const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Ovarian Cancer - OG 34.2';
pres.author = 'Undergraduate Teaching';

// ─── COLOUR PALETTE (light/professional) ───
// Background: very light lavender/white  #F7F4FA
// Header bar:  deep plum                 #4A235A
// Accent:      medium teal               #1A7A8A
// Subheading:  dark slate                #2C3E50
// Body text:   near-black               #1C1C1C
// Highlight:   soft amber               #E8A838
// Table alt:   light lilac              #EDE7F6
// Divider:     mid-lilac                #C9B8D8

const C = {
  bg:        'F7F4FA',
  header:    '4A235A',
  headerTxt: 'FFFFFF',
  accent:    '1A7A8A',
  subhead:   '2C3E50',
  body:      '1C1C1C',
  highlight: 'E8A838',
  tableAlt:  'EDE7F6',
  tableHdr:  '4A235A',
  divider:   'C9B8D8',
  white:     'FFFFFF',
  lightGray: 'F0ECF7',
  accentBg:  'E0F4F6',
};

// ─── HELPER: add standard slide background ───
function newSlide(subtitle) {
  const sl = pres.addSlide();
  // full background
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.bg }, line: { color: C.bg } });
  // top header bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.header }, line: { color: C.header } });
  // bottom footer bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.25, w: 10, h: 0.375, fill: { color: C.header }, line: { color: C.header } });
  // footer text
  sl.addText('OG 34.2  |  Ovarian Cancer  |  Berek & Novak\'s Gynecology', {
    x: 0.2, y: 5.26, w: 7, h: 0.3, fontSize: 8, color: 'CCB8DC', align: 'left', valign: 'middle', margin: 0
  });
  sl.addText('Undergraduate Teaching', {
    x: 7.2, y: 5.26, w: 2.6, h: 0.3, fontSize: 8, color: 'CCB8DC', align: 'right', valign: 'middle', margin: 0
  });
  // header subtitle text
  if (subtitle) {
    sl.addText(subtitle, {
      x: 0.25, y: 0.07, w: 9.5, h: 0.58,
      fontSize: 16, bold: true, color: C.headerTxt, valign: 'middle', margin: 0
    });
  }
  return sl;
}

// ─── HELPER: section heading line ───
function addSectionLine(sl, text, yPos) {
  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: yPos, w: 9.3, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText(text, { x: 0.45, y: yPos + 0.02, w: 9.1, h: 0.34, fontSize: 13, bold: true, color: C.white, valign: 'middle', margin: 0 });
}

// ─── HELPER: bullet block ───
function addBullets(sl, items, x, y, w, h, opts = {}) {
  const fontSize = opts.fontSize || 13;
  const color = opts.color || C.body;
  const textArr = items.map((item, i) => ({
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    options: { bullet: { type: 'bullet', indent: 12 }, breakLine: i < items.length - 1, fontSize, color }
  }));
  sl.addText(textArr, { x, y, w, h, valign: 'top', margin: [2, 4, 2, 4] });
}

// ─── HELPER: 2-column bullets ───
function twoCols(sl, left, right, yStart, colH, opts = {}) {
  addBullets(sl, left,  0.35, yStart, 4.55, colH, opts);
  addBullets(sl, right, 5.1,  yStart, 4.55, colH, opts);
  // divider line
  sl.addShape(pres.ShapeType.line, { x: 4.95, y: yStart + 0.05, w: 0, h: colH - 0.1, line: { color: C.divider, width: 1 } });
}

// ════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  // gradient-like layered bg
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: 'F0EAF8' }, line: { color: 'F0EAF8' } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 2.1, fill: { color: C.header }, line: { color: C.header } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: 10, h: 0.825, fill: { color: C.accent }, line: { color: C.accent } });

  sl.addText('OVARIAN CANCER', {
    x: 0.4, y: 0.22, w: 9.2, h: 0.7, fontSize: 34, bold: true, color: C.white,
    align: 'center', charSpacing: 4, valign: 'middle', margin: 0
  });
  sl.addText('OG 34.2 — Competency Based Medical Education', {
    x: 0.4, y: 0.95, w: 9.2, h: 0.4, fontSize: 13, color: 'D4B8EA', align: 'center', valign: 'middle', margin: 0
  });
  sl.addText('Undergraduate Gynaecology Teaching', {
    x: 0.4, y: 1.4, w: 9.2, h: 0.38, fontSize: 12, italic: true, color: 'CCB8DC', align: 'center', valign: 'middle', margin: 0
  });

  // competency box
  sl.addShape(pres.ShapeType.rect, { x: 0.6, y: 2.25, w: 8.8, h: 1.25, fill: { color: 'EDE7F6' }, line: { color: C.divider, width: 1 } });
  sl.addText('Describe and discuss: Aetiology • Pathology • Classification • Staging\nClinical Features • Differential Diagnosis • Investigations\nPrinciple of Management including Staging Laparotomy', {
    x: 0.7, y: 2.3, w: 8.6, h: 1.15, fontSize: 12.5, color: C.subhead, align: 'center', valign: 'middle'
  });

  sl.addText('Reference: Berek & Novak\'s Gynecology  |  Bailey & Love\'s Surgery', {
    x: 0.4, y: 4.83, w: 9.2, h: 0.4, fontSize: 10.5, color: C.white, align: 'center', valign: 'middle', margin: 0
  });
}

// ════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW & EPIDEMIOLOGY
// ════════════════════════════════════════════════
{
  const sl = newSlide('Overview & Epidemiology');

  addSectionLine(sl, 'Key Facts', 0.85);
  addBullets(sl, [
    '6th most common malignancy in women worldwide',
    'Peak incidence: 56–65 years of age; rare before 45 years',
    '~70% present with advanced stage (III / IV) disease → poor prognosis',
    'Overall 5-year survival < 50% due to late presentation',
    'Epithelial tumours account for ~90% of all ovarian malignancies',
    'BRCA1/BRCA2 mutations: most important hereditary risk factor',
  ], 0.35, 1.32, 9.3, 1.75, { fontSize: 12.5 });

  addSectionLine(sl, 'Global & Indian Burden', 3.15);
  addBullets(sl, [
    'Worldwide: ~313,000 new cases/year; ~207,000 deaths/year (WHO)',
    'India: age-adjusted incidence ~6.6 per 100,000 women',
    'Most cases are sporadic (75–90%); hereditary ~10–15%',
    'No reliable national screening programme currently exists',
  ], 0.35, 3.6, 9.3, 1.5, { fontSize: 12.5 });
}

// ════════════════════════════════════════════════
// SLIDE 3 — AETIOLOGY & RISK FACTORS
// ════════════════════════════════════════════════
{
  const sl = newSlide('Aetiology & Risk Factors');

  // Box headers
  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('INCREASED RISK', { x: 0.45, y: 0.87, w: 4.35, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });

  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.85, w: 4.55, h: 0.38, fill: { color: '1A7A5A' }, line: { color: '1A7A5A' } });
  sl.addText('DECREASED RISK (Protective)', { x: 5.2, y: 0.87, w: 4.35, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addBullets(sl, [
    'Genetic: BRCA1 (39% lifetime risk), BRCA2 (11–17%)',
    'Lynch syndrome (MMR gene mutations)',
    'Nulliparity / low parity',
    'Early menarche / late menopause',
    'Hormone replacement therapy (long-term)',
    'Endometriosis (clear cell, endometrioid types)',
    'Increasing age (>50 years)',
    'Family history of ovarian/breast cancer',
    'Talc / asbestos exposure (proposed)',
  ], 0.35, 1.3, 4.55, 3.7, { fontSize: 11.5 });

  addBullets(sl, [
    'Oral contraceptive use (risk reduced up to 30 yrs post-cessation)',
    'Multiparity / breastfeeding',
    'Tubal ligation',
    'Hysterectomy',
    'Prophylactic bilateral salpingo-oophorectomy (high-risk women)',
    'Early age at first delivery',
  ], 5.1, 1.3, 4.55, 3.7, { fontSize: 11.5 });

  sl.addShape(pres.ShapeType.line, { x: 4.95, y: 1.3, w: 0, h: 3.7, line: { color: C.divider, width: 1.2 } });
}

