whether they are counted as one or multiple primaries?

ICD-10-CM combination code guidelines
NCCN clinical practice guidelines
AJCC TNM staging manual
SEER Multiple Primary and Histology (MP/H) coding rules (Correct answer)

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

The SEER MP/H rules provide site-specific and histology-specific instructions for determining the number of primaries.

Question 124: Which of the following best describes a 'limited data set' as defined by HIPAA?

Fully de-identified data approved for unrestricted public release
Data that excludes most direct identifiers but may retain dates and geographic information below state level (Correct answer)
Data with all 18 HIPAA identifiers removed
Data containing only diagnosis codes and no demographic information

Correct answer: Data that excludes most direct identifiers but may retain dates and geographic information below state level

A limited data set removes most direct identifiers but may include dates (e.g., admission, discharge, birth) and geographic subdivisions smaller than a state.

Question 125: A patient undergoes a lumpectomy for breast cancer followed by radiation. How is the radiation coded in the treatment fields?

Coded as adjuvant therapy in a separate field
As part of surgery since it follows the procedure
As a separate first-course treatment modality (Correct answer)
Only coded if it was given within 30 days of surgery

Correct answer: As a separate first-course treatment modality

Radiation therapy is coded as a separate first-course treatment modality, regardless of sequence with surgery.

Question 126: 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 counted only for the state where the patient resides
It is a non-analytic case only if the patient had prior treatment elsewhere
It is not reportable because the patient does not reside in the state

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 127: 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?

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

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

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

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 129: A patient is diagnosed with lung cancer at an outside facility and comes to your hospital only for a second opinion with no treatment rendered. How should this case be handled?

Abstract as a non-analytic case (Correct answer)
Do not abstract; the case is not reportable
Abstract as an analytic case
Abstract only if the physician documents agreement with diagnosis

Correct answer: Abstract as a non-analytic case

A case diagnosed elsewhere where only a second opinion (consultation) is provided without treatment is abstracted as a non-analytic case.

Question 130: According to SEER program guidelines, which of the following is NOT a reportable condition?

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

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 131: A registrar discovers that a surgical pathology report and a cytology report for the same patient describe different histologies. To ensure data quality, the registrar should:

Code the histology from the most specific specimen type, typically surgical pathology (Correct answer)
Average the two histology codes
Report both histologies as separate primaries
Code the histology from the first report received

Correct answer: Code the histology from the most specific specimen type, typically surgical pathology

SEER coding rules prioritize the most specific tissue diagnosis; surgical pathology generally supersedes cytology when both are available for the same site.

Question 132: According to ICD-O-3, which topography code represents the upper-outer quadrant of the breast?

C50.8
C50.4 (Correct answer)
C50.2
C50.0

Correct answer: C50.4

C50.4 designates the upper-outer quadrant of the breast in ICD-O-3 topography coding.

Question 133: What documentation practice is considered essential in Data Quality & Completeness within the Certified Tumor Registrar field?

Completing all documentation at the end of the workday
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
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 Data Quality & Completeness ensures accuracy, provides a contemporaneous record, and is considered the gold standard for professional accountability and legal defensibility.

Question 134: What is the standard follow-up rate required by the Commission on Cancer (CoC)?

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

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

Private insurance cancer databases
Hospital-based cancer registries only
Veterans Affairs registries
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 136: Which tool is commonly used for identifying data entry errors in a cancer registry?

Coding summaries
Abstracting guidelines
Financial reports
Edit checks (Correct answer)

Correct answer: Edit checks

Edit checks are automated or manual processes designed to identify inconsistencies, errors, or missing information in data fields during or after data entry. These tools compare entered data against predefined rules and ranges, flagging potential mistakes. They are essential for maintaining the accuracy and integrity of cancer registry data by catching errors early.

Question 137: Under STORE rules, when a patient has a single histologic diagnosis of 'adenosquamous carcinoma,' how many primaries should be abstracted?

