mkdir -p /home/daytona/workspace/cancer-ppt && ls /home/daytona/workspace/cancer…

~/cancer-ppt/cancer_boloor.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Natural History of Common Cancers';
pres.author = 'Based on Boloor & Manthappa Text-Based Medicine';

// ── Color Palette ─────────────────────────────────────────────────────────────
const C = {
  darkBg:   "1A1F3A",   // deep navy (title/section slides)
  accent:   "E84A5F",   // vivid red-pink (headings bar)
  light:    "FFFFFF",   // white text
  midBg:    "F5F7FF",   // very light blue-white (content background)
  textDark: "1A1F3A",   // body text
  textMid:  "4A5568",   // sub-text
  bullet:   "E84A5F",   // bullet colour
  tag1:     "2B6CB0",   // blue tag (natural history)
  tag2:     "276749",   // green tag (presentation)
  tag3:     "744210",   // brown tag (complications)
  tag4:     "742A2A",   // dark red tag (cause of death)
  divider:  "CBD5E0",
};

// ── Helper: add a solid background rect ───────────────────────────────────────
function bg(slide, fill) {
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color: fill}, line:{color: fill} });
}

// ── Helper: section divider stripe at top ─────────────────────────────────────
function topBar(slide, color) {
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.55, fill:{color: color}, line:{color: color} });
}

// ── Helper: left accent bar ────────────────────────────────────────────────────
function leftBar(slide) {
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.55, w:0.12, h:5.075, fill:{color: C.accent}, line:{color: C.accent} });
}

// ── Helper: tag box ────────────────────────────────────────────────────────────
function tag(slide, label, x, y, color) {
  slide.addShape(pres.ShapeType.rect, { x, y, w:2.3, h:0.28, fill:{color: color}, line:{color: color}, rounding: 0.1 });
  slide.addText(label, { x, y, w:2.3, h:0.28, fontSize:8, bold:true, color:"FFFFFF", align:"center", valign:"middle", margin:0 });
}

// ── Helper: bullet list ────────────────────────────────────────────────────────
function bullets(slide, items, x, y, w, h, fontSize=9.5) {
  const arr = items.map((t, i) => ({
    text: t,
    options: { bullet:{code:'25B8', color: C.bullet}, breakLine: i < items.length-1, color: C.textDark, fontSize }
  }));
  slide.addText(arr, { x, y, w, h, valign:"top", lineSpacingMultiple:1.3 });
}

// ─────────────────────────────────────────────────────────────────────────────
//  SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.darkBg);
  // decorative circle
  s.addShape(pres.ShapeType.ellipse, { x:7.5, y:-1.2, w:4.5, h:4.5, fill:{color:"2D3561"}, line:{color:"2D3561"} });
  s.addShape(pres.ShapeType.ellipse, { x:8.2, y:3.5, w:2.5, h:2.5, fill:{color:"2D3561"}, line:{color:"2D3561"} });

  s.addText("NATURAL HISTORY OF", { x:0.7, y:1.5, w:8, h:0.6, fontSize:16, color:"E84A5F", bold:true, charSpacing:4 });
  s.addText("Common Cancers", { x:0.7, y:2.0, w:8.5, h:1.1, fontSize:42, color:"FFFFFF", bold:true });
  s.addText("Presentation  •  Course  •  Complications  •  Cause of Death", {
    x:0.7, y:3.1, w:9, h:0.45, fontSize:12, color:"A0AEC0", italic:true
  });
  s.addShape(pres.ShapeType.rect, { x:0.7, y:3.65, w:3.2, h:0.04, fill:{color:"E84A5F"}, line:{color:"E84A5F"} });
  s.addText("Based on Boloor & Manthappa | Text-Based Medicine", {
    x:0.7, y:3.8, w:9, h:0.35, fontSize:10, color:"718096"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
//  SLIDE 2 – INDEX
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.midBg);
  topBar(s, C.darkBg);
  leftBar(s);

  s.addText("CANCERS COVERED", { x:0.25, y:0.08, w:9, h:0.38, fontSize:13, bold:true, color:"FFFFFF", charSpacing:2, margin:0 });

  const cancers = [
    ["01", "Carcinoma Lung"],
    ["02", "Carcinoma Breast"],
    ["03", "Colorectal Carcinoma"],
    ["04", "Carcinoma Stomach"],
    ["05", "Carcinoma Cervix"],
    ["06", "Carcinoma Prostate"],
    ["07", "Hepatocellular Carcinoma"],
    ["08", "Hodgkin Lymphoma"],
  ];

  cancers.forEach(([num, name], i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = 0.35 + col * 4.8;
    const y = 0.75 + row * 1.1;