// ════════════════════════════════════════════════
// SLIDE 4 — PATHOLOGY (Histological Types)
// ════════════════════════════════════════════════
{
  const sl = newSlide('Pathology — Histological Classification');

  addSectionLine(sl, 'A. EPITHELIAL TUMOURS (~90% of ovarian cancers)', 0.85);

  const rows = [
    [{ text: 'Type', options: { bold: true, color: C.white } }, { text: 'Subtype', options: { bold: true, color: C.white } }, { text: 'Notes', options: { bold: true, color: C.white } }],
    ['Serous', 'High-grade (most common ~70%) / Low-grade', 'BRCA1/2 mutation; derives from fallopian tube'],
    ['Mucinous', '~5%; intestinal or endocervical type', 'Large tumours; check for metastasis from GI'],
    ['Endometrioid', '~10%; resembles endometrial gland', 'Associated with endometriosis, Lynch syndrome'],
    ['Clear Cell', '~5%; Müllerian origin', 'Endometriosis-related; platinum resistant'],
    ['Brenner', 'Transitional cell type; mostly benign', 'Rare malignant variant exists'],
    ['Undifferentiated', '<1%', 'Worst prognosis among epithelial types'],
  ];

  sl.addTable(rows, {
    x: 0.35, y: 1.32, w: 9.3, h: 2.35,
    border: { pt: 0.5, color: C.divider },
    fill: { color: C.bg },
    rowH: 0.32,
    fontFace: 'Arial', fontSize: 10.5, color: C.body,
    align: 'left', valign: 'middle',
    colW: [1.6, 3.5, 4.2],
  });

  // fix header row colour via addTable firstRowFill workaround — add coloured rect behind
  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.32, w: 9.3, h: 0.32, fill: { color: C.tableHdr }, line: { color: C.tableHdr } });
  sl.addText('Type', { x: 0.45, y: 1.34, w: 1.4, h: 0.28, fontSize: 11, bold: true, color: C.white, valign: 'middle', margin: 0 });
  sl.addText('Subtype', { x: 2.0, y: 1.34, w: 3.4, h: 0.28, fontSize: 11, bold: true, color: C.white, valign: 'middle', margin: 0 });
  sl.addText('Notes', { x: 5.55, y: 1.34, w: 4.1, h: 0.28, fontSize: 11, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addSectionLine(sl, 'B. OTHER TYPES', 3.8);
  twoCols(sl,
    ['Germ Cell Tumours (5%): dysgerminoma, yolk sac, teratoma, choriocarcinoma', 'Primarily in women <30 years', 'Generally good prognosis'],
    ['Sex Cord–Stromal Tumours (5%): granulosa cell, Sertoli–Leydig, thecoma', 'Hormone-secreting; virilisation / feminisation features'],
    4.2, 0.9, { fontSize: 11.5 }
  );
}

// ════════════════════════════════════════════════
// SLIDE 5 — CLASSIFICATION (Type I vs Type II)
// ════════════════════════════════════════════════
{
  const sl = newSlide('Molecular Classification — Type I vs Type II (Kurman & Shih)');

  // Two columns
  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 4.55, h: 0.38, fill: { color: '1A7A8A' }, line: { color: '1A7A8A' } });
  sl.addText('TYPE I TUMOURS', { x: 0.45, y: 0.87, w: 4.35, h: 0.34, fontSize: 13, bold: true, color: C.white, valign: 'middle', margin: 0 });

  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.header }, line: { color: C.header } });
  sl.addText('TYPE II TUMOURS', { x: 5.2, y: 0.87, w: 4.35, h: 0.34, fontSize: 13, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addBullets(sl, [
    'Low-grade serous carcinoma',
    'Low-grade endometrioid carcinoma',
    'Clear cell carcinoma',
    'Mucinous carcinoma',
    'Brenner tumour',
    '',
    'Develop from benign precursors (step-wise progression)',
    'Mutations: KRAS, BRAF, PTEN, PIK3CA, ARID1A',
    'Genetically STABLE; slow-growing',
    'Tend to present at lower stage',
    'Relatively CHEMORESISTANT',
  ], 0.35, 1.3, 4.55, 3.8, { fontSize: 11.5 });

  addBullets(sl, [
    'High-grade serous carcinoma (~70% of epithelial OC)',
    'High-grade endometrioid carcinoma',
    'Carcinosarcoma (MMMT)',
    'Undifferentiated carcinoma',
    '',
    'Arise de novo from STIC (serous tubal intraepithelial carcinoma)',
    'Mutations: TP53 (>96%), BRCA1/2, CCNE1 amplification',
    'Genetically UNSTABLE (chromosomal instability)',
    'Present at ADVANCED stage (III/IV)',
    'Initially CHEMOSENSITIVE (platinum-based)',
    'High relapse rate',
  ], 5.1, 1.3, 4.55, 3.8, { fontSize: 11.5 });

  sl.addShape(pres.ShapeType.line, { x: 4.95, y: 1.3, w: 0, h: 3.8, line: { color: C.divider, width: 1.2 } });
}

// ════════════════════════════════════════════════
// SLIDE 6 — FIGO STAGING
// ════════════════════════════════════════════════
{
  const sl = newSlide('FIGO Staging of Ovarian Cancer (2014 Revised)');

  const stageRows = [
    [{ text: 'Stage', options: { bold: true, color: C.white } }, { text: 'Description', options: { bold: true, color: C.white } }, { text: 'Sub-stages', options: { bold: true, color: C.white } }],
    ['I', 'Tumour confined to ovaries / fallopian tubes', 'IA: One ovary, capsule intact\nIB: Both ovaries, capsule intact\nIC: Capsule ruptured / surface tumour / malignant ascites'],
    ['II', 'Pelvic extension (below pelvic brim) or primary peritoneal cancer', 'IIA: Extension to uterus / tubes / ovaries\nIIB: Extension to other pelvic organs'],
    ['III', 'Peritoneal spread outside pelvis; retroperitoneal lymph node involvement', 'IIIA: +ve retroperitoneal LN only; microscopic peritoneal mets\nIIIB: Mets ≤2 cm\nIIIC: Mets >2 cm (includes liver / spleen capsule)'],
    ['IV', 'Distant metastasis beyond peritoneal cavity', 'IVA: Pleural effusion with positive cytology\nIVB: Parenchymal mets; extra-abdominal LN (inguinal, supra-clavicular)'],
  ];

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 9.3, h: 0.38, fill: { color: C.header }, line: { color: C.header } });
  sl.addText('Stage', { x: 0.45, y: 0.87, w: 0.9, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });
  sl.addText('Description', { x: 1.4, y: 0.87, w: 3.7, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });
  sl.addText('Sub-stages', { x: 5.15, y: 0.87, w: 4.5, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });

  const stageData = [
    { stage: 'I', desc: 'Tumour CONFINED to ovaries/fallopian tubes', sub: 'IA: One ovary, intact capsule, -ve washings\nIB: Both ovaries, intact capsule\nIC: Capsule ruptured/surface tumour/+ve washings or malignant ascites', bg: C.bg },
    { stage: 'II', desc: 'PELVIC EXTENSION or primary peritoneal cancer (below pelvic brim)', sub: 'IIA: Extension/implants on uterus/tubes/ovaries\nIIB: Extension to other pelvic intraperitoneal tissues', bg: 'F0EEF8' },
    { stage: 'III', desc: 'Peritoneal mets OUTSIDE PELVIS or retroperitoneal LN metastasis', sub: 'IIIA1: +ve retroperitoneal LN only\nIIIA2: Microscopic peritoneal mets ± LN\nIIIB: Macroscopic peritoneal mets ≤2 cm\nIIIC: Macroscopic peritoneal mets >2 cm (incl. liver/spleen surface)', bg: C.bg },
    { stage: 'IV', desc: 'DISTANT METASTASIS beyond peritoneal cavity', sub: 'IVA: Pleural effusion +ve cytology\nIVB: Liver/spleen parenchymal mets; extra-abdominal LN', bg: 'F0EEF8' },
  ];

  const rowH = 0.85;
  const startY = 1.32;
  stageData.forEach((row, i) => {
    const y = startY + i * rowH;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.03, fill: { color: row.bg }, line: { color: C.divider, width: 0.5 } });
    sl.addText(row.stage, { x: 0.45, y: y + 0.05, w: 0.8, h: rowH - 0.13, fontSize: 20, bold: true, color: C.accent, align: 'center', valign: 'middle', margin: 0 });
    sl.addText(row.desc, { x: 1.35, y: y + 0.05, w: 3.7, h: rowH - 0.13, fontSize: 10.5, color: C.subhead, valign: 'middle', margin: [2, 4] });
    sl.addText(row.sub, { x: 5.1, y: y + 0.05, w: 4.45, h: rowH - 0.13, fontSize: 9.5, color: C.body, valign: 'middle', margin: [2, 4] });
    // divider verticals
    sl.addShape(pres.ShapeType.line, { x: 1.3, y: y + 0.05, w: 0, h: rowH - 0.15, line: { color: C.divider, width: 0.7 } });
    sl.addShape(pres.ShapeType.line, { x: 5.05, y: y + 0.05, w: 0, h: rowH - 0.15, line: { color: C.divider, width: 0.7 } });
  });

  sl.addText('Most women (70%) present at Stage III–IV  |  Stage I: 5-yr survival ~90%  |  Stage IV: ~20%', {
    x: 0.35, y: 5.08, w: 9.3, h: 0.2, fontSize: 9.5, italic: true, color: C.accent, align: 'center', margin: 0
  });
}