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

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

NCDB covers a larger share of U.S. cancer cases from CoC-accredited hospitals (Correct answer)
NCDB provides longer follow-up periods for survival analysis
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 139: Stage grouping of 'Stage 0' in most AJCC cancer sites refers to which condition?

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

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 140: 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 most recent document in the medical record
The physician's notes, as the treating physician has final authority

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 141: What is the purpose of the 'Palliative Care' field in the treatment summary?

To flag cases excluded from survival analysis
To record the final chemotherapy regimen
To document hospice enrollment date
To indicate treatment aimed at symptom relief rather than cure (Correct answer)

Correct answer: To indicate treatment aimed at symptom relief rather than cure

The Palliative Care field flags whether treatment was intended to relieve symptoms and improve quality of life rather than achieve cure or remission.

Question 142: Which term describes the total number of persons living with a cancer diagnosis at a given point in time?

Incidence
Prevalence (Correct answer)
Mortality
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.

Question 143: Under AJCC 8th edition, which prefix is applied to the T, N, or M category to indicate staging performed after neoadjuvant therapy?

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

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 144: A registrar notes 'angiolymphatic invasion present' on the pathology report. Which prognostic factor category does this represent?

Site-specific factor
Perineural invasion
Lymphovascular invasion (LVI) (Correct answer)
Grade descriptor

Correct answer: Lymphovascular invasion (LVI)

Angiolymphatic invasion is synonymous with lymphovascular invasion (LVI) and is a recognized adverse prognostic factor recorded by tumor registrars.

Question 145: 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 146: When should the abstract be completed after diagnosis in most registries?

Within 1 year
After treatment ends
Within 6 months (Correct answer)
Within 30 days

Correct answer: Within 6 months

Most cancer registries, particularly those accredited by the CoC, require abstracts to be completed within a specific timeframe after the date of diagnosis. A common standard is within six months to ensure timely data collection and reporting. This allows for prompt analysis and contribution to national databases, supporting current research and quality initiatives.

Question 147: 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
Conduct a comprehensive assessment and gather all relevant information (Correct answer)
Consult with a supervisor before taking any action

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 148: Which federal law specifically establishes the foundation for cancer registry confidentiality protections in relation to public health reporting?

The Cancer Registries Amendment Act (CCRAA) (Correct answer)
The Federal Records Act
The Affordable Care Act (ACA)
The Freedom of Information Act (FOIA)

Correct answer: The Cancer Registries Amendment Act (CCRAA)

The Cancer Registries Amendment Act of 1992 established the National Program of Cancer Registries (NPCR) and includes provisions for the confidentiality of cancer registry data.

Question 149: Which prognostic factor is used specifically for breast cancer staging and reflects tumor cell proliferation rate?

Ki-67 index (Correct answer)
PSA level
AFP level
CEA 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 150: Which of the following data items is REQUIRED on a follow-up contact form to satisfy CoC documentation standards?

Date of contact and vital status at time of contact (Correct answer)
Patient's employment status
Patient's insurance carrier
Attending physician's NPI number

Correct answer: Date of contact and vital status at time of contact

CoC documentation requires at minimum the date of contact and the patient's vital status to count as a valid follow-up contact.

Question 151: Triple-negative breast cancer (TNBC) is defined by the absence of which three receptors or proteins?

ER, HER2, and BRCA1 mutation
PR, BRCA1, and BRCA2 mutation
Estrogen receptor (ER), progesterone receptor (PR), and HER2 (Correct answer)
HER2, EGFR, and VEGF

Correct answer: Estrogen receptor (ER), progesterone receptor (PR), and HER2

Triple-negative breast cancer lacks estrogen receptor, progesterone receptor, and HER2 overexpression, making it ineligible for hormone therapy or HER2-targeted agents.

Question 152: What does 'sequence number' indicate in a cancer registry abstract?

The registry's internal case queue number
The number of metastatic sites identified
The order in which treatment modalities were administered
The order of this tumor among all primary cancers diagnosed in the patient's lifetime (Correct answer)

Correct answer: The order of this tumor among all primary cancers diagnosed in the patient's lifetime

Sequence number identifies whether this is the patient's first, second, or subsequent primary cancer diagnosis.