    s.addShape(pres.ShapeType.rect, { x, y, w:4.4, h:0.9, fill:{color:"FFFFFF"}, line:{color: C.divider, pt:1}, shadow:{type:"outer",color:"BFCFE7",blur:6,offset:2,angle:135,opacity:0.3} });
    s.addShape(pres.ShapeType.rect, { x, y, w:0.52, h:0.9, fill:{color: C.accent}, line:{color: C.accent} });
    s.addText(num, { x, y, w:0.52, h:0.9, fontSize:16, bold:true, color:"FFFFFF", align:"center", valign:"middle", margin:0 });
    s.addText(name, { x: x+0.6, y, w:3.7, h:0.9, fontSize:13, bold:true, color: C.textDark, valign:"middle", margin:0 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// Cancer data
// ─────────────────────────────────────────────────────────────────────────────
const cancerData = [
  {
    num: "01",
    title: "Carcinoma Lung",
    subtitle: "Non-Small Cell (NSCLC) & Small Cell (SCLC)",
    natural: [
      "NSCLC (70-75%): Adenocarcinoma most common overall; Squamous cell from central bronchi; Large cell undifferentiated",
      "SCLC (20-25%): Neuroendocrine origin; fastest growing; almost invariably central",
      "Doubles every 3-6 months; remains silent for years before symptoms",
      "Risk: Smoking (85%), asbestos, radon, occupational carcinogens",
    ],
    presentation: [
      "Central tumour: Cough (most common), haemoptysis, wheeze, stridor, Pancoast syndrome (apical)",
      "Peripheral tumour: Often silent until pleural involvement - chest pain, dyspnoea",
      "Systemic: Weight loss, anorexia, fatigue, fever",
      "SVC obstruction: Facial puffiness, arm oedema, distended neck veins",
      "Paraneoplastic syndromes: SIADH (SCLC), hypercalcaemia (Sq. cell), ACTH excess, LEMS",
    ],
    course: [
      "NSCLC: Slow (Stage I/II) → regional LN spread → mediastinal invasion → haematogenous mets",
      "SCLC: Extremely aggressive; classified as Limited or Extensive disease at diagnosis",
      "Mediastinal spread: Phrenic/recurrent laryngeal nerve palsy; dysphagia",
      "Mets: Brain (50%), liver, adrenals, bone",
      "5-yr survival: Stage I NSCLC ~70%; Stage IV <5%; SCLC ~5%",
    ],
    complications: [
      "Pleural effusion (malignant) → dyspnoea, respiratory failure",
      "Haemoptysis (massive) → asphyxia",
      "Bronchial obstruction → post-obstructive pneumonia, lung abscess",
      "Brain metastasis → seizures, focal deficits, raised ICP",
      "Spinal cord compression → paraplegia",
      "Hypercalcaemia → confusion, renal failure",
    ],
    death: [
      "Respiratory failure (most common) due to tumour bulk or post-obstructive pneumonia",
      "Massive haemoptysis",
      "Complications of brain or spinal metastases",
      "Metabolic failure (SIADH, hypercalcaemia)",
    ],
  },
  {
    num: "02",
    title: "Carcinoma Breast",
    subtitle: "Invasive Ductal / Lobular Carcinoma",
    natural: [
      "Invasive ductal carcinoma (IDC): 70-80% of all breast cancers; arises from ductal epithelium",
      "Invasive lobular carcinoma (ILC): 10-15%; bilateral tendency; often ER+",
      "Pre-invasive stages: DCIS → IDC; LCIS → marker of risk",
      "Risk: BRCA1/2 mutations, family history, early menarche, late menopause, nulliparity, HRT",
      "Doubling time: 100-200 days; clinically detectable at ~10 yrs tumour life",
    ],
    presentation: [
      "Painless, hard, irregular, poorly defined lump (most common) - typically upper outer quadrant",
      "Nipple: Discharge (bloody), retraction, Paget's disease of nipple",
      "Skin changes: Peau d'orange (lymphoedema), dimpling, erythema",
      "Axillary lymphadenopathy (firm, hard nodes)",
      "Inflammatory breast cancer: Rapid onset swelling, warmth, peau d'orange (worst prognosis)",
    ],
    course: [
      "Local spread: Skin, nipple, pectoralis major, chest wall",
      "LN spread: Axillary (Levels I-III) → supraclavicular → internal mammary",
      "Haematogenous: Bone (most common), lung, liver, brain, ovaries",
      "Bone mets often osteolytic (BRCA-related) or mixed; cause pathological fractures",
      "ER/PR+, HER2+ subtypes have distinct natural histories and treatment responses",
    ],
    complications: [
      "Pathological fractures (vertebral collapse, femoral fractures) from bone mets",
      "Hypercalcaemia from bone involvement",
      "Spinal cord compression → paraplegia",
      "Lymphoedema of arm post-axillary clearance/radiotherapy",
      "Brain metastases: Seizures, motor deficits",
      "Malignant pleural effusion → dyspnoea",
    ],
    death: [
      "Respiratory failure (lung/pleural mets or effusion)",
      "Hepatic failure from liver metastases",
      "Complications of brain metastases",
      "Cachexia and multi-organ failure in advanced disease",
    ],
  },
  {
    num: "03",
    title: "Colorectal Carcinoma",
    subtitle: "Adenocarcinoma of Colon & Rectum",
    natural: [
      "Nearly all arise from adenomatous polyps (adenoma → carcinoma sequence): 10-15 years",
      "APC gene mutation → β-catenin accumulation → adenoma → carcinoma (FAP pathway)",
      "HNPCC (Lynch syndrome): MMR gene defects; right-sided, accelerated course",
      "Distribution: Rectum (40%), sigmoid (25%), right colon (25%), transverse/splenic flexure (10%)",
      "Risk: Sedentary lifestyle, red/processed meat, smoking, alcohol, IBD, adenomatous polyps",
    ],
    presentation: [
      "Right colon: Occult bleeding → iron deficiency anaemia, fatigue, mass (often large at presentation)",
      "Left colon/sigmoid: Change in bowel habit, ribbon stools, fresh rectal bleeding, tenesmus",
      "Rectal cancer: Tenesmus, mucus PR, bleeding per rectum, perineal pain",
      "Complications at presentation: Intestinal obstruction, perforation (10-15%)",
      "Systemic: Weight loss, anorexia in advanced disease",
    ],
    course: [
      "Local invasion through bowel wall layers (Dukes/TNM staging determines prognosis)",
      "LN spread: Pericolic → mesenteric → para-aortic nodes",
      "Haematogenous: Liver (portal circulation, most common met site), lung, peritoneum",
      "Peritoneal seeding: Pseudomyxoma peritonei (mucinous variants); malignant ascites",
      "5-yr survival: Stage I >90%; Stage II 70-80%; Stage III 40-70%; Stage IV ~10%",
    ],
    complications: [
      "Acute intestinal obstruction → caecal perforation (closed loop), peritonitis",
      "Colorectal perforation → faecal peritonitis, sepsis",
      "Fistula: Colo-vesical (pneumaturia), colo-vaginal, colo-enteric",
      "Haemorrhage (acute massive, or chronic → anaemia)",
      "Ureteric obstruction → hydronephrosis, renal failure",
      "Liver failure from hepatic metastases",
    ],
    death: [
      "Hepatic failure (most common in metastatic disease)",
      "Sepsis from perforation/fistula",
      "Intestinal obstruction or perforation",
      "Cachexia and multi-organ failure",
    ],
  },
  {
    num: "04",
    title: "Carcinoma Stomach",
    subtitle: "Gastric Adenocarcinoma",
    natural: [
      "Two major types: Intestinal (distal, older males, H.pylori driven, declining incidence) & Diffuse (linitis plastica, younger, signet ring cells, poor prognosis)",
      "H. pylori → chronic atrophic gastritis → intestinal metaplasia → dysplasia → cancer (Correa cascade)",
      "Risk: H.pylori infection, diet (salted/smoked food, nitrites), smoking, blood group A, prior gastrectomy",
      "Usually detected late; >70% present at advanced stage",
    ],
    presentation: [
      "Early: Vague epigastric discomfort (mimics peptic ulcer disease) - often ignored",
      "Late: Epigastric mass, progressive dysphagia (cardiac), vomiting (pyloric obstruction)",
      "Constitutional: Weight loss (most consistent), anorexia, fatigue, early satiety",
      "Virchow's node (left supraclavicular), Sister Mary Joseph nodule (periumbilical), Krukenberg tumour (ovarian mets)",
      "Paraneoplastic: Dermatomyositis, acanthosis nigricans, Trousseau's syndrome (migratory thrombophlebitis)",
    ],
    course: [
      "Linitis plastica: Diffuse mural infiltration → rigid 'leather bottle' stomach",
      "Local spread: Oesophagus, duodenum, transverse colon, pancreas, liver",
      "LN spread: Perigastric → coeliac → para-aortic; Virchow's node via thoracic duct",
      "Haematogenous: Liver (most common), lung, bone, adrenals",
      "Transcoelomic: Peritoneal seeding → malignant ascites",
    ],
    complications: [
      "Pyloric obstruction → projectile vomiting, dehydration, hypokalaemic alkalosis",
      "Gastric bleeding (haematemesis, melaena)",
      "Gastric perforation → acute peritonitis",
      "Malignant ascites from peritoneal dissemination",
      "Anaemia (chronic blood loss or megaloblastic due to intrinsic factor loss post-gastrectomy)",
    ],
    death: [
      "Inanition (starvation/cachexia) - most common",
      "Gastric haemorrhage",
      "Hepatic failure from liver metastases",
      "Sepsis (perforation, aspiration)",
    ],
  },
  {
    num: "05",
    title: "Carcinoma Cervix",
    subtitle: "Squamous Cell Carcinoma / Adenocarcinoma",
    natural: [
      "HPV (types 16, 18) → persistent infection → CIN 1 → CIN 2/3 → Invasive carcinoma",
      "CIN to invasive carcinoma: ~10-15 years for squamous cell; shorter for adenocarcinoma",
      "Squamous cell carcinoma: 70-80%; arises at squamo-columnar junction (transformation zone)",
      "Risk: Early coitus, multiple partners, multiparity, immunosuppression, smoking",
      "Most preventable cancer with HPV vaccination + Pap smear screening",
    ],
    presentation: [
      "Early: Often asymptomatic; detected on Pap smear or colposcopy",
      "Post-coital bleeding (most classic symptom)",
      "Intermenstrual/irregular vaginal bleeding",
      "Offensive watery/bloodstained vaginal discharge",
      "Advanced: Pelvic pain, back pain (ureteric obstruction), leg oedema (lymphatic obstruction)",
      "Vesicovaginal/rectovaginal fistula (advanced local invasion)",
    ],
    course: [
      "Local spread: Parametrium → pelvic side wall → bladder (anterior), rectum (posterior)",
      "FIGO staging determines extent of local/regional spread",
      "LN spread: Paracervical → obturator → internal iliac → external iliac → para-aortic",
      "Haematogenous mets (rare): Lung, liver, bone (late stage)",
      "5-yr survival: Stage I >85%; Stage II 60-75%; Stage III 30-50%; Stage IV <15%",
    ],
    complications: [
      "Ureteric obstruction → bilateral hydronephrosis → uraemia (most common cause of death)",
      "Vesicovaginal fistula → continuous urinary incontinence, UTI",
      "Rectovaginal fistula → faecal soiling",
      "Pelvic haemorrhage (erosion of iliac vessels)",
      "Lymphoedema of lower limbs from pelvic LN block",
      "Pelvic infection/abscess",
    ],
    death: [
      "Uraemia from bilateral ureteric obstruction (most common cause of death)",
      "Massive pelvic haemorrhage",
      "Sepsis (pelvic infection, fistulae)",
      "Cachexia in metastatic disease",
    ],
  },
  {
    num: "06",
    title: "Carcinoma Prostate",
    subtitle: "Adenocarcinoma",
    natural: [
      "Adenocarcinoma arises from peripheral zone (posterior lobe) in 70-80% of cases",
      "Gleason grading (1-5) × 2 patterns = Score 2-10; Gleason ≥7 = aggressive",
      "Latent vs. Clinical cancer: Many men die WITH prostate cancer, not FROM it",
      "Risk: Age >50, family history, BRCA2 mutation, African ancestry, high dietary fat",
      "Testosterone-dependent growth; androgen deprivation is mainstay of advanced disease therapy",
    ],
    presentation: [
      "Early: Asymptomatic (peripheral zone lesion); detected via PSA or DRE",
      "LUTS (lower urinary tract symptoms): Hesitancy, poor stream, frequency, nocturia (central extension)",
      "Haematuria, haematospermia",
      "Bone pain (back, hip) in advanced disease with skeletal mets",
      "DRE: Hard, irregular, nodular, non-tender prostate; loss of median sulcus",
      "Ureteric obstruction → uraemia (advanced pelvic disease)",
    ],
    course: [
      "Local extension: Seminal vesicles, bladder neck, urethra, rectum",
      "LN spread: Obturator → internal iliac → external iliac → para-aortic",
      "Haematogenous: Bone (osteosclerotic/blastic mets - classic) - vertebrae, pelvis, femur",
      "PSA monitoring reflects disease activity; PSA doubling time predicts aggressiveness",
      "Hormone-sensitive → Castration-resistant prostate cancer (CRPC) in 2-3 years",
    ],
    complications: [
      "Spinal cord compression from vertebral mets → paraplegia (oncological emergency)",
      "Pathological fractures from osteosclerotic bony mets",
      "Ureteric obstruction → hydronephrosis → uraemia",
      "Bladder outflow obstruction → acute urinary retention",
      "Anaemia from bone marrow infiltration",
      "Disseminated intravascular coagulation (DIC) in advanced CRPC",
    ],
    death: [
      "Uraemia from ureteric obstruction",
      "Complications of skeletal metastases (fracture, cord compression)",
      "Cachexia and marrow failure in CRPC",
      "Sepsis (urosepsis, infected prostatic abscess)",
    ],
  },
  {
    num: "07",
    title: "Hepatocellular Carcinoma",
    subtitle: "Primary Liver Cancer (HCC)",
    natural: [
      "HCC arises on background of chronic liver disease in 80-90% of cases",
      "Cirrhosis is the strongest risk factor; HBV can cause HCC without cirrhosis",
      "Risk factors: Hepatitis B, Hepatitis C, alcoholic cirrhosis, NAFLD/NASH, aflatoxin B1, haemochromatosis",
      "AFP (alpha-fetoprotein) marker; surveillance with AFP + ultrasound 6-monthly in cirrhotics",
      "Rapidly progressive; most patients die within 6-18 months of diagnosis without treatment",
    ],
    presentation: [
      "Often silent until advanced; discovered on surveillance in compensated cirrhosis",
      "RUQ pain/discomfort; right hypochondrial mass (hepatomegaly with nodularity)",
      "Weight loss, anorexia, fever",
      "Decompensation of pre-existing cirrhosis: Jaundice, ascites, encephalopathy, variceal bleed",
      "Paraneoplastic: Hypoglycaemia (IGF-2), erythrocytosis (EPO), hypercalcaemia",
      "Acute presentation: Haemoperitoneum from tumour rupture",
    ],
    course: [
      "Intrahepatic spread: Portal vein tumour thrombus (PVTT) → rapid progression",
      "Extrahepatic: Lung (most common met), regional LN, adrenal, bone",
      "Barcelona Clinic Liver Cancer (BCLC) staging guides management",
      "PVTT is associated with rapid deterioration; median survival without treatment <4 months",
      "Child-Pugh class determines hepatic reserve and treatment eligibility",
    ],
    complications: [
      "Tumour rupture → haemoperitoneum (life-threatening, acute abdomen)",
      "Portal vein thrombosis → portal hypertension, variceal haemorrhage, ascites",
      "Obstructive jaundice from bile duct invasion",
      "Hepatic failure (tumour replacement of functioning parenchyma)",
      "Metastatic complications (lung, bone)",
      "Hypoglycaemia (paraneoplastic) → altered consciousness",
    ],
    death: [
      "Hepatic failure (most common) - tumour replacement + underlying cirrhosis",
      "Variceal haemorrhage",
      "Haemoperitoneum from tumour rupture",
      "Sepsis (spontaneous bacterial peritonitis in cirrhotic ascites)",
    ],
  },
  {
    num: "08",
    title: "Hodgkin Lymphoma",
    subtitle: "Reed-Sternberg Cell Disease",
    natural: [
      "Bimodal age distribution: 15-35 years and >55 years; male predominance",
      "Reed-Sternberg (RS) cells: Binucleate, prominent 'owl-eye' nucleoli; CD15+, CD30+",
      "WHO subtypes: Nodular Sclerosis (most common, 65%), Mixed Cellularity, Lymphocyte-Rich, Lymphocyte-Depleted",
      "Nodular Sclerosis: Young women; mediastinal mass; excellent prognosis",
      "Aetiology: EBV association (Mixed Cellularity subtype); immunodeficiency",
    ],
    presentation: [
      "Painless, rubbery, discrete cervical lymphadenopathy (most common)",
      "Mediastinal mass: Cough, dyspnoea, SVC syndrome (15-30% have mediastinal disease)",
      "B-symptoms: Drenching night sweats, fever >38°C, weight loss >10% in 6 months",
      "Pel-Ebstein fever: Cyclical fever (pathognomonic)",
      "Alcohol-induced pain at nodal sites (characteristic but rare)",
      "Pruritus (generalised, without rash)",
    ],
    course: [
      "Spreads predictably along contiguous lymph node groups (unlike NHL)",
      "Ann Arbor staging: I (single region) → II (same side of diaphragm) → III (both sides) → IV (extranodal)",
      "Most patients present at Stage II; mediastinal involvement common",
      "Highly curable: 80-90% overall cure with ABVD chemotherapy ± radiotherapy",
      "Relapse: 20% relapse; salvage with DHAP, ESHAP; ASCT for chemosensitive relapse",
      "Late effects of treatment: Secondary malignancy, cardiac toxicity, hypothyroidism",
    ],
    complications: [
      "SVC obstruction from mediastinal disease → facial oedema, dyspnoea",
      "Immunodeficiency: T-cell dysfunction → opportunistic infections (TB, Cryptococcus, Herpes Zoster)",
      "Autoimmune haemolytic anaemia, ITP",
      "Late effects: Radiotherapy → coronary artery disease, lung fibrosis, hypothyroidism, breast cancer",
      "Secondary leukaemia (AML/MDS) from alkylating agents",
      "Spinal cord compression from paravertebral disease",
    ],
    death: [
      "Disease progression (Lymphocyte-Depleted, refractory disease)",
      "Overwhelming opportunistic infection (immunocompromised state)",
      "Complications of treatment: Cardiotoxicity (ABVD), secondary AML",
      "SVC obstruction / respiratory failure from massive mediastinal disease",
    ],
  },
];