// ════════════════════════════════════════════════
// SLIDE 7 — CLINICAL FEATURES
// ════════════════════════════════════════════════
{
  const sl = newSlide('Clinical Features');

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('SYMPTOMS', { x: 0.45, y: 0.87, w: 4.35, h: 0.34, fontSize: 13, bold: true, color: C.white, valign: 'middle', margin: 0 });

  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.header }, line: { color: C.header } });
  sl.addText('SIGNS', { x: 5.2, y: 0.87, w: 4.35, h: 0.34, fontSize: 13, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addBullets(sl, [
    'Abdominal distension / bloating (most common)',
    'Pelvic or abdominal pain / discomfort',
    'Difficulty eating or feeling full quickly',
    'Urinary urgency or frequency',
    'Change in bowel habit',
    'Weight loss (advanced disease)',
    'Shortness of breath (pleural effusion)',
    'Vaginal bleeding (post-menopausal)',
    'Symptoms often vague → delayed diagnosis',
  ], 0.35, 1.3, 4.55, 3.75, { fontSize: 11.5 });

  addBullets(sl, [
    'Pelvic / adnexal mass (solid, fixed, irregular)',
    'Ascites — shifting dullness, fluid thrill',
    'Omental cake / upper abdominal mass',
    'Pleural effusion (predominantly right side)',
    'Cachexia in advanced disease',
    'Bilateral, hard, fixed pelvic mass (Krukenberg tumour)',
    'Sister Mary Joseph nodule (umbilical)',
    'Virchow\'s node / left supraclavicular LN',
  ], 5.1, 1.3, 4.55, 3.75, { fontSize: 11.5 });

  sl.addShape(pres.ShapeType.line, { x: 4.95, y: 1.3, w: 0, h: 3.75, line: { color: C.divider, width: 1.2 } });

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 5.08, w: 9.3, h: 0.2, fill: { color: C.accentBg }, line: { color: C.accentBg } });
  sl.addText('Ovarian Cancer Symptom Index (2007): New/persistent symptoms ≥12 times/month or <1 year duration warrant evaluation', {
    x: 0.4, y: 5.09, w: 9.2, h: 0.18, fontSize: 9, italic: true, color: C.accent, align: 'center', margin: 0
  });
}

// ════════════════════════════════════════════════
// SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ════════════════════════════════════════════════
{
  const sl = newSlide('Differential Diagnosis');

  addSectionLine(sl, 'Pelvic/Adnexal Mass — Key Differentials', 0.85);

  const ddData = [
    { cat: 'Benign Ovarian', items: 'Functional (follicular/luteal) cysts, Dermoid cyst (mature teratoma), Endometrioma ("chocolate cyst"), Cystadenoma (serous/mucinous), PCOS' },
    { cat: 'Malignant Gynaecological', items: 'Borderline ovarian tumour, Fallopian tube carcinoma, Endometrial carcinoma with adnexal spread, Cervical carcinoma with parametrial extension' },
    { cat: 'Metastatic to Ovary', items: 'Krukenberg tumour (stomach/colon primary), Breast cancer mets, Lymphoma' },
    { cat: 'Non-Gynaecological', items: 'Appendix abscess / mucocele, Diverticular abscess, Colorectal carcinoma, Retroperitoneal sarcoma or lymph node mass' },
    { cat: 'Other Conditions with Ascites', items: 'Meigs\' syndrome (benign fibroma + ascites + pleural effusion), Liver cirrhosis, Cardiac failure, Tuberculosis peritonitis, Pseudomyxoma peritonei' },
  ];

  const rowH = 0.68;
  const startY = 1.32;
  ddData.forEach((row, i) => {
    const y = startY + i * rowH;
    const bg = i % 2 === 0 ? C.bg : C.lightGray;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.04, fill: { color: bg }, line: { color: C.divider, width: 0.5 } });
    sl.addText(row.cat, { x: 0.45, y: y + 0.05, w: 2.3, h: rowH - 0.14, fontSize: 11, bold: true, color: C.header, valign: 'top', margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 2.8, y: y + 0.05, w: 0, h: rowH - 0.14, line: { color: C.divider, width: 0.7 } });
    sl.addText(row.items, { x: 2.9, y: y + 0.05, w: 6.65, h: rowH - 0.14, fontSize: 10.5, color: C.body, valign: 'top', margin: [2, 4] });
  });
}

// ════════════════════════════════════════════════
// SLIDE 9 — INVESTIGATIONS
// ════════════════════════════════════════════════
{
  const sl = newSlide('Investigations');

  // 3-column layout
  const cols = [
    {
      title: 'LABORATORY', color: C.accent, x: 0.3, items: [
        'CA-125 (normal <35 U/mL)', '  - Elevated in 50% Stage I; >90% Stage III–IV', '  - Non-specific; elevated in endometriosis, PID, cirrhosis',
        'AFP, β-hCG, LDH', '  - For germ cell tumours (<40 yrs)',
        'CEA, CA 19-9', '  - For mucinous / GI primary',
        'Inhibin A & B', '  - Granulosa cell tumours',
        'FBC, LFTs, RFTs, coagulation', 'Serum electrolytes',
        'BRCA1/2 germline testing', '  - Recommended for all epithelial OC',
      ]
    },
    {
      title: 'IMAGING', color: C.header, x: 3.5, items: [
        'TVUS / USS (FIRST-LINE INVESTIGATION)', '  - Morphology, septae, solid areas, flow',
        'Risk of Malignancy Index (RMI)', '  - RMI = U × M × CA-125', '  - RMI >200 → refer to oncology',
        'CT Abdomen & Pelvis (staging)', '  - Peritoneal deposits, LN, pleural effusion',
        'MRI Pelvis', '  - Better soft tissue characterisation',
        'CXR / CT Chest', '  - Pleural effusion, lung mets',
        'PET-CT (recurrence)', 'Bone scan if indicated',
      ]
    },
    {
      title: 'PATHOLOGY', color: '5D4037', x: 6.7, items: [
        'Peritoneal / ascites cytology', 'Core needle biopsy (inoperable cases)',
        'Intraoperative frozen section', 'Formal histopathology', '  - Immunohistochemistry (WT-1, PAX-8, p53)',
        'Molecular profiling', '  - TP53, BRCA1/2 somatic mutations', '  - HER2, MSI (Lynch)',
        'Diagnostic laparoscopy', '  - When imaging equivocal',
      ]
    },
  ];

  cols.forEach(col => {
    sl.addShape(pres.ShapeType.rect, { x: col.x, y: 0.85, w: 3.1, h: 0.38, fill: { color: col.color }, line: { color: col.color } });
    sl.addText(col.title, { x: col.x + 0.08, y: 0.87, w: 2.94, h: 0.34, fontSize: 11, bold: true, color: C.white, valign: 'middle', margin: 0 });
    addBullets(sl, col.items, col.x, 1.3, 3.1, 3.75, { fontSize: 10 });
  });
}

// ════════════════════════════════════════════════
// SLIDE 10 — RMI & ULTRASOUND SCORING
// ════════════════════════════════════════════════
{
  const sl = newSlide('Risk of Malignancy Index (RMI) & USS Features');

  addSectionLine(sl, 'Risk of Malignancy Index Formula: RMI = U × M × CA-125', 0.85);