Question 153: When a cancer registry performs a casefinding audit using death certificates, the key measure calculated is:

Crude incidence rate
Cause-specific survival rate
Death certificate only (DCO) percentage (Correct answer)
Case fatality rate

Correct answer: Death certificate only (DCO) percentage

The DCO percentage from death certificate linkage indicates cases that were not captured prospectively, serving as a proxy for registry completeness.

Question 154: When a cancer registry transitions to a new software system, which action should be performed FIRST before go-live?

Training all staff on the new system before any data entry begins
Notifying the state registry of the planned system change
Parallel testing by running both old and new systems simultaneously with the same cases (Correct answer)
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 155: Which data quality measure evaluates whether cases diagnosed at the reporting facility were reported within the required timeframe?

Accuracy rate
Duplicate rate
Completeness 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 156: A cancer registrar accidentally sends a report containing patient identifiers to the wrong email address. Under HIPAA, this event is INITIALLY classified as:

A potential breach requiring a risk assessment to determine reportability (Correct answer)
A business associate violation requiring immediate termination of the vendor
A minor incident with no reporting obligations
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 157: 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 158: Which AJCC staging element most directly influences 5-year survival rates reported by cancer registries?

Tumor grade
Treatment facility type
Stage at diagnosis (Correct answer)
Patient age at diagnosis

Correct answer: Stage at diagnosis

Stage at diagnosis is the single most powerful predictor of 5-year survival rates and is the primary stratifier in registry survival reports.

Question 159: Which STORE field records whether chemotherapy was given as part of the first course of treatment?

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

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 160: Which of the following best describes 'first-course treatment' in cancer registry terminology?

Chemotherapy administered during the first hospital admission
The first treatment modality initiated after diagnosis
Surgery performed within 30 days of diagnosis only
All treatment given with curative or palliative intent before disease progression or recurrence (Correct answer)

Correct answer: All treatment given with curative or palliative intent before disease progression or recurrence

First-course treatment encompasses all planned treatment given before the cancer progresses or a new regimen is started due to recurrence.

Question 161: When coding extent of disease for a breast cancer case, what does 'lymphovascular invasion (LVI) present' affect?

N category only
Prognostic stage grouping (Correct answer)
T category only
It has no effect on staging fields

Correct answer: Prognostic stage grouping

LVI presence is a prognostic factor that can influence the overall prognostic stage group in AJCC breast cancer staging.

Question 162: Which standard of practice is MOST important for ensuring quality in Reporting Requirements & Standards?

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

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

Question 163: Which of the following best describes 'concurrent abstraction' as a data quality strategy?

Entering data at the same time a pathology report is signed
Submitting data to the central registry in real time
Abstracting cases while the patient is still receiving treatment to capture data prospectively (Correct answer)
Having two registrars independently abstract the same case simultaneously

Correct answer: Abstracting cases while the patient is still receiving treatment to capture data prospectively

Concurrent abstraction involves registrars reviewing and coding cases while patients are still in the system, improving data completeness and timeliness.

Question 164: What is a requirement of a CoC-accredited cancer program?

Random billing audits
Monthly advertising reports
Registry participation in quality studies (Correct answer)
Weekly patient interviews

Correct answer: Registry participation in quality studies

A CoC-accredited cancer program is required to actively participate in quality improvement initiatives, often involving the cancer registry. This includes contributing data to national databases like the NCDB and engaging in studies that evaluate and improve the quality of cancer care. This ensures the program is continuously striving for excellence and contributing to broader cancer control efforts.

Question 165: In Registry Operations & Management, 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
Conduct a comprehensive assessment and gather all relevant information (Correct answer)
Consult with a supervisor before taking any action

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

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

Correct answer: 8120/3

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

Question 167: In hepatocellular carcinoma (HCC) staging, which system combines tumor characteristics with liver function (Child-Pugh score)?