// ─────────────────────────────────────────────────────────────────────────────
// SECTION SLIDE generator
// ─────────────────────────────────────────────────────────────────────────────
function addSectionSlide(num, title, subtitle) {
  const s = pres.addSlide();
  bg(s, C.darkBg);
  s.addShape(pres.ShapeType.ellipse, { x:7.8, y:-0.8, w:3.5, h:3.5, fill:{color:"2D3561"}, line:{color:"2D3561"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.6, h:5.625, fill:{color: C.accent}, line:{color: C.accent} });
  s.addText(num, { x:0.1, y:0.2, w:0.4, h:0.4, fontSize:11, bold:true, color:"FFFFFF", align:"center", margin:0 });
  s.addText(title, { x:0.85, y:1.4, w:8.5, h:1.2, fontSize:36, bold:true, color:"FFFFFF" });
  s.addText(subtitle, { x:0.85, y:2.6, w:8, h:0.5, fontSize:14, color:"E84A5F", italic:true });
  s.addShape(pres.ShapeType.rect, { x:0.85, y:3.15, w:2.5, h:0.05, fill:{color: C.accent}, line:{color: C.accent} });
  s.addText("Natural History  •  Presentation  •  Course  •  Complications  •  Cause of Death", {
    x:0.85, y:3.3, w:9, h:0.4, fontSize:10, color:"A0AEC0"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// CONTENT SLIDE generator (2-column layout)
// ─────────────────────────────────────────────────────────────────────────────
function addContentSlide(cancer) {
  const s = pres.addSlide();
  bg(s, C.midBg);
  topBar(s, C.darkBg);
  leftBar(s);

  // Title bar
  s.addText(cancer.title.toUpperCase(), { x:0.25, y:0.08, w:7, h:0.38, fontSize:13, bold:true, color:"FFFFFF", charSpacing:1, margin:0 });
  s.addText(cancer.num, { x:9.1, y:0.08, w:0.8, h:0.38, fontSize:12, bold:true, color: C.accent, align:"right", margin:0 });

  // LEFT COLUMN
  const lx = 0.22, rw = 4.3, lw = 4.35;

  // Natural History
  tag(s, "NATURAL HISTORY", lx + 0.1, 0.65, C.tag1);
  bullets(s, cancer.natural, lx + 0.1, 0.97, lw, 1.35);

  // Presentation
  tag(s, "CLINICAL PRESENTATION", lx + 0.1, 2.38, C.tag2);
  bullets(s, cancer.presentation, lx + 0.1, 2.7, lw, 1.55);

  // RIGHT COLUMN
  const rx = 5.3;

  // Course
  tag(s, "DISEASE COURSE", rx, 0.65, "4A5568");
  bullets(s, cancer.course, rx, 0.97, rw, 1.35);

  // Complications
  tag(s, "COMPLICATIONS", rx, 2.38, C.tag3);
  bullets(s, cancer.complications, rx, 2.7, rw, 1.55);

  // Cause of death - full width strip at bottom
  s.addShape(pres.ShapeType.rect, { x:0.22, y:4.32, w:9.56, h:1.18, fill:{color:"FFF5F5"}, line:{color:"FEB2B2", pt:1} });
  s.addShape(pres.ShapeType.rect, { x:0.22, y:4.32, w:2.3, h:0.28, fill:{color: C.tag4}, line:{color: C.tag4} });
  s.addText("CAUSE OF DEATH", { x:0.22, y:4.32, w:2.3, h:0.28, fontSize:8, bold:true, color:"FFFFFF", align:"center", valign:"middle", margin:0 });
  const deathText = cancer.death.join("   |   ");
  s.addText(deathText, { x:0.28, y:4.62, w:9.44, h:0.85, fontSize:9, color: C.tag4, valign:"top", lineSpacingMultiple:1.3 });
}

// ─────────────────────────────────────────────────────────────────────────────
// Build all slides
// ─────────────────────────────────────────────────────────────────────────────
cancerData.forEach(c => {
  addSectionSlide(c.num, c.title, c.subtitle);
  addContentSlide(c);
});

// ─────────────────────────────────────────────────────────────────────────────
// FINAL SLIDE – Summary / Key Takeaways
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.darkBg);
  s.addShape(pres.ShapeType.ellipse, { x:7, y:-1, w:5, h:5, fill:{color:"2D3561"}, line:{color:"2D3561"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.12, h:5.625, fill:{color: C.accent}, line:{color: C.accent} });

  s.addText("KEY PATTERNS ACROSS CANCERS", { x:0.4, y:0.5, w:9, h:0.5, fontSize:12, bold:true, color: C.accent, charSpacing:2 });
  s.addText("Common Themes", { x:0.4, y:1.0, w:8, h:0.8, fontSize:28, bold:true, color:"FFFFFF" });

  const themes = [
    "Painless mass is the most common early presentation across all solid cancers",
    "Weight loss + anorexia = constitutional symptoms suggesting advanced disease",
    "Most cancers are silent for years; late diagnosis worsens prognosis significantly",
    "Haematogenous spread: Lung → systemic; Portal drainage → Liver first for GI cancers",
    "Respiratory failure (lung mets/effusion) and hepatic failure (liver mets) are frequent final events",
    "Uraemia (cervix, prostate) and haemorrhage (HCC, gastric) are cancer-specific causes of death",
    "Spinal cord compression is an oncological emergency common to breast, prostate, and lung cancers",
    "Paraneoplastic syndromes (SIADH, hypercalcaemia, Trousseau) point to specific tumour types",
  ];

  const arr = themes.map((t, i) => ({
    text: t,
    options: { bullet:{code:'25B8', color: C.accent}, breakLine: i < themes.length-1, color:"FFFFFF", fontSize:10.5 }
  }));
  s.addText(arr, { x:0.4, y:1.85, w:9, h:3.3, valign:"top", lineSpacingMultiple:1.35 });
}

// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/cancer-ppt/Common_Cancers_Boloor_Manthappa.pptx" })
  .then(() => console.log("PPT created successfully!"))
  .catch(e => console.error("Error:", e));

cd /home/daytona/workspace/cancer-ppt && node cancer_boloor.js

ls -lh /home/daytona/workspace/cancer-ppt/Common_Cancers_Boloor_Manthappa.pptx &…

~/cancer-ppt/cancer_25slides.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Natural History of Common Cancers';
pres.author = 'Based on Boloor & Manthappa Text-Based Medicine';

// ── Palette ───────────────────────────────────────────────────────────────────
const C = {
  navy:    "1A1F3A",
  accent:  "E84A5F",
  white:   "FFFFFF",
  offWhite:"F5F7FF",
  textDark:"1A1F3A",
  mid:     "4A5568",
  blue:    "2B6CB0",
  green:   "276749",
  brown:   "744210",
  dkRed:   "742A2A",
  ltRed:   "FFF0F0",
  ltBlue:  "EBF4FF",
  ltGreen: "F0FFF4",
  ltBrown: "FFFAF0",
  divider: "CBD5E0",
  rowAlt:  "EDF2FF",
};

// ── Helpers ───────────────────────────────────────────────────────────────────
const W = 13.3, H = 7.5; // LAYOUT_WIDE inches

function bg(s, fill) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:W, h:H, fill:{color:fill}, line:{color:fill} });
}
function topBar(s, col, height=0.65) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:W, h:height, fill:{color:col}, line:{color:col} });
}
function leftStripe(s) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0.65, w:0.14, h:H-0.65, fill:{color:C.accent}, line:{color:C.accent} });
}
function pill(s, label, x, y, w, bgCol) {
  s.addShape(pres.ShapeType.rect, { x, y, w, h:0.34, fill:{color:bgCol}, line:{color:bgCol} });
  s.addText(label, { x, y, w, h:0.34, fontSize:9.5, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
}
function sectionHeader(s, num, title, subtitle, accentCol) {
  bg(s, C.navy);
  // big circle decoration
  s.addShape(pres.ShapeType.ellipse, { x:9.5, y:-1.5, w:6, h:6, fill:{color:"252B54"}, line:{color:"252B54"} });
  s.addShape(pres.ShapeType.ellipse, { x:10.5, y:5.0, w:3.5, h:3.5, fill:{color:"252B54"}, line:{color:"252B54"} });
  // left stripe
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.7, h:H, fill:{color:accentCol||C.accent}, line:{color:accentCol||C.accent} });
  // number badge
  s.addShape(pres.ShapeType.ellipse, { x:1.2, y:1.6, w:1.2, h:1.2, fill:{color:accentCol||C.accent}, line:{color:accentCol||C.accent} });
  s.addText(num, { x:1.2, y:1.6, w:1.2, h:1.2, fontSize:28, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
  // text
  s.addText(title, { x:2.8, y:1.5, w:9.5, h:1.4, fontSize:44, bold:true, color:C.white });
  s.addText(subtitle, { x:2.8, y:3.0, w:9, h:0.6, fontSize:17, color:C.accent, italic:true });
  s.addShape(pres.ShapeType.rect, { x:2.8, y:3.7, w:3, h:0.06, fill:{color:C.accent}, line:{color:C.accent} });
  s.addText("Boloor & Manthappa | Text-Based Medicine", { x:2.8, y:3.9, w:9, h:0.4, fontSize:12, color:"8899BB" });
}