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.32, w: 9.3, h: 1.5, fill: { color: C.accentBg }, line: { color: C.accent, width: 1 } });
  sl.addText([
    { text: 'U (Ultrasound score): ', options: { bold: true, color: C.subhead } },
    { text: 'U=0 (no features), U=1 (1 feature), U=3 (≥2 features)\n', options: { color: C.body } },
    { text: 'USS features scored: ', options: { bold: true, color: C.subhead } },
    { text: 'Multilocularity, solid areas, bilateral lesions, ascites, intra-abdominal metastases\n', options: { color: C.body } },
    { text: 'M (Menopausal status): ', options: { bold: true, color: C.subhead } },
    { text: 'M=1 (premenopausal), M=3 (postmenopausal)\n', options: { color: C.body } },
    { text: 'CA-125: ', options: { bold: true, color: C.subhead } },
    { text: 'Absolute value in U/mL', options: { color: C.body } },
  ], { x: 0.5, y: 1.38, w: 9.0, h: 1.38, fontSize: 12, valign: 'top', margin: [4, 6] });

  addSectionLine(sl, 'Interpretation', 2.95);

  const rmiData = [
    ['RMI Score', 'Risk Category', 'Management', 'Malignancy Risk'],
    ['< 25', 'Low risk', 'Routine gynaecology', '< 3%'],
    ['25 – 250', 'Moderate risk', 'Gynaecology unit review', '~20%'],
    ['> 200 / > 250', 'HIGH RISK', 'URGENT referral to Gynaecological Oncology Centre', '~75%'],
  ];

  rmiData.forEach((row, i) => {
    const y = 3.4 + i * 0.38;
    const bg = i === 0 ? C.header : (i % 2 === 0 ? C.lightGray : C.bg);
    const textColor = i === 0 ? C.white : (i === 3 ? 'C0392B' : C.body);
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.36, fill: { color: bg }, line: { color: C.divider, width: 0.5 } });
    const cw = [2.0, 2.2, 3.5, 1.6];
    let cx = 0.45;
    row.forEach((cell, ci) => {
      sl.addText(cell, { x: cx, y: y + 0.03, w: cw[ci], h: 0.3, fontSize: i === 0 ? 10.5 : 10, bold: i === 0 || i === 3, color: textColor, valign: 'middle', margin: 0 });
      cx += cw[ci];
    });
  });
}

// ════════════════════════════════════════════════
// SLIDE 11 — PRINCIPLES OF MANAGEMENT
// ════════════════════════════════════════════════
{
  const sl = newSlide('Principles of Management');

  addSectionLine(sl, 'OVERVIEW: General Principle = Cytoreductive Surgery + Platinum-based Chemotherapy', 0.85);

  const steps = [
    { no: '1', title: 'Preoperative Workup', body: 'Full history & examination • Tumour markers • CT staging • MDT discussion • BRCA testing • Bowel prep', color: C.accent },
    { no: '2', title: 'Surgical Staging / Cytoreduction', body: 'Staging laparotomy via midline incision • TAH + BSO + Omentectomy • Lymph node dissection • Peritoneal biopsies • Appendicectomy (mucinous)', color: C.header },
    { no: '3', title: 'Adjuvant Chemotherapy', body: 'Carboplatin + Paclitaxel (6 cycles, 3-weekly) is standard first-line • IV or IV + IP administration • Bevacizumab (anti-VEGF) added in some advanced-stage cases', color: '1A5A7A' },
    { no: '4', title: 'Targeted Therapy / Maintenance', body: 'PARP inhibitors (olaparib, niraparib) for BRCA-mutated / HRD-positive disease • Bevacizumab maintenance • Hormone therapy for low-grade serous or endometrioid', color: '6A3A8A' },
    { no: '5', title: 'Follow-up & Recurrence', body: 'Clinical review + CA-125 every 3 months × 2 yrs, then 6-monthly • CT on clinical suspicion • Secondary cytoreduction ± PARP inhibitor • Palliative care for platinum-resistant disease', color: '1A7A5A' },
  ];

  const rowH = 0.72;
  steps.forEach((step, i) => {
    const y = 1.32 + i * rowH;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.04, fill: { color: i % 2 === 0 ? C.bg : C.lightGray }, line: { color: C.divider, width: 0.5 } });
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.5, h: rowH - 0.04, fill: { color: step.color }, line: { color: step.color } });
    sl.addText(step.no, { x: 0.35, y: y + 0.05, w: 0.5, h: rowH - 0.14, fontSize: 16, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0 });
    sl.addText(step.title, { x: 0.9, y: y + 0.05, w: 2.3, h: rowH - 0.14, fontSize: 11, bold: true, color: step.color, valign: 'middle', margin: 0 });
    sl.addText(step.body, { x: 3.25, y: y + 0.05, w: 6.3, h: rowH - 0.14, fontSize: 10.5, color: C.body, valign: 'middle', margin: [2, 4] });
    sl.addShape(pres.ShapeType.line, { x: 3.2, y: y + 0.06, w: 0, h: rowH - 0.18, line: { color: C.divider, width: 0.7 } });
  });
}

// ════════════════════════════════════════════════
// SLIDE 12 — STAGING LAPAROTOMY (DETAILED)
// ════════════════════════════════════════════════
{
  const sl = newSlide('Staging Laparotomy — Technique & Steps');

  addSectionLine(sl, 'Indications for Staging Laparotomy', 0.85);
  addBullets(sl, [
    'Suspected ovarian malignancy on imaging (USS + CT)',
    'Elevated tumour markers (CA-125 > 200, or +ve RMI)',
    'Definitive primary surgical management of ovarian cancer',
  ], 0.35, 1.3, 9.3, 0.72, { fontSize: 12 });

  addSectionLine(sl, 'Surgical Steps (Bailey & Love / Berek & Novak)', 2.1);

  const steps = [
    'Midline laparotomy incision (pubis to xiphisternum)',
    'Collect peritoneal washings from pelvis, bilateral paracolic gutters, and diaphragm for cytology',
    'Careful inspection of all peritoneal surfaces, bowel, and mesentery',
    'Total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH + BSO)',
    'Infracolic omentectomy',
    'Pelvic + para-aortic lymph node sampling / dissection',
    'Biopsy of all suspicious peritoneal lesions; random blind peritoneal biopsies (right hemi-diaphragm, bladder reflection, cul-de-sac, paracolic recesses, pelvic side walls)',
    'Appendicectomy (especially for mucinous tumours)',
    'Cytoreduction: aim for optimal debulking — residual disease < 1 cm (ideally R0 — no macroscopic disease)',
  ];

  steps.forEach((step, i) => {
    const y = 2.55 + i * 0.28;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.28, h: 0.23, fill: { color: C.accent }, line: { color: C.accent } });
    sl.addText(String(i + 1), { x: 0.35, y, w: 0.28, h: 0.23, fontSize: 9, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0 });
    sl.addText(step, { x: 0.7, y: y + 0.01, w: 8.95, h: 0.24, fontSize: 10.5, color: C.body, valign: 'middle', margin: 0 });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 5.1, w: 9.3, h: 0.18, fill: { color: 'FFF3CD' }, line: { color: C.highlight, width: 0.7 } });
  sl.addText('Goal: MAXIMUM CYTOREDUCTION — Residual disease determines prognosis more than any other surgical variable', {
    x: 0.4, y: 5.11, w: 9.2, h: 0.16, fontSize: 9, bold: true, color: '7B5800', align: 'center', margin: 0
  });
}

// ════════════════════════════════════════════════
// SLIDE 13 — CHEMOTHERAPY IN DETAIL
// ════════════════════════════════════════════════
{
  const sl = newSlide('Chemotherapy & Targeted Therapy');

  addSectionLine(sl, 'First-Line Chemotherapy', 0.85);

