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

Question 1: In cancer epidemiology, what does a 'cohort study' examine?

Randomized patients assigned to treatment or placebo
Cancer cases and matched controls interviewed about past exposures
A group followed over time to observe who develops cancer (Correct answer)
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 2: What documentation practice is considered essential in Confidentiality & Data Security within the Certified Tumor Registrar field?

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
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 Confidentiality & Data Security ensures accuracy, provides a contemporaneous record, and is considered the gold standard for professional accountability and legal defensibility.

Question 3: For colorectal cancer, which Dukes classification corresponds to AJCC Stage III?

Dukes C (Correct answer)
Dukes B
Dukes A
Dukes D

Correct answer: Dukes C

Dukes C corresponds to regional lymph node involvement, which aligns with AJCC Stage III colorectal cancer.

Question 4: Which date is used as the 'date of diagnosis' when a biopsy and a subsequent surgical resection both confirm malignancy?

Date the oncologist first evaluated the patient
Date the pathology report was signed
Date of the biopsy confirming malignancy (Correct answer)
Date of surgical resection

Correct answer: Date of the biopsy confirming malignancy

The date of diagnosis is the earliest date on which a definitive diagnosis of cancer was established, typically the biopsy date.

Question 5: A cancer registry manager receives a request from a life insurance company asking for a patient's cancer history to assess a policy application. The CORRECT response is to:

Require a signed, valid patient authorization before releasing any information (Correct answer)
Provide the information because insurance companies are authorized requesters
Share de-identified data since it does not reveal the specific patient
Refer the insurer directly to the treating oncologist

Correct answer: Require a signed, valid patient authorization before releasing any information

Disclosure to a life insurance company requires the patient's valid written authorization because this is not a treatment, payment, or healthcare operations purpose.

Question 6: 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
Hospital inpatients with chronic disease
Patients with the same cancer who received no treatment

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 7: A cancer registry uses a third-party cloud storage vendor to back up patient data. According to HIPAA, this vendor must sign which type of agreement?

A memorandum of understanding (MOU)
A data use agreement (DUA)
A qualified protective order
A business associate agreement (BAA) (Correct answer)

Correct answer: A business associate agreement (BAA)

Any vendor that creates, receives, maintains, or transmits PHI on behalf of a covered entity is a business associate and must sign a BAA.

Question 8: What action is required when a cancer registrar discovers that a previously submitted case was incorrectly classified as reportable?

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

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

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

Question 9: A central registry rejects a hospital's submission because 4% of records fail the 'Diagnosis Year vs. Date of Birth' edit. This is an example of which quality control mechanism?

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

Correct answer: Automated edit check at submission

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

Question 10: A patient with colorectal cancer receives bevacizumab along with FOLFOX. How should bevacizumab be classified?

Chemotherapy
Immunotherapy
Hormone therapy
Targeted therapy (Correct answer)

Correct answer: Targeted therapy

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

Question 11: What does the term 'completeness' mean in the context of a central cancer registry's data quality?

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

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 12: A pathology report mentions 'signet ring cell features' in a gastric adenocarcinoma. How should histology be coded?

8140/3 — Adenocarcinoma, NOS
8490/3 — Signet ring cell carcinoma (Correct answer)
8145/3 — Carcinoma, diffuse type
8010/3 — Carcinoma, NOS

Correct answer: 8490/3 — Signet ring cell carcinoma

When signet ring cell features are identified, ICD-O-3 code 8490/3 (Signet ring cell carcinoma) is the most specific and preferred code.

Question 13: 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
Each hospital sets its own submission standards
Only SEER standards apply

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

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

Correct answer: They verify data accuracy and consistency

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

Question 15: Which standard-setter publishes the rules that define the 'casefinding' process used by hospital cancer registries accredited by the American College of Surgeons?

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

Correct answer: CoC (Commission on Cancer)

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

Question 16: What does age-adjusted (age-standardized) cancer rate allow researchers to do?

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

Correct answer: Compare rates across populations with different age distributions

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

Question 17: What is the purpose of the NAACCR Call for Data in the context of data quality?

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

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

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

Question 18: 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
Relative survival rate
Cause-specific survival rate (Correct answer)

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 19: A patient receives a diagnosis of carcinoma in situ of the cervix (CIN III). Under most state and central registry rules, this case is:

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

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 20: What does the term 'first course of treatment' mean in cancer registry abstracting?

The first chemotherapy regimen only
Only surgery performed within 30 days of diagnosis
All treatment given before recurrence or progression (Correct answer)
Treatment given in the first hospital visit

Correct answer: All treatment given before recurrence or progression

First course of treatment includes all planned therapy given before disease recurrence, progression, or the start of a new treatment approach.

Question 21: Which statistical test is most commonly used to compare Kaplan-Meier survival curves between two groups?

Student's t-test
Fisher's exact test
Chi-square test
Log-rank test (Correct answer)

Correct answer: Log-rank test

The log-rank test (Mantel-Cox test) compares the overall survival experience between groups across all time points.

Question 22: The concept of 'lead time bias' in cancer screening studies refers to:

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

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

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

Question 23: 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 24: Which statistic is most useful for assessing whether cancer mortality rates are declining over time in a population?

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

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

The number of registry-certified hospitals in a region
Population counts used to calculate incidence and mortality rates (Correct answer)
The total number of cancer cases in the numerator
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 26: A patient receives neoadjuvant chemotherapy followed by surgery. How should sequence of systemic therapy and surgery be coded?

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

Correct answer: Systemic before surgery

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

Question 27: 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 casefinding error
A coding discrepancy

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 28: 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 29: Which field in a cancer abstract captures the specific hospital department or service where the cancer was first recognized within the facility?

Source of Case Report (Correct answer)
Primary Site
Type of Reporting Source
Admitting Diagnosis

Correct answer: Source of Case Report

Source of Case Report (NAACCR Item #380) identifies the department or service within the hospital that initially identified the cancer.

Question 30: Under AJCC 8th edition, which biomarker is NOT part of the breast cancer prognostic stage grouping?

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

Correct answer: Ki-67 proliferation index

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

Question 31: When a conflict arises between standard procedures and a unique situation in Data Quality & Completeness, what should a CTR professional prioritize?

Strict adherence to written procedures without exception
The preference of the client or stakeholder
The most cost-effective solution available
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.

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).

Questions

35 min

Time Limit

70%

To Pass

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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

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