// ── Row-based content builder ─────────────────────────────────────────────────
// Each slide has a header + N rows of data (label col + content col)
// rowHeight auto-calculated to fill slide
function addTableSlide(opts) {
  // opts: { slideTitle, cancerName, cancerNum, accentCol, rows: [{label, labelBg, content}] }
  const s = pres.addSlide();
  bg(s, C.offWhite);
  topBar(s, C.navy, 0.65);
  leftStripe(s);

  // Top bar text
  s.addText(opts.cancerName.toUpperCase(), {
    x:0.25, y:0.1, w:9, h:0.45,
    fontSize:15, bold:true, color:C.white, charSpacing:1.5, margin:0
  });
  s.addText(opts.slideTitle, {
    x:0.25, y:0.1, w:12.8, h:0.45,
    fontSize:14, bold:true, color:C.accent, align:"right", margin:0
  });
  // Cancer number badge (top-right)
  s.addShape(pres.ShapeType.rect, { x:12.4, y:0, w:0.9, h:0.65, fill:{color:opts.accentCol||C.accent}, line:{color:opts.accentCol||C.accent} });
  s.addText(opts.cancerNum, { x:12.4, y:0, w:0.9, h:0.65, fontSize:16, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });

  const rows = opts.rows;
  const topY = 0.72;
  const availH = H - topY - 0.08;
  const rowH = availH / rows.length;
  const labelW = 2.2;
  const contentX = 0.28 + labelW;
  const contentW = W - contentX - 0.15;

  rows.forEach((row, i) => {
    const y = topY + i * rowH;
    const rowBg = i % 2 === 0 ? C.white : C.rowAlt;
    // row background
    s.addShape(pres.ShapeType.rect, { x:0.16, y, w:W-0.22, h:rowH-0.04,
      fill:{color:rowBg}, line:{color:C.divider, pt:0.5} });
    // label badge
    s.addShape(pres.ShapeType.rect, { x:0.18, y:y+0.04, w:labelW, h:rowH-0.12,
      fill:{color:row.labelBg||C.navy}, line:{color:row.labelBg||C.navy} });
    s.addText(row.label, {
      x:0.18, y:y+0.04, w:labelW, h:rowH-0.12,
      fontSize:11.5, bold:true, color:C.white, align:"center", valign:"middle",
      margin:4, wrap:true
    });
    // content
    const items = row.content;
    const fs = rowH > 0.85 ? 12.5 : 11.5;
    if (Array.isArray(items)) {
      const arr = items.map((t, j) => ({
        text: "  " + t,
        options: { bullet:{code:'25B8', color:row.labelBg||C.accent}, breakLine: j<items.length-1,
                   color:C.textDark, fontSize:fs }
      }));
      s.addText(arr, { x:contentX+0.12, y:y+0.06, w:contentW-0.12, h:rowH-0.14,
        valign:"middle", lineSpacingMultiple:1.25 });
    } else {
      s.addText(items, { x:contentX+0.12, y:y+0.06, w:contentW-0.12, h:rowH-0.14,
        fontSize:fs, color:C.textDark, valign:"middle", lineSpacingMultiple:1.25 });
    }
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.navy);
  s.addShape(pres.ShapeType.ellipse, { x:9.5, y:-2, w:7, h:7, fill:{color:"252B54"}, line:{color:"252B54"} });
  s.addShape(pres.ShapeType.ellipse, { x:11, y:6, w:4, h:4, fill:{color:"252B54"}, line:{color:"252B54"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.7, h:H, fill:{color:C.accent}, line:{color:C.accent} });
  s.addText("NATURAL HISTORY OF", { x:1.2, y:1.5, w:10, h:0.8, fontSize:22, bold:true, color:C.accent, charSpacing:5 });
  s.addText("Common Cancers", { x:1.2, y:2.2, w:11, h:2.0, fontSize:64, bold:true, color:C.white });
  s.addText("Presentation  •  Course  •  Complications  •  Cause of Death", {
    x:1.2, y:4.3, w:11, h:0.55, fontSize:16, color:"A0AEC0", italic:true });
  s.addShape(pres.ShapeType.rect, { x:1.2, y:5.05, w:4.5, h:0.06, fill:{color:C.accent}, line:{color:C.accent} });
  s.addText("Based on Boloor & Manthappa | Text-Based Medicine", {
    x:1.2, y:5.2, w:10, h:0.45, fontSize:13, color:"718096" });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – INDEX  (8 cancer cards)
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.offWhite);
  topBar(s, C.navy);
  leftStripe(s);
  s.addText("CANCERS COVERED IN THIS DECK", {
    x:0.25, y:0.1, w:12, h:0.45, fontSize:15, bold:true, color:C.white, charSpacing:1.5, margin:0 });

  const cards = [
    {n:"01", name:"Carcinoma Lung",          col:C.blue},
    {n:"02", name:"Carcinoma Breast",         col:"A0522D"},
    {n:"03", name:"Colorectal Carcinoma",     col:C.green},
    {n:"04", name:"Carcinoma Stomach",        col:"6B46C1"},
    {n:"05", name:"Carcinoma Cervix",         col:"B7791F"},
    {n:"06", name:"Carcinoma Prostate",       col:"2C7A7B"},
    {n:"07", name:"Hepatocellular Carcinoma", col:C.dkRed},
    {n:"08", name:"Hodgkin Lymphoma",         col:"553C9A"},
  ];
  const cols = 4, cw = 2.9, ch = 1.35, gap = 0.38;
  const startX = 0.45, startY = 0.82;
  cards.forEach((c, i) => {
    const col = i % cols, row = Math.floor(i / cols);
    const x = startX + col * (cw + gap);
    const y = startY + row * (ch + 0.3);
    s.addShape(pres.ShapeType.rect, { x, y, w:cw, h:ch, fill:{color:C.white},
      line:{color:C.divider, pt:1}, shadow:{type:"outer",color:"C4CDE0",blur:8,offset:2,angle:135,opacity:0.25} });
    s.addShape(pres.ShapeType.rect, { x, y, w:0.6, h:ch, fill:{color:c.col}, line:{color:c.col} });
    s.addText(c.n, { x, y, w:0.6, h:ch, fontSize:20, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    s.addText(c.name, { x:x+0.7, y, w:cw-0.75, h:ch, fontSize:15, bold:true, color:C.textDark, valign:"middle", margin:6, wrap:true });
  });
  // legend
  s.addText("Each cancer → 3 slides: (A) Natural History & Presentation  (B) Course & Complications  (C) Cause of Death", {
    x:0.3, y:7.1, w:13, h:0.36, fontSize:11, color:C.mid, italic:true });
}