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.3, w: 9.3, h: 0.96, fill: { color: C.accentBg }, line: { color: C.accent, width: 1 } });
  sl.addText([
    { text: 'Standard Regimen: ', options: { bold: true, color: C.header } },
    { text: 'Carboplatin (AUC 5–6) + Paclitaxel (175 mg/m²) IV, every 3 weeks × 6 cycles\n', options: { color: C.body } },
    { text: 'Alternatively: ', options: { bold: true, color: C.header } },
    { text: 'Weekly dose-dense paclitaxel + 3-weekly carboplatin (GOG-0262 / JGOG 3016)\n', options: { color: C.body } },
    { text: 'IP Chemotherapy: ', options: { bold: true, color: C.header } },
    { text: 'Intraperitoneal cisplatin + paclitaxel — survival benefit in optimally debulked Stage III (GOG-172)', options: { color: C.body } },
  ], { x: 0.45, y: 1.35, w: 9.1, h: 0.86, fontSize: 11, valign: 'top', margin: [3, 6] });

  addSectionLine(sl, 'Targeted Agents (Maintenance Therapy)', 2.35);

  const agents = [
    { name: 'Bevacizumab (Avastin)', mech: 'Anti-VEGF monoclonal antibody', use: 'Added to chemo + maintenance in Stage III/IV (ICON7, GOG-0218 trials)', color: C.accent },
    { name: 'Olaparib (Lynparza)', mech: 'PARP inhibitor', use: 'BRCA1/2 mutated advanced OC: 1st-line maintenance (SOLO-1 trial)', color: C.header },
    { name: 'Niraparib (Zejula)', mech: 'PARP inhibitor', use: 'HRD-positive tumours; PRIMA trial — regardless of BRCA status', color: '1A5A7A' },
    { name: 'Rucaparib (Rubraca)', mech: 'PARP inhibitor', use: 'BRCA mutated recurrent OC after ≥2 lines of chemo', color: '6A3A8A' },
  ];

  agents.forEach((agent, i) => {
    const y = 2.82 + i * 0.56;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.52, fill: { color: i % 2 === 0 ? C.bg : C.lightGray }, line: { color: C.divider, width: 0.5 } });
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.12, h: 0.52, fill: { color: agent.color }, line: { color: agent.color } });
    sl.addText(agent.name, { x: 0.52, y: y + 0.04, w: 2.6, h: 0.2, fontSize: 11, bold: true, color: agent.color, margin: 0 });
    sl.addText(agent.mech, { x: 0.52, y: y + 0.26, w: 2.6, h: 0.2, fontSize: 9.5, italic: true, color: C.subhead, margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 3.15, y: y + 0.06, w: 0, h: 0.4, line: { color: C.divider, width: 0.7 } });
    sl.addText(agent.use, { x: 3.25, y: y + 0.08, w: 6.3, h: 0.36, fontSize: 10.5, color: C.body, valign: 'middle', margin: 0 });
  });
}

// ════════════════════════════════════════════════
// SLIDE 14 — GERM CELL & STROMAL TUMOURS
// ════════════════════════════════════════════════
{
  const sl = newSlide('Non-Epithelial Ovarian Tumours');

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('GERM CELL TUMOURS', { x: 0.45, y: 0.87, w: 4.35, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });

  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 0.85, w: 4.55, h: 0.38, fill: { color: C.header }, line: { color: C.header } });
  sl.addText('SEX CORD–STROMAL TUMOURS', { x: 5.2, y: 0.87, w: 4.35, h: 0.34, fontSize: 12, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addBullets(sl, [
    '~5% of ovarian malignancies',
    'Young women (peak <30 years)',
    'Types:',
    '  - Dysgerminoma (most common; LDH↑)',
    '  - Yolk sac tumour / Endodermal sinus (AFP↑)',
    '  - Immature teratoma (AFP↑)',
    '  - Choriocarcinoma (β-hCG↑)',
    '  - Mixed germ cell tumour',
    'Treatment: BEP chemotherapy (Bleomycin + Etoposide + Cisplatin)',
    'Fertility-sparing surgery possible in Stage IA',
    'Excellent prognosis with treatment',
  ], 0.35, 1.3, 4.55, 3.75, { fontSize: 11 });

  addBullets(sl, [
    '~5–8% of ovarian malignancies',
    'Hormone-secreting tumours',
    'Types:',
    '  - Granulosa cell tumour (inhibin↑, oestrogen↑)',
    '    → Abnormal uterine bleeding, endometrial hyperplasia',
    '  - Sertoli–Leydig cell tumour (androgen↑)',
    '    → Virilisation, acne, oligomenorrhoea',
    '  - Thecoma (oestrogen-producing; usually benign)',
    '  - Fibrothecoma → Meigs\' syndrome',
    'Call–Exner bodies on histology (granulosa cells)',
    'Generally low malignant potential; good prognosis',
    'Oestrogen effects → Endometrial carcinoma risk',
  ], 5.1, 1.3, 4.55, 3.75, { fontSize: 11 });

  sl.addShape(pres.ShapeType.line, { x: 4.95, y: 1.3, w: 0, h: 3.75, line: { color: C.divider, width: 1.2 } });
}

// ════════════════════════════════════════════════
// SLIDE 15 — BORDERLINE TUMOURS
// ════════════════════════════════════════════════
{
  const sl = newSlide('Borderline Ovarian Tumours (BOT)');

  addSectionLine(sl, 'Key Characteristics', 0.85);
  addBullets(sl, [
    'Also called "tumours of low malignant potential" (LMP)',
    'Atypical epithelial proliferation WITHOUT stromal invasion',
    'Most common: serous borderline (50–55%) and mucinous borderline (40–45%)',
    'Average age at diagnosis ~46 years (younger than invasive OC)',
    'Generally STAGE I at presentation; excellent prognosis',
    '5-year survival: Stage I ~99%; even advanced stage ~80–90%',
  ], 0.35, 1.32, 9.3, 1.5, { fontSize: 12 });

  addSectionLine(sl, 'Management', 2.95);

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 3.38, w: 4.55, h: 0.38, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('FERTILITY DESIRED', { x: 0.45, y: 3.4, w: 4.35, h: 0.34, fontSize: 11.5, bold: true, color: C.white, valign: 'middle', margin: 0 });
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 3.38, w: 4.55, h: 0.38, fill: { color: C.header }, line: { color: C.header } });
  sl.addText('FERTILITY NOT DESIRED (or postmenopausal)', { x: 5.2, y: 3.4, w: 4.35, h: 0.34, fontSize: 11.5, bold: true, color: C.white, valign: 'middle', margin: 0 });

  addBullets(sl, [
    'Fertility-sparing surgery: unilateral salpingo-oophorectomy',
    'Staging: peritoneal washings, omental biopsy, peritoneal biopsies',
    'Cystectomy in very young patients (high recurrence risk)',
    'Close follow-up with USS + CA-125',
  ], 0.35, 3.82, 4.55, 1.25, { fontSize: 11 });
  addBullets(sl, [
    'TAH + BSO + complete surgical staging',
    'Omentectomy + peritoneal biopsies',
    'No role for adjuvant chemotherapy in Stage I',
    'Chemotherapy only for invasive implants or recurrence',
  ], 5.1, 3.82, 4.55, 1.25, { fontSize: 11 });
  sl.addShape(pres.ShapeType.line, { x: 4.95, y: 3.82, w: 0, h: 1.25, line: { color: C.divider, width: 1.2 } });
}

// ════════════════════════════════════════════════
// SLIDE 16 — HEREDITARY OC / BRCA
// ════════════════════════════════════════════════
{
  const sl = newSlide('Hereditary Ovarian Cancer & Genetic Risk');

  addSectionLine(sl, 'Hereditary Syndromes', 0.85);

  const synData = [
    { gene: 'BRCA1', risk: '39–46% lifetime risk', notes: 'Chromosome 17q12; HGSOC; risk-reducing salpingo-oophorectomy at 35–40 years' },
    { gene: 'BRCA2', risk: '11–17% lifetime risk', notes: 'Chromosome 13q12; also associated with breast cancer; RRSO at 40–45 years' },
    { gene: 'Lynch Syndrome (MLH1, MSH2, MSH6, PMS2)', risk: '9–12% lifetime risk', notes: 'MMR gene mutations; endometrioid/clear cell OC; associated endometrial Ca risk' },
    { gene: 'RAD51C/D, BRIP1, PALB2', risk: 'Moderate elevated risk', notes: 'Homologous recombination deficiency (HRD); eligible for PARP inhibitor therapy' },
  ];

  synData.forEach((row, i) => {
    const y = 1.32 + i * 0.66;
    const bg = i % 2 === 0 ? C.bg : C.lightGray;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.62, fill: { color: bg }, line: { color: C.divider, width: 0.5 } });
    sl.addText(row.gene, { x: 0.45, y: y + 0.06, w: 2.7, h: 0.5, fontSize: 11, bold: true, color: C.header, valign: 'middle', margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 3.2, y: y + 0.06, w: 0, h: 0.5, line: { color: C.divider, width: 0.7 } });
    sl.addText(row.risk, { x: 3.3, y: y + 0.06, w: 2.2, h: 0.5, fontSize: 10.5, color: C.accent, bold: true, valign: 'middle', margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 5.55, y: y + 0.06, w: 0, h: 0.5, line: { color: C.divider, width: 0.7 } });
    sl.addText(row.notes, { x: 5.65, y: y + 0.06, w: 3.9, h: 0.5, fontSize: 10, color: C.body, valign: 'middle', margin: 0 });
  });

  addSectionLine(sl, 'Risk-Reducing Measures', 4.0);
  addBullets(sl, [
    'Risk-reducing bilateral salpingo-oophorectomy (RRSO): reduces OC risk by ~80–96% in BRCA carriers',
    'Oral contraceptive use reduces risk (30–50% risk reduction)',
    'Genetic counselling and cascade family testing recommended for all epithelial OC patients',
    'Annual surveillance with CA-125 + TVUS (not proven to reduce mortality — no national screening)',
  ], 0.35, 4.45, 9.3, 0.78, { fontSize: 11 });
}

