Objectives	To describe the impact of cancer therapies on fertility and counsel patients with pregnancies occurring after cancer To be able to diagnose, stage, and treat pregnant patients with cancer considering both maternal and foetal issues
Key Concepts	Demonstrate an understanding of the importance of contraception during and after cancer treatment Explain fertility preservation options before treatment and the need of early referral Describe the epidemiology of the most frequent types of cancer occurring during pregnancy Recognise that frequent diagnostic pitfalls of cancer during pregnancy are mostly linked to low suspicion and assumed physiologic pregnancy changes Recognise the importance of coordination of the multidisciplinary treatment care and recognise cases that will require referral to specialised centres Determine the appropriate diagnostic and staging procedures considered safe for the pregnant patient and the foetus, including consideration on the effects of imaging studies and anaesthesia (local or general) Recognise that treatment is guided by tumour type, stage, gestational age (pregnancy trimester), maternal-foetal complication risks and teratogenic risks Demonstrate an understanding of the principles of surgery, radiation therapy, and systemic therapy during pregnancy, including data limitation on modern therapies, such as immune checkpoint inhibitors Express knowledge in pharmacokinetics and develop awareness of frequent dose correction requirements following weight changes during pregnancy Demonstrate an understanding that when indicated and when allowed by local laws, early pregnancy termination could be discussed, and a shared decision-making process with patient and partner should be prioritised Recognise clinical scenarios when early delivery should be considered, such as rapid maternal deterioration due to disease progression Determine that children exposed in utero to treatment of maternal malignancy should have a long-term follow-up Explain the feasibility and safety of pregnancy following oncologic treatment Recognise the potential impact of previous therapies on subsequent pregnancies after cancer treatment, including maternal effects (eg, drug-induced infertility, cardiomyopathy, radiation-induced breast fibrosis) and foetal effects (eg, genotoxicity of recent treatment)
Skills	Demonstrate the ability to: Apply routine pregnancy testing into clinical practice and provide counselling on contraception to women of childbearing potential before oncologic treatment start and as necessary  Promote increased awareness of early diagnosis of cancer during pregnancy and exercise judgement to refer patients to centres with experience on multidisciplinary care  Perform a detailed medical history and physical examination of the pregnant patient with cancer, considering key aspects as gestational age calculation  Participate in the multidisciplinary management of the pregnant patient with cancer throughout pregnancy and puerperium, including tailored treatment planning and frequent re-assessment with appropriate consultation of the surgeon, radiation oncologist, obstetrician, perinatologist, and phycologist when appropriate  Discuss treatment options and recommendations according to tumour type and gestational age, including maternal-foetal prognostic considerations  Select, communicate, and adequately prescribe systemic therapies in pregnant women diagnosed with cancer Recognise the challenges and limitations of clinical trial conduction in this setting, discuss inclusion of data on maternal-foetal outcomes into international registries after patients' consent  Demonstrate an empathic, non-judgemental care and share the decision-making process with the patient and her family  Counsel patients on the safety and feasibility of subsequent pregnancies after oncologic treatment, when appropriate