// ─────────────────────────────────────────────────────────────────────────────
// CANCER DATA
// ─────────────────────────────────────────────────────────────────────────────
const cancers = [
  {
    num:"01", name:"Carcinoma Lung", subtitle:"NSCLC (70%) & SCLC (25%)", accentCol: C.blue,
    nh: [
      { label:"Types", labelBg:"1A5276",   content:["NSCLC: Adenocarcinoma (most common overall), Squamous cell (central), Large cell undifferentiated","SCLC: Neuroendocrine origin; always central; fastest growing lung cancer"] },
      { label:"Aetiology", labelBg:"1A5276", content:["Smoking (85%): 20 pack-year history; risk proportional to pack-years","Others: Asbestos (mesothelioma + lung Ca), radon, arsenic, chromium, nickel"] },
      { label:"Pre-malignant", labelBg:"1F618D", content:["Squamous: Squamous metaplasia → dysplasia → CIS → Invasive","Adenocarcinoma: Atypical adenomatous hyperplasia → Adenocarcinoma in situ → Invasive"] },
      { label:"Doubling Time", labelBg:"1F618D", content:["Adenocarcinoma: 180 days; Squamous: 90 days; SCLC: 30 days","Tumour clinically silent for 8-10 years before symptom threshold reached"] },
    ],
    pres: [
      { label:"Central Tumour", labelBg:"117A65",  content:["Cough (most common, 75%), haemoptysis, wheeze, stridor","Hoarseness (recurrent laryngeal nerve palsy), dysphagia"] },
      { label:"Peripheral Tumour", labelBg:"117A65", content:["Often silent until pleural involvement; chest pain, dyspnoea","Pancoast (superior sulcus): Shoulder pain, Horner's syndrome, wasting of hand muscles"] },
      { label:"Systemic", labelBg:"148F77",         content:["Weight loss, anorexia, fatigue, fever, clubbing (NSCLC)","SVC syndrome: Facial/arm oedema, distended neck veins, headache"] },
      { label:"Paraneoplastic", labelBg:"148F77",   content:["SIADH (SCLC) → hyponatraemia; PTHrP → hypercalcaemia (Sq. cell)","LEMS (SCLC): Proximal weakness; ACTH excess → Cushing's syndrome"] },
    ],
    course: [
      { label:"Local Spread", labelBg:"6E2F1A", content:["NSCLC: T1 (≤3cm) → T2 → T3 (chest wall/diaphragm) → T4 (mediastinum, carina)","Pericardium invasion → malignant pericardial effusion, cardiac tamponade"] },
      { label:"LN Spread", labelBg:"6E2F1A", content:["Ipsilateral hilar (N1) → ipsilateral mediastinal (N2) → contralateral/supraclavicular (N3)","N3 disease = inoperable; N2 disease requires neoadjuvant therapy assessment"] },
      { label:"Haematogenous", labelBg:"7B241C", content:["Brain (50%), liver (30%), adrenals, bone, contralateral lung","SCLC: Almost always disseminated at diagnosis; Limited vs Extensive disease staging"] },
      { label:"Prognosis", labelBg:"7B241C", content:["Stage I NSCLC: 5-yr survival 70-90% (resected); Stage IV: <5%","SCLC Limited: Median survival 15-20 months; Extensive: 8-12 months with chemo"] },
    ],
    comp: [
      { label:"Pulmonary", labelBg:"784212", content:["Lobar collapse/consolidation (post-obstructive) → lung abscess, empyema","Massive haemoptysis → asphyxia; malignant pleural effusion → respiratory failure"] },
      { label:"Neurological", labelBg:"784212", content:["Brain metastases (50%): Seizures, raised ICP, focal deficits, herniation","Spinal cord compression: Back pain → weakness → paraplegia (emergency)"] },
      { label:"Metabolic", labelBg:"7D6608", content:["Hypercalcaemia (Sq. cell / bone mets): Confusion, polyuria, renal failure, coma","SIADH (SCLC): Hyponatraemia → nausea, seizures, coma if Na <120 mmol/L"] },
      { label:"Vascular/Other", labelBg:"7D6608", content:["SVC obstruction: Facial oedema, proptosis, dilated superficial veins","Phrenic nerve palsy → elevated hemidiaphragm; recurrent laryngeal → hoarseness"] },
    ],
    death: [
      { label:"Most Common", labelBg:C.dkRed, content:["Respiratory failure from tumour bulk, post-obstructive pneumonia, or pleural effusion","This accounts for >50% of deaths in lung cancer patients"] },
      { label:"Haemorrhage", labelBg:"922B21", content:["Massive haemoptysis from erosion of pulmonary artery or bronchial vessels","Often sudden and catastrophic; occurs in central squamous cell carcinoma"] },
      { label:"CNS", labelBg:"922B21", content:["Brain herniation from metastases or intracranial hypertension","Spinal cord complications leading to urinary retention, infection, DVT, PE"] },
      { label:"Metabolic / Sepsis", labelBg:C.dkRed, content:["Electrolyte crises (SIADH, hypercalcaemia) causing multi-organ failure","Sepsis from post-obstructive pneumonia or neutropenia following chemotherapy"] },
    ],
  },
  {
    num:"02", name:"Carcinoma Breast", subtitle:"Invasive Ductal / Lobular Carcinoma", accentCol:"A0522D",
    nh: [
      { label:"Pathology", labelBg:"6E2F1A", content:["IDC (70-80%): Arises from ductal epithelium; most common breast cancer type","ILC (10-15%): Bilateral tendency; discohesive single-file infiltration; often ER+"] },
      { label:"Pre-malignant", labelBg:"6E2F1A", content:["DCIS → IDC sequence (low/intermediate/high grade); Paget's disease of nipple = underlying DCIS/IDC","LCIS: Not pre-malignant; marker of 7-11x increased lifetime risk"] },
      { label:"Molecular Subtypes", labelBg:"784212", content:["Luminal A (ER+/PR+, HER2-): Best prognosis; hormonal therapy responsive","Triple Negative (ER-/PR-/HER2-): Worst prognosis; BRCA1 associated; chemo only"] },
      { label:"Risk Factors", labelBg:"784212", content:["BRCA1/2 mutations, family history (1st-degree), early menarche, late menopause","Nulliparity, HRT (combined), obesity (post-menopausal), alcohol, prior chest irradiation"] },
    ],
    pres: [
      { label:"Lump", labelBg:"117A65", content:["Painless, hard, irregular, poorly defined lump — upper outer quadrant (most common)","Fixed to skin or deep structures in advanced disease; mobile = more likely benign"] },
      { label:"Nipple Changes", labelBg:"117A65", content:["Bloody discharge (duct ectasia vs. DCIS vs. Paget's disease)","Nipple retraction/inversion (new onset); Paget's: Eczematous rash of nipple-areola"] },
      { label:"Skin Changes", labelBg:"148F77", content:["Peau d'orange: Lymphoedema causing skin dimpling resembling orange peel","Skin dimpling, tethering (ligament of Cooper invasion), erythema, skin nodules"] },
      { label:"Inflammatory / Advanced", labelBg:"148F77", content:["Inflammatory breast cancer: Rapid onset painful swelling, warmth, peau d'orange (T4d)","Axillary nodes: Firm, hard, matted; supraclavicular nodes = Stage IV (M1)"] },
    ],
    course: [
      { label:"Local Spread", labelBg:"5D4037", content:["Skin, nipple-areola complex, pectoralis major, chest wall","Posterior fixation to chest wall = T4 disease; inoperable without neoadjuvant therapy"] },
      { label:"LN Spread", labelBg:"5D4037", content:["Axillary nodes: Level I (low axilla) → Level II (mid) → Level III (infraclavicular)","Internal mammary LN (medial tumours); Supraclavicular nodes = distant (M1)"] },
      { label:"Haematogenous", labelBg:"6D4C41", content:["Bone (most common): Vertebrae, pelvis, femur — osteolytic (BRCA) or mixed","Lung, liver, brain, ovaries; ER+ tends to late, indolent mets; Triple-negative: early aggressive mets"] },
      { label:"Prognosis", labelBg:"6D4C41", content:["Stage I: 5-yr survival >95%; Stage II: 80-90%; Stage III: 40-70%; Stage IV: 25-30%","Luminal A has best prognosis; Triple-negative has worst; HER2+ improved by trastuzumab"] },
    ],
    comp: [
      { label:"Skeletal", labelBg:"6E2F1A", content:["Pathological fractures: Vertebral collapse → paraplegia; femoral neck fractures","Hypercalcaemia from osteolytic mets: Confusion, abdominal pain, polyuria, renal failure"] },
      { label:"Neurological", labelBg:"6E2F1A", content:["Brain metastases: Seizures, motor/sensory deficits, raised ICP, cerebellar signs","Spinal cord compression: Acute paraplegia (emergency: IV dexamethasone + radiotherapy)"] },
      { label:"Lymphoedema", labelBg:"784212", content:["Post-axillary clearance ± radiotherapy: Chronic arm lymphoedema, cellulitis risk","Limits function, causes pain; managed with compression garments and physiotherapy"] },
      { label:"Pleural / Pericardial", labelBg:"784212", content:["Malignant pleural effusion: Exudative, lymphocyte-rich; dyspnoea, orthopnoea","Pericardial effusion: Tamponade → haemodynamic compromise; rare but life-threatening"] },
    ],
    death: [
      { label:"Most Common", labelBg:C.dkRed, content:["Respiratory failure from malignant pleural effusion or pulmonary metastases","Accounts for ~40% of breast cancer deaths; often preceded by progressive dyspnoea"] },
      { label:"Hepatic Failure", labelBg:"922B21", content:["Liver metastases → hepatic replacement → jaundice, coagulopathy, encephalopathy","More common in Triple-negative and HER2+ subtypes with visceral tropism"] },
      { label:"CNS", labelBg:"922B21", content:["Brain metastases → herniation; HER2+ and Triple-negative have highest brain met rate","Leptomeningeal carcinomatosis: Confusion, multiple cranial nerve palsies, death"] },
      { label:"Cachexia / Sepsis", labelBg:C.dkRed, content:["Cancer cachexia with multi-organ failure in refractory advanced disease","Neutropenic sepsis from chemotherapy; bone marrow infiltration → pancytopenia"] },
    ],
  },
  {
    num:"03", name:"Colorectal Carcinoma", subtitle:"Adenocarcinoma of Colon & Rectum", accentCol:C.green,
    nh: [
      { label:"Adenoma-Carcinoma", labelBg:"1D5016", content:["Polyp → Dysplasia → Carcinoma sequence takes 10-15 years (sporadic adenoma)","APC mutation → Wnt/β-catenin overactivation → tubular/villous adenoma → carcinoma"] },
      { label:"Hereditary", labelBg:"1D5016", content:["FAP: APC germline mutation; 100% lifetime risk; hundreds of polyps by age 20","Lynch syndrome (HNPCC): MLH1/MSH2 MMR mutations; right-sided; accelerated <5 yrs"] },
      { label:"Distribution", labelBg:"276749", content:["Rectum 40%, Sigmoid 25%, Right colon 25%, Transverse/Splenic flexure 10%","Right-sided: Polypoid/bulky; Left-sided: Annular, constricting 'napkin ring' lesion"] },
      { label:"Risk Factors", labelBg:"276749", content:["Red/processed meat, low-fibre diet, sedentary lifestyle, smoking, alcohol, obesity","IBD (ulcerative colitis >8 yrs, Crohn's), prior colorectal cancer or polyps, family history"] },
    ],
    pres: [
      { label:"Right Colon", labelBg:"117A65", content:["Occult bleeding → iron deficiency anaemia (fatigue, pallor, tachycardia) — no visible bleeding","Often presents late with large mass; PR exam may be normal; anaemia in >50% at diagnosis"] },
      { label:"Left Colon / Sigmoid", labelBg:"117A65", content:["Change in bowel habit (alternating constipation/diarrhoea), ribbon stools, tenesmus","Fresh/dark red blood per rectum; mucus PR; lower abdominal pain/bloating"] },
      { label:"Rectal Cancer", labelBg:"148F77", content:["Tenesmus (feeling of incomplete evacuation), mucus + blood PR, anorectal pain","Perineal pain = involvement of levator ani/sacrum (advanced, T4 disease)"] },
      { label:"Complications at Presentation", labelBg:"148F77", content:["Acute intestinal obstruction (10-15%): Left-sided; absolute constipation, vomiting","Perforation with peritonitis; fistula (colo-vesical, colo-vaginal); anaemia; weight loss"] },
    ],
    course: [
      { label:"Dukes / TNM Staging", labelBg:"1D5016", content:["T1: Submucosa; T2: Muscularis propria; T3: Pericolorectal tissue; T4: Adjacent organs","Dukes A (T1-2, N0); B (T3-4, N0); C (any T, N+); D = distant mets (obsolete now = M1)"] },
      { label:"LN Spread", labelBg:"1D5016", content:["Pericolic nodes → intermediate mesenteric → para-aortic nodes","LN ratio (positive/total harvested) is independent prognostic factor; minimum 12 nodes needed"] },
      { label:"Haematogenous", labelBg:"276749", content:["Liver via portal circulation (most common; 20-30% at presentation)","Lung (systemic venous; rectal cancer bypasses portal → higher rate of lung mets)"] },
      { label:"Prognosis", labelBg:"276749", content:["Stage I: 5-yr >90%; Stage II: 70-85%; Stage III: 40-70%; Stage IV: ~10-15% (resected mets 30%)","MSI-High tumours: Better prognosis spontaneously; respond to immunotherapy (pembrolizumab)"] },
    ],
    comp: [
      { label:"Obstruction", labelBg:"744210", content:["Acute left-sided obstruction: Closed-loop if ileocaecal valve competent → caecal blow-out","Emergency: Hartmann's procedure or self-expanding metal stent (SEMS) as bridge to surgery"] },
      { label:"Perforation", labelBg:"744210", content:["At tumour site (ulceration) or proximal caecum (distension) → faecal peritonitis, sepsis","High mortality (20-30%); emergency laparotomy with stoma formation required"] },
      { label:"Fistula", labelBg:"6B4226", content:["Colo-vesical fistula: Pneumaturia, faecuria, recurrent polymicrobial UTI","Colo-vaginal: Faecal vaginal discharge; Colo-enteric: Diarrhoea, malabsorption"] },
      { label:"Metastatic", labelBg:"6B4226", content:["Liver mets → hepatic failure, obstructive jaundice, portal hypertension","Peritoneal carcinomatosis → malignant ascites, small bowel obstruction, inanition"] },
    ],
    death: [
