CTR exam – how many practice questions did you do before feeling ready?
I'm scheduled for the CTR exam in 7 weeks and I've been working as a cancer registrar for 2 years under supervision. The exam has 200 questions and I know the first-time pass rate isn't great, so I'm trying to take prep seriously. Right now I've done about 400 practice questions across the content areas and I'm averaging around 72%, which I know isn't where I need to be yet.
Abstracting rules and ICD-O-3 coding feel like my stronger areas since I do those every day. But the anatomy, physiology, and staging content is harder – especially TNM staging for less common cancer sites I don't see in my registry. I'm at a community hospital so my case mix is pretty narrow compared to what the exam covers.
I've been using the NCRA study guide plus a question set from my chapter. I study about 90 minutes a day after work, which is tough after a full day of abstracting. At this stage should I be doing more questions or focusing more on reading and understanding weak areas before doing more questions?
Also any advice on the operations section? That content feels abstract to me since I don't have much exposure to the management and compliance side of running a registry – my supervisor handles most of that.
For the operations content, the NCRA CoC standards document is worth reading even if you don't deal with accreditation day to day. The exam tests whether you understand what a compliant registry looks like, not whether you personally run one. Knowing the case finding requirements and timeliness standards cold will cover a lot of those questions.
Staging for rare sites is real – I work at an academic center and still felt underprepared for some of the rarer cancer types. SEER's online training modules cover a lot of that content and they're free. I did probably 15-20 hours of those modules specifically for the staging section before my exam.
TNM 8th edition rules for certain head and neck sites tripped me up specifically.
90 minutes a day is solid given how draining registry work is. I'd shift to 60% practice questions and 40% targeted reading for areas below 70% rather than rereading everything again. At 7 weeks out, questions surface your gaps faster than rereading material.
I did close to 1,200 practice questions before my exam and passed with a 78%. The volume matters but only if you're reviewing every wrong answer carefully – mindlessly grinding questions won't move your score much. At 72% with 7 weeks left you have time to get there if you're disciplined about review.
I was in a pretty similar spot -- working full-time and studying in whatever pockets of time I could find. I ended up doing around 800 questions total over about 10 weeks, but honestly the number matters less than how you're using them. I'd do maybe 20-30 questions on my lunch break or right after putting the kids to bed, then actually review every single wrong answer before moving on. That review step is what I skipped at first and it really hurt me.
Casefinding was the area that tripped me up most, so I spent extra time on it -- there's a solid set of free ctr casefinding questions that I kept coming back to. With 2 years of hands-on experience you're already ahead of a lot of people sitting that exam. I'd say once you're consistently hitting 75-80% on practice sets you haven't seen before, you're in good shape. Seven weeks is enough time if you're consistent.
I just passed in April so I'll share what clicked for me. I did around 800 questions total, but honestly the number isn't what mattered. It was when I stopped just marking answers and started actually understanding why the wrong answers were wrong. That shift made a huge difference.
The one thing that really moved the needle was drilling the hematopoietic and lymphoid rules until they were automatic. So many questions touch that section and if you're shaky on it you'll second-guess yourself everywhere. Seven weeks is plenty of time if you're intentional. You've got this.
I failed my first attempt and honestly it wasn't the number of questions that did me in, it was how I was studying them. I'd blown through like 600 questions just clicking answers without really digging into the WHY behind each one. Second time I slowed way down, probably did 350-400 total but actually read every single rationale. I also spent a lot more time on casefinding since that tripped me up more than I expected, so I used a free ctr casefinding resource to drill that section specifically.
Passed the second time with a score I was actually proud of. Seven weeks is enough time if you're intentional about it. Don't just chase a question count, make sure you understand the logic behind the STORE rules and abstracting decisions, because that's where the exam really tests you.
I failed my first attempt and it stung. I'd done around 500 practice questions but I was doing them too passively — just clicking through and moving on. What I changed the second time was slowing way down on anything I got wrong and actually reading the rationale. For cancer biology specifically I used ctr/questions/cancer biology pathology 2 and that section alone probably saved me because I'd been shaky on staging rules and histology distinctions that kept showing up.
Honestly the number of questions matters less than how you review them. I hit around 800 total before my second attempt but it wasn't the volume, it was that I stopped treating wrong answers as something to forget and started treating them as the actual study material. Seven weeks is enough time if you're doing it right.
Quick update since I posted this -- I just finished a 50-question timed mock and scored a 74%, which felt like a real turning point after weeks of hovering in the high 60s. I've been grinding the SEER coding sections pretty hard because that's where I kept losing points, and it's finally clicking.
I'm sitting for the real thing in about 3 weeks. Honestly I think once you hit around 600-700 practice questions and you're consistently scoring 72 or above, you're probably ready. Don't let yourself get into the trap of just doing more and more questions without reviewing the ones you got wrong -- that's what I was doing early on and it wasn't moving the needle at all.