// ════════════════════════════════════════════════
// SLIDE 17 — PROGNOSIS & SURVIVAL
// ════════════════════════════════════════════════
{
  const sl = newSlide('Prognosis & Prognostic Factors');

  addSectionLine(sl, '5-Year Survival by Stage', 0.85);

  const survData = [
    { stage: 'Stage I', survival: '~90%', color: '1A8A4A', pct: 90 },
    { stage: 'Stage II', survival: '~70–80%', color: '1A7A8A', pct: 75 },
    { stage: 'Stage III', survival: '~30–40%', color: C.highlight, pct: 35 },
    { stage: 'Stage IV', survival: '~15–25%', color: 'C0392B', pct: 20 },
  ];

  const barY = 1.32;
  const barH = 0.55;
  survData.forEach((row, i) => {
    const y = barY + i * (barH + 0.12);
    sl.addText(row.stage, { x: 0.35, y: y + 0.12, w: 1.1, h: 0.3, fontSize: 12, bold: true, color: C.subhead, valign: 'middle', margin: 0 });
    // bar background
    sl.addShape(pres.ShapeType.rect, { x: 1.5, y, w: 6, h: barH, fill: { color: 'E8E0F0' }, line: { color: C.divider, width: 0.5 } });
    // filled bar
    const fillW = (row.pct / 100) * 6;
    sl.addShape(pres.ShapeType.rect, { x: 1.5, y, w: fillW, h: barH, fill: { color: row.color }, line: { color: row.color } });
    sl.addText(row.survival, { x: 7.6, y: y + 0.1, w: 1.5, h: 0.35, fontSize: 13, bold: true, color: row.color, valign: 'middle', margin: 0 });
  });

  addSectionLine(sl, 'Key Prognostic Factors', 3.95);
  twoCols(sl,
    ['FIGO Stage (most important factor)', 'Residual disease after surgery', 'Histological grade', 'Histological type (clear cell worst)', 'Patient performance status'],
    ['BRCA1/2 mutation status (better prognosis)', 'Response to platinum-based chemo', 'Age at diagnosis', 'CA-125 nadir after first-line chemo', 'Tumour microenvironment / immune profile'],
    4.38, 0.85, { fontSize: 11.5 }
  );
}

// ════════════════════════════════════════════════
// SLIDE 18 — SUMMARY TABLE
// ════════════════════════════════════════════════
{
  const sl = newSlide('Summary — OG 34.2 Ovarian Cancer at a Glance');

  const summaryData = [
    { topic: 'Incidence', content: '6th commonest cancer in women; peak 56–65 yrs; 70% present at advanced stage' },
    { topic: 'Aetiology', content: 'BRCA1/2 (most important), nulliparity, HRT, endometriosis; OCP is protective' },
    { topic: 'Histology', content: 'Epithelial 90% (serous >> endometrioid > clear cell > mucinous); Germ cell; Sex cord–stromal' },
    { topic: 'Classification', content: 'Type I (low-grade, slow, chemo-resistant) vs Type II (high-grade, TP53 mutant, BRCA related)' },
    { topic: 'Staging', content: 'FIGO I–IV; Stage I = confined to ovary; Stage III = peritoneal spread; Stage IV = distant mets' },
    { topic: 'Clinical Features', content: 'Bloating, abdominal pain, urinary frequency, ascites, adnexal mass — often vague and late' },
    { topic: 'Investigations', content: 'USS (first-line) + RMI score + CA-125 → CT staging; BRCA testing; ascites cytology' },
    { topic: 'Management', content: 'Staging laparotomy: TAH+BSO+omentectomy+LN sampling+peritoneal biopsies → Carbo+Taxol chemo' },
    { topic: 'Staging Laparotomy', content: 'Midline incision; washings; all peritoneal surfaces; TAH+BSO; omentectomy; LN dissection; appendicectomy (mucinous)' },
  ];

  const rowH = 0.47;
  const startY = 0.82;
  summaryData.forEach((row, i) => {
    const y = startY + i * rowH;
    const bg = i % 2 === 0 ? C.bg : C.lightGray;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.02, fill: { color: bg }, line: { color: C.divider, width: 0.5 } });
    sl.addText(row.topic, { x: 0.45, y: y + 0.04, w: 1.8, h: rowH - 0.1, fontSize: 10.5, bold: true, color: C.header, valign: 'middle', margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 2.3, y: y + 0.04, w: 0, h: rowH - 0.1, line: { color: C.divider, width: 0.7 } });
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}

// ════════════════════════════════════════════════
// SLIDE 19 — THANK YOU / REFERENCES
// ════════════════════════════════════════════════
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  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: 'F0EAF8' }, line: { color: 'F0EAF8' } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.8, fill: { color: C.header }, line: { color: C.header } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.0, w: 10, h: 0.625, fill: { color: C.accent }, line: { color: C.accent } });

  sl.addText('Thank You', { x: 0.5, y: 0.2, w: 9, h: 0.8, fontSize: 36, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0 });
  sl.addText('Questions & Discussion', { x: 0.5, y: 1.1, w: 9, h: 0.5, fontSize: 16, italic: true, color: 'D4B8EA', align: 'center', valign: 'middle', margin: 0 });

  addSectionLine(sl, 'References', 2.0);
  const refs = [
    'Berek JS, Hacker NF. Berek & Hacker\'s Gynecologic Oncology. 7th ed. Lippincott Williams & Wilkins; 2021.',
    'Berek JS. Berek & Novak\'s Gynecology. 16th ed. Lippincott Williams & Wilkins; 2019.',
    'Bailey H, Love M. Bailey & Love\'s Short Practice of Surgery. 28th ed. CRC Press; 2022.',
    'Schwartz. Schwartz\'s Principles of Surgery. 11th ed. McGraw-Hill; 2019.',
    'FIGO Staging of Ovarian Cancer (2014). Int J Gynecol Obstet. 2014;124(1):1–5.',
    'NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer (Version 2.2024).',
    'Shaw RW, Luesley D, Monga AK. Gynaecology. 4th ed. Churchill Livingstone.',
  ];
  refs.forEach((ref, i) => {
    sl.addText(`${i + 1}. ${ref}`, { x: 0.4, y: 2.46 + i * 0.34, w: 9.2, h: 0.3, fontSize: 9.5, color: C.subhead, margin: 0 });
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  sl.addText('OG 34.2  |  Undergraduate Gynaecology  |  Ovarian Cancer', {
    x: 0.4, y: 5.03, w: 9.2, h: 0.36, fontSize: 10, color: C.white, align: 'center', valign: 'middle', margin: 0
  });
}

// ── WRITE FILE ──
pres.writeFile({ fileName: '/home/daytona/workspace/ovarian-cancer-ppt/Ovarian_Cancer_OG34.2.pptx' })
  .then(() => console.log('PPT created successfully!'))
  .catch(err => console.error('Error:', err));

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/ovarian-cancer-ppt/create_ppt.js'

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Ovarian Cancer OG 34.2';
pres.author = 'Undergraduate Gynaecology Teaching';

const C = {
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function newSlide(subtitle) {
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function sectionBar(sl, text, yPos) {
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// ===========================================
// SLIDE 1 — TITLE
// ===========================================
{
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  sl.addText('OVARIAN CANCER', {
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  });
  sl.addText('OG 34.2 — Competency Based Medical Education (CBME)', {
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  sl.addText('Learning Objectives (OG 34.2):', {
    x: 0.75, y: 2.25, w: 8.5, h: 0.3, fontSize: 12, bold: true, color: C.header, margin: 0
  });
  sl.addText('Describe & discuss: Aetiology  •  Pathology  •  Classification  •  FIGO Staging\nClinical Features  •  Differential Diagnosis  •  Investigations\nPrinciple of Management  •  Staging Laparotomy', {
    x: 0.75, y: 2.57, w: 8.5, h: 0.9, fontSize: 12, color: C.subhead, align: 'center', valign: 'middle'
  });
  sl.addText("Reference: Berek & Novak's Gynecology  |  Bailey & Love's Surgery  |  Shaw's Gynaecology", {
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  });
}