      { label:"Hepatic Failure", labelBg:C.dkRed, content:["Most common cause in metastatic CRC; liver replacement → jaundice, coagulopathy, coma","Median time from liver-only mets to death = 6-8 months untreated"] },
      { label:"Sepsis", labelBg:"922B21", content:["Faecal peritonitis from perforation; anastomotic leak post-surgery","Ascending cholangitis from biliary obstruction by liver mets"] },
      { label:"Obstruction / Fistula", labelBg:"922B21", content:["Recurrent small bowel obstruction from peritoneal seeding → starvation, aspiration","Uncontrolled fistulae leading to infection and metabolic derangement"] },
      { label:"Cachexia", labelBg:C.dkRed, content:["Cancer-associated cachexia: Profound weight loss, muscle wasting, multi-organ failure","Electrolyte imbalance, hypoalbuminaemia, immunosuppression in terminal disease"] },
    ],
  },
  {
    num:"04", name:"Carcinoma Stomach", subtitle:"Gastric Adenocarcinoma", accentCol:"6B46C1",
    nh: [
      { label:"Types", labelBg:"4A235A", content:["Intestinal type: Distal stomach; older males; H.pylori driven; Correa cascade; declining incidence","Diffuse type: Young patients; linitis plastica; signet ring cells; no glandular differentiation; worse prognosis"] },
      { label:"Correa Cascade", labelBg:"4A235A", content:["H.pylori → Chronic superficial gastritis → Atrophic gastritis → Intestinal metaplasia → Dysplasia → Adenocarcinoma","Each step takes years; H.pylori eradication halts/reverses early steps"] },
      { label:"Risk Factors", labelBg:"6C3483", content:["H.pylori infection (most modifiable); diet: salted, smoked, pickled food, nitrites, low fruit/veg intake","Smoking, alcohol; Blood group A (diffuse type); prior gastrectomy (15-20 yr latency); pernicious anaemia"] },
      { label:"Detection", labelBg:"6C3483", content:["Japan / Korea: Mass screening programmes → 50%+ early-stage detection; 5-yr survival >90%","Western countries: 70-80% present at advanced/metastatic stage; median survival <12 months"] },
    ],
    pres: [
      { label:"Early (Vague)", labelBg:"117A65", content:["Vague epigastric discomfort — often attributed to PUD or GERD and ignored","Early satiety, nausea, occasional dyspepsia; endoscopy essential in >45 yrs with new dyspepsia"] },
      { label:"Late Symptoms", labelBg:"117A65", content:["Progressive dysphagia (cardia/GEJ tumours); projectile vomiting (pyloric obstruction)","Epigastric mass, progressive weight loss (most consistent finding), anorexia, fatigue"] },
      { label:"Metastatic Signs", labelBg:"148F77", content:["Virchow's node (left supraclavicular LN via thoracic duct — Troisier's sign)","Sister Mary Joseph nodule (periumbilical); Krukenberg tumour (ovarian mets, transcoelomic)","Blumer's shelf: Rectal shelf on PR exam (pouch of Douglas mets); Irish's node (left axillary LN)"] },
      { label:"Paraneoplastic", labelBg:"148F77", content:["Trousseau's syndrome: Migratory thrombophlebitis (hypercoagulable state)","Acanthosis nigricans (velvety axillary plaques); Dermatomyositis; Microangiopathic haemolytic anaemia"] },
    ],
    course: [
      { label:"Local Spread", labelBg:"4A235A", content:["Oesophagus (proximal extension), duodenum (distal), transverse colon (posterior), pancreas, liver (direct)","Linitis plastica: Diffuse mural infiltration → rigid leather-bottle stomach, loss of peristalsis"] },
      { label:"LN Spread", labelBg:"4A235A", content:["Perigastric nodes → coeliac axis → hepatic/splenic hilum → para-aortic","Virchow's node via thoracic duct; Irish's node (left axillary) via mediastinal lymphatics"] },
      { label:"Haematogenous & Transcoelomic", labelBg:"6C3483", content:["Liver most common haematogenous met; lung, adrenals, bone","Transcoelomic spread to peritoneum → malignant ascites; Krukenberg tumour (ovaries); Blumer's shelf"] },
      { label:"Prognosis", labelBg:"6C3483", content:["Overall 5-yr survival in West: 25-30%; Japan (screened early): 60-70%","Stage IA: 5-yr >80%; Stage IIB: ~40%; Stage IV: <5%; Complete R0 resection essential for cure"] },
    ],
    comp: [
      { label:"Obstruction", labelBg:"6E2F1A", content:["Pyloric/antral obstruction: Projectile non-bilious vomiting, dehydration, hypokalaemic hypochloraemic alkalosis","Cardia obstruction: Progressive solid then liquid dysphagia; aspiration pneumonia risk"] },
      { label:"Haemorrhage", labelBg:"6E2F1A", content:["Haematemesis (ulcerated tumour eroding vessel) and melaena; chronic bleeding → iron deficiency anaemia","Massive haemorrhage requiring emergency endoscopic or angiographic intervention"] },
      { label:"Perforation / Fistula", labelBg:"784212", content:["Gastric perforation → acute generalised peritonitis (rare but highly lethal)","Gastro-colic fistula: Faeculent vomiting (brown vomiting), severe diarrhoea, malabsorption"] },
      { label:"Nutritional", labelBg:"784212", content:["Malabsorption, B12 deficiency (post-gastrectomy; loss of intrinsic factor), dumping syndrome","Profound cachexia with muscle wasting; hypoalbuminaemia → oedema, impaired healing"] },
    ],
    death: [
      { label:"Inanition / Cachexia", labelBg:C.dkRed, content:["Starvation and cachexia = most common cause; inability to eat due to obstruction or anorexia","Progressive protein-calorie malnutrition leads to organ failure and immunosuppression"] },
      { label:"Haemorrhage", labelBg:"922B21", content:["Massive gastric haemorrhage from tumour erosion of gastric or coeliac vessels","Tumour erosion into aorta is rare but catastrophic"] },
      { label:"Hepatic Failure", labelBg:"922B21", content:["Liver metastases or biliary obstruction leading to progressive liver failure","Jaundice, coagulopathy, hepatic encephalopathy in final stages"] },
      { label:"Sepsis / Peritonitis", labelBg:C.dkRed, content:["Perforation-induced faecal peritonitis or aspiration pneumonia from obstruction","Spontaneous bacterial peritonitis superimposed on malignant ascites"] },
    ],
  },
  {
    num:"05", name:"Carcinoma Cervix", subtitle:"Squamous Cell Carcinoma / Adenocarcinoma", accentCol:"B7791F",
    nh: [
      { label:"HPV Pathway", labelBg:"7D6608", content:["HPV 16 (squamous, 50%) and HPV 18 (adenocarcinoma, 20%) cause 70% of cervical cancers","E6 protein → p53 degradation; E7 protein → Rb inactivation → cell cycle escape → malignancy"] },
      { label:"Precursor Lesions", labelBg:"7D6608", content:["CIN 1 (mild dysplasia) → CIN 2/3 (moderate-severe) → FIGO Stage 0 (CIS) → Stage I Invasive","CIN to invasive squamous: 10-15 years; Adenocarcinoma: 5-10 years; CIN 1: 70% regress spontaneously"] },
      { label:"Risk Factors", labelBg:"975A16", content:["Multiple sexual partners, early age of first coitus (<16 yrs), multiparity, HPV co-infection","Immunosuppression (HIV, transplant), oral contraceptives >5 yrs, smoking, low socioeconomic status"] },
      { label:"Prevention", labelBg:"975A16", content:["HPV vaccine (bivalent/quadrivalent/nonavalent): Prevents 70-90% of cervical cancers if given pre-exposure","Pap smear (cytology) every 3 years or HPV co-testing every 5 years = secondary prevention"] },
    ],
    pres: [
      { label:"Early (Asymptomatic)", labelBg:"117A65", content:["Most pre-invasive and early invasive (Stage IA) lesions are asymptomatic","Detected only on routine Pap smear or colposcopy; hence screening is life-saving"] },
      { label:"Classic Symptoms", labelBg:"117A65", content:["Post-coital bleeding (most characteristic symptom of invasive cervical cancer)","Intermenstrual or postmenopausal bleeding; offensive watery or blood-stained vaginal discharge"] },
      { label:"Advanced Local", labelBg:"148F77", content:["Pelvic/back pain (ureteric involvement or sacral nerve infiltration in late disease)","Lower limb oedema (lymphatic obstruction); deep pelvic pain; haematuria or rectal bleeding"] },
      { label:"Fistulae (Very Advanced)", labelBg:"148F77", content:["Vesicovaginal fistula: Continuous urinary incontinence — urine per vaginum","Rectovaginal fistula: Faecal soiling per vaginum; combined = total pelvic exenteration territory"] },
    ],
    course: [
      { label:"Local Spread", labelBg:"7D6608", content:["Parametrium → pelvic side wall (Stage III) → bladder (anterior), rectum (posterior) = Stage IVA","Ureteric involvement at pelvic side wall → hydronephrosis → uraemia (most common cause of death)"] },
      { label:"LN Spread", labelBg:"7D6608", content:["Paracervical → obturator fossa → internal iliac → external iliac → common iliac → para-aortic","LN metastasis found in 15% Stage I, 29% Stage II, 47% Stage III; N+ doubles recurrence risk"] },
      { label:"Haematogenous", labelBg:"975A16", content:["Rare in early stages; lung, liver, bone in Stage IV disease","Supraclavicular LN enlargement = distant mets (Stage IVB)"] },
      { label:"Prognosis (FIGO)", labelBg:"975A16", content:["Stage I: 5-yr >85%; Stage II: 60-75%; Stage III: 30-50%; Stage IVA: <20%; Stage IVB: <10%","Concurrent chemo-radiation (cisplatin + radiotherapy) = standard for Stage IIB-IVA"] },
    ],
    comp: [
      { label:"Ureteric Obstruction", labelBg:"6E2F1A", content:["Bilateral hydronephrosis → uraemia = most common cause of death in cervical cancer","Unilateral obstruction may be asymptomatic; bilateral = oliguria/anuria, raised creatinine"] },
      { label:"Fistulae", labelBg:"6E2F1A", content:["Vesicovaginal: Continuous incontinence, recurrent UTIs, urosepsis; very distressing quality of life impact","Rectovaginal: Faecal discharge per vaginum; pelvic infection risk; palliation with diverting colostomy"] },
      { label:"Haemorrhage", labelBg:"784212", content:["Massive pelvic haemorrhage from erosion of internal/external iliac vessels","Life-threatening; managed with embolisation, packing, or ligation in palliative setting"] },
      { label:"Lymphoedema / Infection", labelBg:"784212", content:["Lower limb lymphoedema from pelvic LN block or post-radiotherapy lymphatic damage","Pelvic abscess, radiation-induced bowel injury (proctitis, fistula, stricture)"] },
    ],
    death: [
      { label:"Uraemia", labelBg:C.dkRed, content:["MOST COMMON cause of death — bilateral ureteric obstruction by pelvic disease → renal failure","Uraemic death: Nausea, confusion, asterixis, pericarditis, pulmonary oedema, coma"] },
      { label:"Haemorrhage", labelBg:"922B21", content:["Massive pelvic haemorrhage from erosion of major pelvic vessels","Vaginal packing, interventional radiology, or palliative care pathway"] },
      { label:"Sepsis", labelBg:"922B21", content:["Pelvic infection, vesicovaginal fistula-related urosepsis, bowel fistula-related peritonitis","Immunosuppression from advanced disease + chemoradiation increases infection risk"] },
      { label:"Cachexia", labelBg:C.dkRed, content:["Terminal cachexia in Stage IV disease with distant metastases to lung/liver/bone","Bone pain, anorexia, metabolic failure in the final phase"] },
    ],
  },
  {
    num:"06", name:"Carcinoma Prostate", subtitle:"Adenocarcinoma", accentCol:"2C7A7B",
    nh: [
      { label:"Pathology", labelBg:"1A5276", content:["Adenocarcinoma arises from peripheral zone (70-80%); central zone: rare; transition zone: BPH area","Gleason grading (1-5 per pattern × 2 patterns = score 2-10); ≥7 = significant; Grade Group 1-5 (new)"] },
      { label:"Latent vs. Clinical", labelBg:"1A5276", content:["Latent/incidental: Autopsy studies — 70% of men >80 yrs have histological Ca; most never become clinical","Clinical: Only 1 in 7 men develop symptomatic disease; 1 in 40 die of prostate cancer"] },
      { label:"Androgen Dependence", labelBg:"1B4F72", content:["Testosterone → DHT (5α-reductase) binds androgen receptor → proliferation, survival signalling","Androgen deprivation therapy (ADT): GnRH agonists/antagonists or bilateral orchidectomy"] },
      { label:"Risk Factors", labelBg:"1B4F72", content:["Age >50 (rare <40), BRCA2 mutation (aggressive), African descent, positive family history","High saturated fat diet; low sunlight/Vitamin D; cadmium exposure; obesity (aggressive subtypes)"] },
    ],
    pres: [
      { label:"Early (Asymptomatic)", labelBg:"117A65", content:["Peripheral zone tumour is clinically silent early; PSA elevation or abnormal DRE = incidental finding","PSA >4 ng/mL: Sensitivity 21%, Specificity 91% for Ca; PSA velocity and free:total PSA improve accuracy"] },
      { label:"LUTS", labelBg:"117A65", content:["Hesitancy, poor urinary stream, incomplete bladder emptying, post-micturition dribbling","Frequency, nocturia (central extension into transition zone compresses urethra/bladder neck)"] },
      { label:"DRE Findings", labelBg:"148F77", content:["Hard, irregular, nodular posterior prostate; obliteration of median sulcus in advanced disease","Asymmetry; tenderness suggests prostatitis (typically absent in cancer)"] },
      { label:"Advanced Symptoms", labelBg:"148F77", content:["Bone pain: Back pain (vertebral mets), hip pain (pelvic mets) — dull, progressive, worse at night","Leg weakness/numbness (cord compression); lymphoedema; haematuria; uraemia"] },
    ],
    course: [
      { label:"Local Extension", labelBg:"1A5276", content:["Seminal vesicle invasion (T3b) = independent poor prognostic factor","Bladder neck → trigone → ureter obstruction; rectal wall infiltration (rare) → tenesmus"] },
