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EXAM CONTENT

The current CTR Examination content is:

  • Registry organization and operations.
  • Anatomy, physiology, and histology of the human body related to the disease processes of cancer.
  • Abstracting and coding of cancer data items using standard registry coding references.
  • Statistical and graphic concepts used in the presentation of cancer incidence, treatment, and survival information
  • Practical application of registry principles to determine appropriate registry responses.
  • Computerized data management.

The Certification Examination for Cancer Registrars is a two-part examination composed of a maximum of 250 multiple-choice, objective questions. Part I will be a closed book examination with no reference materials permitted. Part II is open book which requires the use of specific coding & staging references.

The 250-question CTR Examination Content
and Weighting
PART I - Closed Book
I. Registry Organization and Operations...25%
II. Concepts of Abstracting, Coding and Follow-up...35%
III. Data Analysis and Interpretation...20%
Part II - Open Book
IV. Application of Coding and Staging Principles...20%

The exam is a total of 4.5 hours; 3 hours maximum is allotted for Part I. After completing the first 200 items (Part I), you will indicate you are completely finished with Part I since you will NOT be able to return to the first 200 items after the break. There will be a mandatory break (10 minutes) in between Parts I & II to allow for the introduction of the reference materials needed for the 50 open-book items (Part II). Any extra time from Part I will be carried over to Part II, which is a minimum of 1.5 hours.

Questions for the examination are obtained from individuals with expertise in the Cancer Registry field and are reviewed for construction, accuracy, and appropriateness by representatives of NCRA’s Council on Certification and the Professional Testing Corporation.

CTR Exam Detailed Outline

PART I - Closed Book
I. Registry Organization and Operations...25%
II. Concepts of Abstracting, Coding and Follow-up...35%
III. Data Analysis and Interpretation...20%
PART II - Open Book
Application of Coding and Staging Principles...20%

Part I — Closed Book

I. REGISTRY ORGANIZATION AND OPERATION

  1. Types of cancer registries
    1. Facility
      1. Hospital
      2. Network
      3. Free-standing
      4. Military
      5. Veterans Administration
      6. Other types of facility registries
    2. Central registry
      1. Types
        1. Population-based
        2. Non-population based
      2. National
        1. Department of Defense (DOD)
        2. National Cancer Data Base (NCDB)
        3. National Program on Cancer Registration (NPCR)
        4. Surveillance, Epidemiology, and End Results (SEER)
      3. International
    3. Specialty
      1. Site-specific
      2. Pediatric
      3. Research
    4. Other health registries
  2. Standard setting/registry organizations
    1. American Joint Committee on Cancer (AJCC)
    2. Centers for Disease Control (CDC/NPCR)
    3. Commission on Cancer (COC)
    4. International Agency for Research On Cancer (IARC/IACR)
    5. National Cancer Institute’s Surveillance, Epidemiology, And End Results Program (SEER)
    6. North American Association of Central Cancer Registries (NAACCR)
  3. Cancer program
    1. Cancer registry management
      1. Database management
      2. Policy and procedure manual
      3. Reference date
      4. Budgets
      5. Productivity standards
      6. Position descriptions
    2. Cancer conferences
    3. Community outreach
    4. Research
      1. Clinical trials
        1. Phases
        2. Types of trials
      2. Institutional review board (IRB)
  4. Legal and ethical issues
    1. Legal aspects
      1. Confidentiality
      2. Release of cancer registry data
      3. Personnel policies and procedures
      4. Data security
      5. Data transmissions
    2. Ethical aspects
  5. Privacy and security
    1. Current drivers
    2. Identifying confidential information
    3. Individual right of control
    4. Security
  6. Quality control of cancer registry data
    1. General Concepts
    2. Quality control methods
      1. Visual review of abstracts
      2. Edit checks
      3. Reabstracting studies
      4. Case finding studies
      5. Recoding studies
      6. Statistical analysis
  7. Commission on Cancer standards for approval
  8. Healthcare delivery systems
    1. Insurance
    2. Federal and state agencies
    3. Reimbursement methods
  9. Central cancer registry
    1. Administration and operations
    2. Data sets
    3. Computerization unique to central registries
      1. Geocoding
      2. Record linkage
      3. Death clearance and follow-back
      4. Other central cancer registry activities

II. CONCEPTS OF ABSTRACTING, CODING, AND FOLLOW-UP

  1. Anatomy and physiology
    1. Derivation of cells and tissues
    2. Tissues, body systems and neoplasms
      1. Tissues
      2. Body systems
        1. Integumentary
        2. Lymphatic and hematopoietic
        3. Cardiovascular
        4. Respiratory
        5. Digestive
        6. Urinary
        7. Reproductive
        8. Endocrine
        9. Special senses
        10. Nervous system
        11. Musculoskeletal
      3. Characteristics of cancer
      4. Body locations and position
  2. Case finding and case ascertainment principles
    1. Reportable list/agreement
    2. Case finding methods
      1. Active/rapid ascertainment
      2. Passive/death clearance
      3. Combinations of a. and b.
    3. Case finding sources
  3. Abstract principles and coding
    1. Demographics
    2. Disease identification
      1. Reportable case identification
      2. General guidelines
    3. Diagnosis
    4. Extent of disease
      1. Staging systems
      2. General guidelines
    5. Treatment
      1. Types
      2. General guidelines
    6. Outcomes (follow-up) principles
      1. Purpose
      2. Methodology
      3. Policy and procedures
      4. General guidelines

III. DATA ANALYSIS AND INTERPRETATION

  1. Statistics and methodology
    1. Statistics concepts and terminology
    2. Statistical techniques
    3. Study design
    4. Epidemiology
  2. Report preparation
    1. Data selection and query
    2. Data presentation and interpretation
  3. Data utilization
  4. Performance Improvement studies

Part II — Open Book

IV. APPLICATION OF CODING AND STAGING PRINCIPLES

  1. Disease Identification
    1. Lip, Oral Cavity, and Pharynx
    2. Digestive Organs and Peritoneum
    3. Respiratory System and Intrathoracic Organs
    4. Hematopoietic and Reticuloendothelial Systems
    5. Bones, Joints, and Articular Cartilage
    6. Connective, Subcutaneous, and Other Soft Tissues
    7. Skin
    8. Breast
    9. Genitourinary Organs
    10. Eye and Lacrimal Gland
    11. Nervous System
    12. Endocrine Glands
    13. Lymph Nodes
    14. Other
  2. Extent of Disease
    1. Bladder
    2. Breast
    3. Colon
    4. Lung
    5. Prostate

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