Barcelona Clinic Liver Cancer (BCLC) (Correct answer)
MELD score
Milan criteria
AJCC TNM

Correct answer: Barcelona Clinic Liver Cancer (BCLC)

The BCLC staging system integrates tumor burden, liver function (Child-Pugh), and performance status to guide HCC treatment decisions.

Question 168: A hospital tumor registry is conducting a rapid case ascertainment (RCA) study. The PRIMARY purpose of RCA is to:

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

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 169: According to SEER guidelines, how should a registrar handle a case where the patient was diagnosed at autopsy with no prior cancer history?

Abstract as a DCO case
Abstract only if a pathology report is available
Abstract the case and code Basis of Diagnosis as 'autopsy only' (Correct answer)
Do not abstract the case since the patient is deceased

Correct answer: Abstract the case and code Basis of Diagnosis as 'autopsy only'

Autopsy-only cases are reportable and coded with the appropriate Basis of Diagnosis code to distinguish them from clinically diagnosed cases.

Question 170: Which U.S. national program collects population-based cancer incidence and survival data from registries across the country?

CoC (Commission on Cancer)
SEER (Surveillance, Epidemiology, and End Results) (Correct answer)
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 171: What patient demographic detail is critical in cancer abstracting?

Dietary habits
Vaccination records
Patient demographic details (Correct answer)
Employment history

Correct answer: Patient demographic details

Patient demographic details, such as age, sex, race, ethnicity, and place of residence, are critical in cancer abstracting. This information allows for epidemiological analysis, helping to identify cancer incidence and survival disparities among different population groups. It is essential for public health planning and targeted interventions.

Question 172: When coding the histology of a tumor described as 'poorly differentiated adenocarcinoma,' which grade code is assigned?

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

Correct answer: Grade 3

Poorly differentiated tumors are assigned Grade 3 in the standard four-tier grading system used in cancer registries.

Question 173: A patient is found in the National Death Index (NDI) with a cause of death listed as 'cardiac arrest.' The primary cancer was colon. How should the cancer registrar code the vital status?

Dead — cause unknown
Alive
Dead — cancer as underlying cause
Dead — other cause (Correct answer)

Correct answer: Dead — other cause

When NDI identifies the cause of death as a non-cancer condition, vital status is coded dead with another cause, not the cancer.

Question 174: A tumor registrar notices that the same patient has been abstracted twice under two different medical record numbers. This is an example of:

A duplicate record (Correct answer)
An incomplete abstract
A coding discrepancy
A casefinding error

Correct answer: A duplicate record

Duplicate records occur when the same patient is entered more than once in the registry, often due to multiple medical record numbers or facility visits.

Question 175: The 'Class of Case' field in a cancer registry distinguishes between:

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

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

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

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 177: A tumor registrar sees 'pN2(sn)' on a breast cancer report. What does '(sn)' indicate?

Sentinel node not identified
Supraclavicular node involvement
Staging by sentinel node biopsy (Correct answer)
Synchronous nodal disease

Correct answer: Staging by sentinel node biopsy

The suffix '(sn)' denotes that nodal classification was based on sentinel lymph node biopsy rather than full axillary dissection.

Question 178: Which of the following is NOT a required component of the CoC's casefinding audit?

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

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 179: Which of the following best describes the purpose of a 'casefinding audit' in a hospital cancer registry?

To assess the quality of treatment data
To evaluate the timeliness of case submission
To verify that staging codes are accurate
To confirm all reportable cancer cases are being identified and entered (Correct answer)

Correct answer: To confirm all reportable cancer cases are being identified and entered

A casefinding audit verifies that the registry's case identification process captures all reportable malignancies seen at the facility.

Question 180: What does age-adjusted (age-standardized) cancer rate allow researchers to do?

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

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.

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

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

ncra-usa.org — Renewal, eligibility, passing score, retake policy, score release, test dates, time limit, test delivery, fees, registration deadline · verified Oct 2026