      { label:"LN Spread", labelBg:"1A5276", content:["Obturator fossa nodes → internal iliac → external iliac → para-aortic chain","LN+ = Stage IV disease; nomograms (Partin tables) predict LN risk pre-operatively"] },
      { label:"Skeletal Mets", labelBg:"1B4F72", content:["Osteoblastic (sclerotic) mets — classic for prostate cancer (unlike lytic mets of most others)","Axial skeleton preferentially: Vertebrae, pelvis, ribs, skull; hotspot on bone scan"] },
      { label:"CRPC & Prognosis", labelBg:"1B4F72", content:["Hormone-sensitive → Castration-Resistant Prostate Cancer (CRPC) median 2-3 years on ADT","Localised: 5-yr survival ~99%; Metastatic: 5-yr ~30%; CRPC median OS ~3 years with novel agents"] },
    ],
    comp: [
      { label:"Spinal Cord Compression", labelBg:"6E2F1A", content:["ONCOLOGICAL EMERGENCY — vertebral mets collapse onto spinal cord → bilateral weakness/pain","High-dose IV dexamethasone immediately; MRI spine; radiotherapy or surgical decompression"] },
      { label:"Skeletal", labelBg:"6E2F1A", content:["Pathological fractures (femoral neck, vertebral): High morbidity; difficult healing (osteoblastic)","Bone marrow infiltration → anaemia, thrombocytopenia, leucoerythroblastic picture"] },
      { label:"Urological", labelBg:"784212", content:["Acute urinary retention from bladder neck invasion; bilateral ureteric obstruction → uraemia","Haematuria from bladder invasion; prostatic abscess (rare)"] },
      { label:"Haematological", labelBg:"784212", content:["DIC: Especially in CRPC with high tumour burden; PT/APTT prolonged; microangiopathic changes","Bone marrow failure → pancytopenia in end-stage disease"] },
    ],
    death: [
      { label:"Uraemia", labelBg:C.dkRed, content:["Bilateral ureteric obstruction from pelvic disease leading to renal failure","May require nephrostomy tubes in selected patients for palliation"] },
      { label:"Skeletal Complications", labelBg:"922B21", content:["Paraplegia from spinal cord compression and its sequelae (PE, urosepsis)","Pathological fracture of femoral neck or vertebral body with failed surgical management"] },
      { label:"Cachexia / Marrow Failure", labelBg:"922B21", content:["End-stage CRPC with bone marrow replacement → transfusion-dependent pancytopenia","Profound cachexia with infection-related mortality from immunosuppression"] },
      { label:"Cardiotoxicity / Sepsis", labelBg:C.dkRed, content:["ADT → accelerated cardiovascular disease; DVT/PE from immobility","Urosepsis from catheter-related UTI; septicaemia in immunocompromised terminal patient"] },
    ],
  },
  {
    num:"07", name:"Hepatocellular Carcinoma", subtitle:"Primary Liver Cancer (HCC)", accentCol:C.dkRed,
    nh: [
      { label:"Background Liver Disease", labelBg:"6E2F1A", content:["HCC arises on background of cirrhosis in 80-90%; any cause of cirrhosis confers risk","HBV (unique): Can cause HCC without cirrhosis via direct oncogenic integration into host DNA"] },
      { label:"Risk Factors", labelBg:"6E2F1A", content:["Hepatitis B (most common worldwide, esp. Asia/Africa), Hepatitis C (West), Alcoholic cirrhosis","NASH/NAFLD (rising incidence in West), Aflatoxin B1 (HBV × Aflatoxin = synergistic), haemochromatosis, Wilson's disease"] },
      { label:"Tumour Markers & Surveillance", labelBg:"7B241C", content:["AFP (alpha-fetoprotein): Elevated in 70% of HCC; >400 ng/mL highly specific","Surveillance: AFP + abdominal ultrasound every 6 months in all cirrhotics — detects early, resectable HCC"] },
      { label:"Prognosis Without Treatment", labelBg:"7B241C", content:["Untreated: Median survival 2-6 months from diagnosis; rapidly progressive","BCLC-D (end-stage): 3-month median survival; best supportive care only"] },
    ],
    pres: [
      { label:"Incidental / Surveillance", labelBg:"117A65", content:["Increasingly detected on surveillance ultrasound in compensated cirrhotics (asymptomatic)","Early HCC: Small nodule on imaging, elevated AFP → diagnostic CT/MRI → arterial enhancement (washout pattern)"] },
      { label:"Symptomatic", labelBg:"117A65", content:["Right upper quadrant pain/discomfort; hepatomegaly with nodularity; hepatic bruit (vascular tumour)","Weight loss, anorexia, fever (tumour necrosis); deteriorating performance status in known cirrhotics"] },
      { label:"Decompensation of Cirrhosis", labelBg:"148F77", content:["HCC accelerates decompensation: New/worsening ascites, jaundice, hepatic encephalopathy","Variceal haemorrhage precipitated by portal vein tumour thrombus (PVTT) → sudden portal hypertension"] },
      { label:"Paraneoplastic", labelBg:"148F77", content:["Hypoglycaemia (IGF-2 secretion or glycogen depletion) → altered consciousness, sweating","Erythrocytosis (EPO); hypercalcaemia (PTHrP); watery diarrhoea (VIP); hypercholesterolaemia"] },
    ],
    course: [
      { label:"Intrahepatic Spread", labelBg:"6E2F1A", content:["Portal vein tumour thrombus (PVTT): Satellite nodules; rapid intrahepatic dissemination","PVTT = poor prognostic sign; contraindication to surgery; median survival <4 months untreated"] },
      { label:"Extrahepatic Mets", labelBg:"6E2F1A", content:["Lung (most common haematogenous met); regional LN, adrenal gland, bone, peritoneum","Bile duct invasion → obstructive jaundice (uncommon but recognised)"] },
      { label:"BCLC Staging", labelBg:"7B241C", content:["BCLC 0/A: Very early/early — curative intent (resection, ablation, transplant)","BCLC B: Intermediate — TACE; BCLC C: Advanced — sorafenib/lenvatinib; BCLC D: Terminal — BSC"] },
      { label:"Prognosis", labelBg:"7B241C", content:["Resectable without cirrhosis: 5-yr 50-70%; Liver transplant (Milan criteria): 5-yr 70%","BCLC C (portal invasion/mets): Median OS 6-8 months with sorafenib; PVTT: <4 months"] },
    ],
    comp: [
      { label:"Tumour Rupture", labelBg:"6E2F1A", content:["Spontaneous rupture in 10-15% of HCC (more common in Asia) → haemoperitoneum","Acute abdomen, haemodynamic collapse, shock; mortality 20-50%; emergency hepatic embolisation"] },
      { label:"Portal Hypertension", labelBg:"6E2F1A", content:["PVTT → acute portal hypertension → massive variceal haemorrhage → haemodynamic collapse","Worsening ascites: Tense, diuretic-resistant; spontaneous bacterial peritonitis risk"] },
      { label:"Biliary & Metabolic", labelBg:"7B241C", content:["Bile duct invasion → obstructive jaundice, pruritus, cholangitis","Tumour-induced hypoglycaemia (acute confusion); hypercalcaemia (polyuria, dehydration, renal failure)"] },
      { label:"Treatment-Related", labelBg:"7B241C", content:["Post-embolisation syndrome (TACE): Fever, pain, nausea, transient liver decompensation","Sorafenib toxicity: Hand-foot syndrome, diarrhoea, hypertension, hepatotoxicity"] },
    ],
    death: [
      { label:"Hepatic Failure", labelBg:C.dkRed, content:["MOST COMMON cause — tumour replacement of functioning hepatic parenchyma plus underlying cirrhosis","Progressive jaundice, coagulopathy, ascites, encephalopathy → multi-organ failure"] },
      { label:"Variceal Haemorrhage", labelBg:"922B21", content:["Massive upper GI bleed from oesophageal/gastric varices (PVTT accelerates portal hypertension)","Haemodynamic collapse; poor prognosis of rescue TIPS in decompensated HCC"] },
      { label:"Haemoperitoneum", labelBg:"922B21", content:["Tumour rupture with exsanguination into peritoneal cavity","Occurs in 10-15% without warning; emergency embolisation; poor survival"] },
      { label:"Sepsis", labelBg:C.dkRed, content:["Spontaneous bacterial peritonitis (SBP) in cirrhotic ascites","Cholangitis, post-procedure infections (TACE, ablation), aspiration pneumonia in encephalopathic patients"] },
    ],
  },
  {
    num:"08", name:"Hodgkin Lymphoma", subtitle:"Reed-Sternberg Cell Disease", accentCol:"553C9A",
    nh: [
      { label:"Epidemiology", labelBg:"44337A", content:["Bimodal age distribution: 15-35 years (nodular sclerosis subtype) and >55 years (mixed cellularity)","Male predominance overall; nodular sclerosis subtype slightly more common in young females"] },
      { label:"Reed-Sternberg Cell", labelBg:"44337A", content:["RS cell: Large binucleate/multinucleate; prominent 'owl-eye' eosinophilic nucleoli; CD15+, CD30+, CD45-","Derived from germinal centre B-cells; RS cells are <5% of tumour — background reactive cells dominate"] },
      { label:"WHO Subtypes", labelBg:"553C9A", content:["Nodular Sclerosis (65%): Young women, mediastinal mass, collagen bands; best prognosis","Mixed Cellularity (25%): Older men, EBV+, systemic symptoms; Lymphocyte-Depleted: Elderly/HIV, worst prognosis"] },
      { label:"Aetiology", labelBg:"553C9A", content:["EBV association: 40% overall (70% in Mixed Cellularity subtype); EBV latent protein LMP-1 mimics CD40","Immunodeficiency (HIV, post-transplant); family history (siblings have 3-7x risk); HLA-A1 association"] },
    ],
    pres: [
      { label:"Lymphadenopathy", labelBg:"117A65", content:["Painless, rubbery, discrete, non-tender cervical LN enlargement (60-70%) — most common presentation","Axillary (20%) and inguinal (10-20%) involvement also seen; mediastinal in 60% at diagnosis"] },
      { label:"Mediastinal Disease", labelBg:"117A65", content:["Cough, dyspnoea, chest discomfort from mediastinal mass (Bulky = ≥1/3 mediastinal width)","SVC syndrome: Facial oedema, arm oedema, venous engorgement (15-30% at presentation)"] },
      { label:"B-Symptoms", labelBg:"148F77", content:["Drenching night sweats (soaking clothes/bedding) — part of Ann Arbor staging (B-symptoms)","Fever >38°C (Pel-Ebstein fever: cyclical — weeks on, weeks off — pathognomonic for HL)","Weight loss >10% body weight in preceding 6 months (unexplained)"] },
      { label:"Characteristic Features", labelBg:"148F77", content:["Alcohol-induced pain at nodal sites: Patient reports pain when drinking alcohol — PATHOGNOMONIC","Generalised pruritus without rash (often severe; can predate diagnosis by months)","Anaemia of chronic disease, low ESR paradoxically in nodular lymphocyte-predominant subtype"] },
    ],
    course: [
      { label:"Contiguous Spread", labelBg:"44337A", content:["HL spreads PREDICTABLY along contiguous lymph node chains (unlike NHL which skips)","Cervical → mediastinal → para-aortic → splenic; predictable spread enables field radiotherapy planning"] },
      { label:"Ann Arbor Staging", labelBg:"44337A", content:["Stage I: Single LN region; Stage II: ≥2 regions same side of diaphragm","Stage III: Both sides of diaphragm; Stage IV: Extranodal involvement (liver, bone marrow, lung)"] },
      { label:"Curability", labelBg:"553C9A", content:["80-90% cure rate with ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ± involved-field RT","Most curable of all lymphomas; even advanced Stage III-IV HL has 70-80% 5-yr survival with treatment"] },
      { label:"Relapse & Late Effects", labelBg:"553C9A", content:["20% relapse; salvage DHAP/ESHAP → autologous stem cell transplant (ASCT) for chemosensitive disease","LATE EFFECTS of treatment (major long-term concern): Secondary malignancy (breast, AML), cardiac toxicity (Adriamycin, RT), pulmonary fibrosis (bleomycin), hypothyroidism (cervical RT)"] },
    ],
    comp: [
      { label:"Immunodeficiency", labelBg:"44337A", content:["Profound T-cell dysfunction (despite normal B-cell function in early disease)","Susceptibility to: TB, Cryptococcus, Herpes Zoster (dermatomal), PCP, CMV, Aspergillus"] },
      { label:"SVC Obstruction", labelBg:"44337A", content:["Mediastinal disease compresses SVC → facial/arm oedema, venous distension, dyspnoea, headache","Oncological emergency if severe → high-dose dexamethasone + urgent RT; stenting if needed"] },
      { label:"Haematological", labelBg:"553C9A", content:["Autoimmune haemolytic anaemia (AIHA), immune thrombocytopenic purpura (ITP)","Bone marrow involvement (Stage IV) → pancytopenia, leucoerythroblastic anaemia"] },
      { label:"Treatment Late Effects", labelBg:"553C9A", content:["Secondary AML/MDS (MOPP regimen, 5-7 yr peak); Secondary solid tumours (breast Ca in mediastinal RT fields, 15-30 yr latency)","Adriamycin cardiomyopathy; mediastinal RT → coronary artery disease, pericarditis, valvulopathy; Bleomycin lung fibrosis"] },
    ],
    death: [
      { label:"Disease Progression", labelBg:C.dkRed, content:["Refractory/relapsed HL unresponsive to salvage therapy (Lymphocyte-Depleted subtype; HIV-HL)","Bone marrow failure, organ infiltration, uncontrolled disease in elderly/frail patients"] },
      { label:"Infection", labelBg:"922B21", content:["Overwhelming opportunistic infection in T-cell immunodeficient state","Sepsis from neutropenia post-chemotherapy; PCP, invasive Aspergillosis, disseminated Herpes"] },
      { label:"Treatment Complications", labelBg:"922B21", content:["Adriamycin cardiomyopathy → congestive cardiac failure (dose-dependent; cumulative dose >450 mg/m²)","Secondary AML following MOPP/ABVD → blast crisis; fatal haemorrhage in thrombocytopenia"] },
      { label:"Massive Mediastinal Disease", labelBg:C.dkRed, content:["Respiratory failure from massive mediastinal HL compressing airways and lungs","SVC syndrome with superior mediastinal obstruction in untreated/refractory bulky disease"] },
    ],
  },
];