// ===========================================
// SLIDE 2 — OVERVIEW & EPIDEMIOLOGY
// ===========================================
{
  const sl = newSlide('Overview & Epidemiology');
  sectionBar(sl, 'Key Epidemiological Facts', 0.85);
  addBullets(sl, [
    '6th most common malignancy in women worldwide',
    'Peak incidence: 56–65 years of age; rare before 45 years',
    '~70% present with advanced stage (III/IV) disease → overall prognosis poor',
    'Overall 5-year survival < 50% due to late presentation and aggressive biology',
    'Epithelial tumours account for ~90% of all ovarian malignancies',
    'Most serous carcinomas now thought to originate from the FALLOPIAN TUBE (STIC lesions)',
    'Worldwide incidence: ~313,000 new cases/year; ~207,000 deaths/year (WHO)',
    'India: age-adjusted incidence ~6.6 per 100,000 women',
    'Sporadic: 85–90%; Hereditary (BRCA1/2): 10–15%',
    'No proven national screening programme — no mortality benefit demonstrated',
  ], 0.35, 1.27, 9.3, 3.8, { fontSize: 12 });
}

// ===========================================
// SLIDE 3 — AETIOLOGY & RISK FACTORS
// ===========================================
{
  const sl = newSlide('Aetiology & Risk Factors');
  colHeader(sl, 'INCREASED RISK', 0.35, 0.85, 4.55, C.accent);
  colHeader(sl, 'DECREASED RISK (Protective)', 5.1, 0.85, 4.55, C.green);

  addBullets(sl, [
    'BRCA1 mutation — 39–46% lifetime OC risk',
    'BRCA2 mutation — 11–17% lifetime OC risk',
    'Lynch syndrome (MLH1, MSH2, MSH6, PMS2)',
    'Nulliparity / low parity',
    'Early menarche / late menopause',
    'Long-term HRT (combined oestrogen-progestogen)',
    'Endometriosis (clear cell, endometrioid subtypes)',
    'Increasing age (> 50 years)',
    'Family history of ovarian / breast cancer',
    'Infertility and fertility drugs (possible)',
  ], 0.35, 1.28, 4.55, 3.8, { fontSize: 11.5 });

  addBullets(sl, [
    'Oral contraceptive pill use',
    '  (risk reduced 30–50%; persists up to 30 yrs post-cessation)',
    'Multiparity / breastfeeding',
    'Tubal ligation',
    'Hysterectomy without oophorectomy',
    'Risk-reducing bilateral salpingo-oophorectomy (RRSO)',
    '  (reduces OC risk by 80–96% in BRCA carriers)',
    'Early age at first delivery',
    'Physical activity',
  ], 5.1, 1.28, 4.55, 3.8, { fontSize: 11.5 });
  vline(sl, 4.95, 1.28, 3.8);
}

// ===========================================
// SLIDE 4 — PATHOLOGY
// ===========================================
{
  const sl = newSlide('Pathology — Histological Types');
  sectionBar(sl, 'A.  EPITHELIAL TUMOURS  (~90%)', 0.82);

  const epData = [
    { type: 'Serous (HG)', freq: '~70%', cell: 'Fallopian tube epithelium', notes: 'TP53 mutation; BRCA-related; presents advanced stage' },
    { type: 'Serous (LG)', freq: '~5%', cell: 'Fallopian tube / peritoneum', notes: 'KRAS/BRAF mutations; slow-growing; chemo-resistant' },
    { type: 'Endometrioid', freq: '~10%', cell: 'Endometrial gland', notes: 'Associated with endometriosis and Lynch syndrome' },
    { type: 'Clear Cell', freq: '~5%', cell: 'Mullerian epithelium', notes: 'Endometriosis-related; platinum-resistant; poorer prognosis' },
    { type: 'Mucinous', freq: '~5%', cell: 'Intestinal / endocervical', notes: 'Large; exclude GI primary (Krukenberg); KRAS mutation' },
    { type: 'Brenner', freq: '< 1%', cell: 'Transitional cell', notes: 'Usually benign; malignant variant rare' },
  ];

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  const cx = [0.35, 1.9, 2.62, 4.75];
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  });

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  sectionBar(sl, 'B.  OTHER TUMOUR TYPES', 3.74);
  addBullets(sl, [
    'Germ Cell Tumours (~5%): Dysgerminoma, YST (AFP+), Immature teratoma, Choriocarcinoma (hCG+) — young women <30 yr; treat with BEP chemo',
    'Sex Cord–Stromal Tumours (~5–8%): Granulosa cell (inhibin+, oestrogen+), Sertoli–Leydig (androgen+), Fibrothecoma (Meigs syndrome)',
    'Metastatic to Ovary: Krukenberg tumour (gastric/colon primary), Breast, Lymphoma',
  ], 0.35, 4.15, 9.3, 0.98, { fontSize: 11 });
}

// ===========================================
// SLIDE 5 — CLASSIFICATION: TYPE I vs II
// ===========================================
{
  const sl = newSlide("Molecular Classification — Type I vs Type II (Kurman & Shih 2011)");
  colHeader(sl, 'TYPE I TUMOURS — Low-grade', 0.35, 0.85, 4.55, C.accent);
  colHeader(sl, 'TYPE II TUMOURS — High-grade', 5.1, 0.85, 4.55, C.header);

  addBullets(sl, [
    'Low-grade serous carcinoma',
    'Low-grade endometrioid carcinoma',
    'Clear cell carcinoma',
    'Mucinous carcinoma',
    'Brenner tumour',
    '',
    'PATHOGENESIS: Step-wise mutation from',
    '  benign precursors (cystadenoma → borderline → invasive)',
    '',
    'KEY MUTATIONS: KRAS, BRAF, PTEN, PIK3CA,',
    '  CTNNB1, ARID1A, PPP2R1A',
    '',
    'Genetically STABLE',
    'Slow-growing; tend to present at LOWER stage',
    'Relatively CHEMORESISTANT',
    'Better long-term prognosis for stage I disease',
  ], 0.35, 1.28, 4.55, 3.9, { fontSize: 11 });

  addBullets(sl, [
    'High-grade serous carcinoma (HGSOC ~70% of all OC)',
    'High-grade endometrioid carcinoma',
    'Carcinosarcoma (MMMT)',
    'Undifferentiated carcinoma',
    '',
    'PATHOGENESIS: De novo from STIC (serous tubal',
    '  intraepithelial carcinoma) in fallopian tube fimbriae',
    '',
    'KEY MUTATIONS: TP53 (>96%), BRCA1/2 germline',
    '  or somatic, CCNE1 amplification, RB1 loss',
    '',
    'Genetically UNSTABLE (chromosomal instability)',
    'Aggressive; presents at ADVANCED stage (III/IV)',
    'Initially PLATINUM-SENSITIVE',
    'High relapse rate; PARP inhibitors used in maintenance',
  ], 5.1, 1.28, 4.55, 3.9, { fontSize: 11 });
  vline(sl, 4.95, 1.28, 3.9);
}

// ===========================================
// SLIDE 6 — FIGO STAGING 2014
// ===========================================
{
  const sl = newSlide('FIGO Staging of Ovarian / Fallopian Tube / Peritoneal Cancer (2014)');

  const stageData = [
    {
      stage: 'I', bg: C.bg,
      desc: 'Tumour CONFINED to ovaries or fallopian tubes',
      sub: 'IA: One ovary/tube; intact capsule; no surface tumour; -ve washings\nIB: Both ovaries/tubes; intact capsule; -ve washings\nIC1: Surgical spill  IC2: Capsule ruptured/surface tumour  IC3: Malignant ascites/+ve washings'
    },
    {
      stage: 'II', bg: C.lightGray,
      desc: 'Tumour involves one or both ovaries WITH PELVIC EXTENSION',
      sub: 'IIA: Extension/implants on uterus, tubes, or ovaries\nIIB: Extension to other pelvic intraperitoneal structures'
    },
    {
      stage: 'III', bg: C.bg,
      desc: 'Peritoneal metastasis OUTSIDE the pelvis and/or retroperitoneal LN metastasis',
      sub: 'IIIA1: +ve retroperitoneal LN only (i: ≤10mm; ii: >10mm)\nIIIA2: Microscopic peritoneal mets ± LN  IIIB: Mets ≤2 cm  IIIC: Mets >2 cm (incl. liver/spleen capsule)'
    },
    {
      stage: 'IV', bg: C.lightGray,
      desc: 'DISTANT METASTASIS beyond peritoneum',
      sub: 'IVA: Pleural effusion with +ve cytology\nIVB: Parenchymal liver/spleen mets; extra-abdominal organs; inguinal/supraclavicular LN'
    },
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  let yy = 1.22;
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  });

