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

Question 1: The Oncotype DX Recurrence Score is a genomic prognostic tool used primarily for which cancer type?

Non-small cell lung cancer
Prostate cancer with Gleason 7
Colon cancer with Lynch syndrome
ER+/HER2- early-stage breast cancer (Correct answer)

Correct answer: ER+/HER2- early-stage breast cancer

Oncotype DX is validated for hormone receptor-positive, HER2-negative early-stage breast cancer to predict chemotherapy benefit and 10-year recurrence risk.

Question 2: Under CoC standards, what is the maximum allowable time between diagnosis and completion of the cancer registry abstract?

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

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

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

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

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

Question 4: A patient undergoes a lumpectomy for breast cancer followed by radiation. How is the radiation coded in the treatment fields?

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

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 5: Which field is used to record the first course of treatment that was planned and/or administered to the patient?

Salvage therapy field
Subsequent treatment
Palliative care sequence
First course of treatment (Correct answer)

Correct answer: First course of treatment

The 'first course of treatment' field captures all planned and administered treatment from diagnosis through the initial treatment plan.

Question 6: Which STORE code is used when a patient receives radiation therapy as the first course of treatment?

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

Correct answer: Code 1

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

Question 7: Which cancer is currently the leading cause of cancer death among both men and women in the United States?

Breast cancer
Prostate cancer
Colorectal 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 8: Which NAACCR standard item is used to flag a data element that was reviewed and confirmed as correct, even if it appears unusual?

Quality index
Sequence number
Over-ride flag (Correct answer)
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 9: A tumor registrar discovers a case was abstracted with an incorrect primary site two years ago. What is the correct action?

Delete the case and re-enter it fresh
Amend the original abstract with a correction and document the change (Correct answer)
Leave the error to avoid disrupting longitudinal data
Report the error only to the state registry, not the hospital registry

Correct answer: Amend the original abstract with a correction and document the change

Erroneous abstracts should be corrected via amendment with documentation of the change to maintain data integrity.

Question 10: Which U.S. national program collects population-based cancer incidence and survival data from registries across the country?

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

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 11: Under AJCC 8th edition colorectal cancer staging, N2a is defined as metastasis in how many regional lymph nodes?

4–6 nodes (Correct answer)
1 node
2–3 nodes
7 or more nodes

Correct answer: 4–6 nodes

AJCC 8th edition defines N2a colorectal as metastasis in 4–6 regional lymph nodes.

Question 12: 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
Compare rates across populations with different age distributions (Correct answer)
Determine the stage distribution of a cancer type

Correct answer: Compare rates across populations with different age distributions

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

Question 13: Cancer registries submit data to SEER using which standard file exchange format?

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

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 14: 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 15: The STORE manual (Standards for Oncology Registry Entry) is published by which organization?

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

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 16: In EOD 2018, which data item captures the farthest extent of tumor spread for solid tumors, replacing the old CS Extension field?

EOD Mets
EOD Primary Tumor (Correct answer)
Summary Stage 2018
EOD Regional Nodes

Correct answer: EOD Primary Tumor

EOD Primary Tumor in the EOD 2018 schema captures the greatest extent of the primary tumor, analogous to the former CS Extension field.

Question 17: Cancer incidence rate is calculated per how many persons in standard epidemiologic reporting?

100,000 persons (Correct answer)
1,000 persons
10,000 persons
1,000,000 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 18: A cancer registrar is auditing data and finds that 12% of cases have no follow-up documented for over 24 months. Which corrective action is most appropriate?

Flag them as 'lost to follow-up' immediately
Recode them as deceased based on length of inactivity
Delete the cases from the registry
Initiate an active tracing protocol using available contact and database resources (Correct answer)

Correct answer: Initiate an active tracing protocol using available contact and database resources

When cases lack recent follow-up, the registrar should initiate active tracing before assigning any vital status code.

Question 19: How does risk management apply to daily practice in Data Quality & Completeness for Certified Tumor Registrar professionals?

Only through responding to incidents after they occur
Through annual safety audits exclusively
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 Data Quality & Completeness requires proactive hazard identification and preventive measures, not just reactive responses. This approach reduces incidents, improves outcomes, and protects both professionals and clients.

Question 20: 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?

SEER Summary Staging Manual
NAACCR Race and Ethnicity Code Set Volume II (Correct answer)
ICD-O-3 Topography Index
AJCC Cancer 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 21: Triple-negative breast cancer (TNBC) is defined by the absence of which three receptors or proteins?

PR, BRCA1, and BRCA2 mutation
ER, HER2, and BRCA1 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 22: Which term describes the total number of persons living with a cancer diagnosis at a given point in time?

Incidence
Case fatality rate
Prevalence (Correct answer)
Mortality

Correct answer: Prevalence

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

Question 23: A tumor registrar is performing a quality control edit check and finds a case where the 'date of diagnosis' is earlier than the 'date of birth.' This is classified as:

An interfield edit error (Correct answer)
A casefinding error
A follow-up error
An intrafield edit error

Correct answer: An interfield edit error

An interfield edit error occurs when two or more fields in the same abstract contain logically inconsistent values, such as diagnosis before birth.

Question 24: 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 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
The operative report, as it was written first

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 25: 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
Overestimation of incidence due to improved case finding
The delay between symptom onset and diagnosis

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 26: A tumor described as 'well-differentiated' most accurately means:

The tumor cells closely resemble the normal cells of the tissue of origin (Correct answer)
The tumor has a high mitotic rate and rapid growth
The tumor is ineligible for surgical resection
The tumor has spread to multiple organ systems

Correct answer: The tumor cells closely resemble the normal cells of the tissue of origin

Well-differentiated (Grade 1) tumors retain features similar to the normal parent tissue, are typically slower growing, and generally carry a more favorable prognosis.

Question 27: Which type of cancer registry collects data from an entire defined geographic population regardless of where treatment occurs?

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

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 28: When reviewing the endoscopy unit log for casefinding, a registrar finds 'adenomatous polyp, colon' on a pathology report. Is this case reportable?

Yes, all colonic polyps are reportable
Only if the patient has a family history of colon cancer
No, adenomatous polyps are benign and not reportable (Correct answer)
Yes, if the polyp is larger than 1 cm

Correct answer: No, adenomatous polyps are benign and not reportable

Adenomatous polyps are benign lesions and are not reportable to the cancer registry; only malignant or in situ neoplasms are reportable.

Question 29: What is the PRIMARY purpose of continuing education requirements in Registry Operations & Management for CTR professionals?

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

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

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

Question 30: In cancer epidemiology, what does a 'cohort study' examine?

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

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

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

Correct answer: Breast cancer

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

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%

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