// ─────────────────────────────────────────────────────────────────────────────
// BUILD SLIDES: Title + Index + 8 × 3 slides = 26 → skip one section header
// Strategy: Title(1) + Index(1) + [no section slides] + 8 × 3 content slides = 25
// ─────────────────────────────────────────────────────────────────────────────

cancers.forEach(c => {
  // Slide A: Natural History + Presentation
  addTableSlide({
    slideTitle: `${c.num} — NATURAL HISTORY & PRESENTATION`,
    cancerName: c.name,
    cancerNum: c.num,
    accentCol: c.accentCol,
    rows: [...c.nh, ...c.pres],
  });
  // Slide B: Course + Complications
  addTableSlide({
    slideTitle: `${c.num} — DISEASE COURSE & COMPLICATIONS`,
    cancerName: c.name,
    cancerNum: c.num,
    accentCol: c.accentCol,
    rows: [...c.course, ...c.comp],
  });
  // Slide C: Cause of Death (4 rows, large text)
  addTableSlide({
    slideTitle: `${c.num} — CAUSE OF DEATH`,
    cancerName: c.name,
    cancerNum: c.num,
    accentCol: c.accentCol,
    rows: c.death,
  });
});

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 25 — SUMMARY PATTERN SLIDE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  bg(s, C.navy);
  s.addShape(pres.ShapeType.ellipse, { x:9, y:-2, w:7, h:7, fill:{color:"252B54"}, line:{color:"252B54"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.7, h:H, fill:{color:C.accent}, line:{color:C.accent} });
  s.addText("KEY PATTERNS ACROSS ALL CANCERS", { x:1.0, y:0.4, w:11, h:0.55, fontSize:14, bold:true, color:C.accent, charSpacing:2.5 });
  s.addText("Summary Principles", { x:1.0, y:0.9, w:10, h:0.9, fontSize:36, bold:true, color:C.white });
  s.addShape(pres.ShapeType.rect, { x:1.0, y:1.82, w:4, h:0.06, fill:{color:C.accent}, line:{color:C.accent} });

  const themes = [
    { icon:"01", text:"Painless lump / occult bleeding = the most common early presentation across solid cancers" },
    { icon:"02", text:"Weight loss + anorexia = constitutional symptoms always suggest advanced or metastatic disease" },
    { icon:"03", text:"Most cancers are clinically silent for years; late presentation remains the primary determinant of poor prognosis" },
    { icon:"04", text:"GI cancers (colorectal, gastric) metastasise to LIVER first via portal circulation; lung mets follow" },
    { icon:"05", text:"Respiratory failure (lung/pleural mets) and hepatic failure (liver mets) are the most frequent terminal events" },
    { icon:"06", text:"Uraemia from bilateral ureteric obstruction = most common cause of death in cervical and prostate cancer" },
    { icon:"07", text:"Spinal cord compression (breast, prostate, lung) is an oncological EMERGENCY requiring immediate IV dexamethasone" },
    { icon:"08", text:"Paraneoplastic syndromes fingerprint the primary: SIADH→SCLC; PTHrP hypercalcaemia→Squamous; Trousseau→Gastric; Pel-Ebstein fever→HL" },
  ];

  themes.forEach((t, i) => {
    const y = 2.0 + i * 0.67;
    s.addShape(pres.ShapeType.ellipse, { x:1.0, y:y+0.05, w:0.45, h:0.45, fill:{color:C.accent}, line:{color:C.accent} });
    s.addText(t.icon, { x:1.0, y:y+0.05, w:0.45, h:0.45, fontSize:10, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    s.addText(t.text, { x:1.6, y:y, w:11.2, h:0.58, fontSize:13, color:C.white, valign:"middle", lineSpacingMultiple:1.2 });
  });
}

pres.layout = 'LAYOUT_WIDE';
pres.writeFile({ fileName: "/home/daytona/workspace/cancer-ppt/Common_Cancers_25slides.pptx" })
  .then(() => console.log("Done! Slides created."))
  .catch(e => console.error(e));