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

Question 1: What is the primary purpose of using ICD-O-3 morphology codes in cancer registry data collection?

To determine the patient's insurance eligibility
To assign the cancer stage
To identify the treating physician's specialty
To classify the histologic type and behavior of the tumor (Correct answer)

Correct answer: To classify the histologic type and behavior of the tumor

ICD-O-3 morphology codes specify both the cell type (histology) and the behavior (benign, malignant, in situ) of neoplasms.

Question 2: Which NAACCR data standard defines the required data items, their permitted codes, and edit specifications for central registry submissions?

NAACCR Volume II — Data Standards and Data Dictionary (Correct answer)
NAACCR Volume I — Data Exchange Standards
CoC STORE Manual
SEER Program Coding and Staging Manual

Correct answer: NAACCR Volume II — Data Standards and Data Dictionary

NAACCR Volume II specifies data item definitions, coding instructions, and the edit set used to validate submissions to central registries.

Question 3: 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
Five-year relative survival rate
Annual percent change (APC) in age-adjusted mortality rate (Correct answer)

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 4: Which type of ambulatory surgery center report is MOST useful for casefinding?

Billing encounter forms only
Nursing care plans
Procedure logs with pathology results (Correct answer)
Anesthesia pre-op assessments

Correct answer: Procedure logs with pathology results

Procedure logs paired with pathology results identify surgical cases with confirmed malignancy, making them the most productive casefinding source in ambulatory settings.

Question 5: Which of the following scenarios requires a new primary to be abstracted under the 2023 SEER MP/H rules for colon cancers?

Different histology, same subsite, diagnosed 5 years apart (Correct answer)
Different subsite, same histology, diagnosed on the same day
Same histology, same subsite, diagnosed within 3 years
Same histology, adjacent subsite, diagnosed 1 year apart

Correct answer: Different histology, same subsite, diagnosed 5 years apart

Under MP/H rules, different histologies in the colon regardless of subsite and timing generally constitute separate primaries.

Question 6: What is the primary purpose of the NAACCR Inter-rater Reliability Study in data quality assessment?

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

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

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

Question 7: Which accreditation body sets standards for hospital-based cancer registries in the United States?

American College of Surgeons (ACoS) Commission on Cancer (Correct answer)
Centers for Medicare & Medicaid Services (CMS)
National Institutes of Health (NIH)
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 8: The multi-step process by which normal cells accumulate genetic alterations and transform into malignant cells is called:

Metaplasia
Angiogenesis
Apoptosis
Carcinogenesis (Correct answer)

Correct answer: Carcinogenesis

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

Question 9: Which term describes the total number of persons living with a cancer diagnosis at a given point in time?

Incidence
Prevalence (Correct answer)
Case fatality rate
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 10: Which cancer is currently the leading cause of cancer death among both men and women in the United States?

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

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

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

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

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

Correct answer: Grade Group 2

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

Question 13: What documentation practice is considered essential in Reporting Requirements & Standards within the Certified Tumor Registrar field?

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

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

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

Question 14: Cancer incidence rate is calculated per how many persons in standard epidemiologic reporting?

1,000,000 persons
100,000 persons (Correct answer)
1,000 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 15: Which measure expresses the probability of dying FROM cancer (rather than with it) over a specified time period?

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

Correct answer: Cause-specific survival rate

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

Question 16: The STORE manual (Standards for Oncology Registry Entry) is published by which organization?

NAACCR
American College of Surgeons Commission on Cancer (Correct answer)
SEER Program / NCI
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 17: When a conflict arises between standard procedures and a unique situation in Cancer Registry Data Collection, what should a CTR professional prioritize?

The preference of the client or stakeholder
Strict adherence to written procedures without exception
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 Cancer Registry Data Collection. 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 18: 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 19: Which best describes the purpose of the 'Date of Death' field in a tumor registry abstract?

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

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 20: Brachytherapy is best categorized under which type of radiation therapy delivery?

Internal radiation (Correct answer)
Proton beam therapy
External beam radiation
Stereotactic radiosurgery

Correct answer: Internal radiation

Brachytherapy places radioactive sources inside or immediately adjacent to the tumor, classifying it as internal radiation.

Question 21: Which U.S. national program collects population-based cancer incidence and survival data from registries across the country?

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

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 22: Which ICD-O-3 behavior code indicates an in-situ neoplasm?

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

Correct answer: /2

ICD-O-3 behavior code /2 denotes carcinoma in situ, meaning the tumor has not invaded surrounding tissue.

Question 23: Which of the following scenarios would trigger a 'suspense' status in a cancer registry case?

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

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 24: In Confidentiality & Data Security, what is the FIRST step a CTR professional should take when encountering a new case or situation?

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

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

In Confidentiality & Data Security, 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 25: 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)
Share de-identified data since it does not reveal the specific patient
Provide the information because insurance companies are authorized requesters
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 26: Triple-negative breast cancer (TNBC) is defined by the absence of which three receptors or proteins?

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

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 27: Which AJCC staging element most directly influences 5-year survival rates reported by cancer registries?

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

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

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

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 29: 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 5% (Correct answer)
Less than 1%
Less than 15%
Less than 20%

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 30: A state central registry performs a completeness assessment by linking registry data to death certificates. Cases appearing on death certificates but not in the registry are called:

Death Certificate Only (DCO) cases (Correct answer)
Non-analytic cases
Lost-to-follow-up cases
Duplicate cases

Correct answer: Death Certificate Only (DCO) cases

DCO cases are cancer cases identified only through death certificate review, indicating the registry did not capture the case during the patient's life.

Question 31: In prostate cancer staging, what Gleason score range indicates Grade Group 5 (the highest grade)?

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

Correct answer: Gleason 9-10

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

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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