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  sl.addText('70% of patients present at Stage III–IV  |  Stage I: 5-yr survival ~90%  |  Stage III: ~30–40%  |  Stage IV: ~15–25%', {
    x: 0.4, y: 4.9, w: 9.2, h: 0.18, fontSize: 9.5, bold: true, color: '7B5800', align: 'center', margin: 0
  });
}

// ===========================================
// SLIDE 7 — CLINICAL FEATURES
// ===========================================
{
  const sl = newSlide('Clinical Features');
  colHeader(sl, 'SYMPTOMS', 0.35, 0.85, 4.55, C.accent);
  colHeader(sl, 'SIGNS', 5.1, 0.85, 4.55, C.header);

  addBullets(sl, [
    'Abdominal distension / bloating (most common)',
    'Pelvic or abdominal pain',
    'Difficulty eating or feeling full quickly',
    'Urinary urgency or frequency',
    'Change in bowel habit / constipation',
    'Weight loss (advanced disease)',
    'Shortness of breath (pleural effusion)',
    'Abnormal vaginal bleeding (post-menopausal)',
    'Symptoms often vague → 50% present to non-gynaecology first',
    'Ovarian Cancer Symptom Index 2007:',
    '  Symptoms ≥12×/month, duration <1 yr → investigate',
  ], 0.35, 1.28, 4.55, 3.8, { fontSize: 11.5 });

  addBullets(sl, [
    'Abdominal / pelvic mass — solid, fixed, irregular',
    'Ascites — shifting dullness, fluid thrill',
    'Omental cake on palpation',
    'Pleural effusion (right > left)',
    'Cachexia in advanced disease',
    'Hard bilateral pelvic mass fixed to sacrum',
    "Sister Mary Joseph nodule (periumbilical metastasis)",
    "Virchow's node — left supraclavicular LN",
    'Rectal shelf (Blumer\'s shelf) on per rectal exam',
    'Krukenberg tumour signs (if from GI primary)',
  ], 5.1, 1.28, 4.55, 3.8, { fontSize: 11.5 });
  vline(sl, 4.95, 1.28, 3.8);
}

// ===========================================
// SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ===========================================
{
  const sl = newSlide('Differential Diagnosis of Pelvic / Adnexal Mass');
  sectionBar(sl, 'Key Differentials to Consider', 0.82);

  const ddData = [
    { cat: 'Benign Ovarian', col: C.accent, items: 'Functional cysts (follicular/luteal), Dermoid cyst (mature cystic teratoma), Endometrioma ("chocolate cyst"), Serous/mucinous cystadenoma, PCOS' },
    { cat: 'Malignant Gynaecological', col: C.header, items: 'Borderline ovarian tumour, Fallopian tube carcinoma, Uterine sarcoma, Endometrial carcinoma with adnexal involvement' },
    { cat: 'Metastatic to Ovary', col: '8B3A8B', items: "Krukenberg tumour (gastric/colon), Breast cancer metastasis, Lymphoma" },
    { cat: 'Non-Gynaecological', col: '1A5A7A', items: 'Appendix abscess/mucocele, Diverticular abscess, Colorectal carcinoma, Retroperitoneal sarcoma/lymph node mass, Pelvic kidney' },
    { cat: 'Ascites Differentials', col: '8B6A1A', items: "Meigs' syndrome (benign fibroma + ascites + pleural effusion), Liver cirrhosis, Heart failure, TB peritonitis, Pseudomyxoma peritonei" },
  ];

  const rowH = 0.72;
  ddData.forEach((row, i) => {
    const y = 1.24 + i * rowH;
    const bg = i % 2 === 0 ? C.bg : C.lightGray;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.04, fill: { color: bg }, line: { color: C.divider, width: 0.4 } });
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.1, h: rowH - 0.04, fill: { color: row.col }, line: { color: row.col } });
    sl.addText(row.cat, { x: 0.5, y: y + 0.05, w: 2.3, h: rowH - 0.16, fontSize: 11, bold: true, color: row.col, valign: 'top', margin: 0 });
    vline(sl, 2.85, y + 0.05, rowH - 0.16);
    sl.addText(row.items, { x: 2.95, y: y + 0.05, w: 6.6, h: rowH - 0.14, fontSize: 10.5, color: C.body, valign: 'top', margin: [2,4] });
  });
}

// ===========================================
// SLIDE 9 — INVESTIGATIONS
// ===========================================
{
  const sl = newSlide('Investigations');

  const colsData = [
    {
      title: 'LABORATORY TESTS', color: C.accent, x: 0.25, w: 3.1,
      items: [
        'CA-125 (normal < 35 U/mL)',
        '  50% elevated Stage I; >90% Stage III–IV',
        '  Non-specific: elevated in endometriosis, PID, cirrhosis, menstruation',
        'AFP, β-hCG, LDH',
        '  Germ cell tumours (<40 yrs)',
        'CEA, CA 19-9',
        '  Mucinous / GI primary',
        'Inhibin A & B',
        '  Granulosa cell tumours',
        'FBC, LFTs, RFTs',
        'BRCA1/2 germline testing',
        '  Recommended ALL epithelial OC',
      ]
    },
    {
      title: 'IMAGING', color: C.header, x: 3.45, w: 3.1,
      items: [
        'TVS/USS — FIRST LINE',
        '  Morphology, septae, solid areas, vascularity',
        'Risk of Malignancy Index (RMI)',
        '  RMI = U × M × CA-125',
        '  RMI >200 → urgent oncology referral',
        'CT Abdomen+Pelvis',
        '  Staging: peritoneal mets, LN, ascites',
        'MRI Pelvis',
        '  Better soft tissue characterisation',
        'CXR — pleural effusion',
        'PET-CT (recurrence)',
        'Echocardiogram (pre-chemo)',
      ]
    },
    {
      title: 'TISSUE DIAGNOSIS', color: '6A3A8A', x: 6.65, w: 3.1,
      items: [
        'Peritoneal/ascites cytology',
        'Core needle biopsy (inoperable)',
        'Intraoperative frozen section',
        'Formal histopathology + IHC',
        '  WT-1, PAX-8, p53, ER/PR',
        'Molecular profiling',
        '  BRCA1/2 somatic, TP53, HRD score',
        'Diagnostic laparoscopy',
        '  When imaging equivocal',
        'Endometrial biopsy',
        '  If endometrioid suspected',
      ]
    },
  ];

  colsData.forEach(col => {
    colHeader(sl, col.title, col.x, 0.85, col.w, col.color);
    addBullets(sl, col.items, col.x, 1.27, col.w, 3.9, { fontSize: 10 });
  });
}

// ===========================================
// SLIDE 10 — RMI & ULTRASOUND
// ===========================================
{
  const sl = newSlide("Risk of Malignancy Index (RMI) — Jacobs et al.");
  sectionBar(sl, 'Formula:  RMI  =  U  ×  M  ×  CA-125 (U/mL)', 0.82);

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.24, w: 9.3, h: 1.72, fill: { color: C.accentBg }, line: { color: C.accent, width: 1 } });

  sl.addText([
    { text: 'U (Ultrasound score):  ', options: { bold: true, color: C.header } },
    { text: 'U = 0 (no features),  U = 1 (1 feature present),  U = 3 (≥ 2 features present)\n', options: { color: C.body } },
    { text: 'Ultrasound features scored:  ', options: { bold: true, color: C.header } },
    { text: 'Multilocular cyst  |  Solid areas  |  Bilateral lesions  |  Ascites  |  Intra-abdominal metastasis\n\n', options: { color: C.body } },
    { text: 'M (Menopausal status):  ', options: { bold: true, color: C.header } },
    { text: 'M = 1 (premenopausal)   M = 3 (postmenopausal)\n\n', options: { color: C.body } },
    { text: 'CA-125:  ', options: { bold: true, color: C.header } },
    { text: 'Absolute serum value in U/mL', options: { color: C.body } },
  ], { x: 0.5, y: 1.3, w: 9.0, h: 1.6, fontSize: 11.5, valign: 'top', margin: [4, 8] });

  sectionBar(sl, 'RMI Score Interpretation & Clinical Action', 3.1);

  const rmiRows = [
    { score: '< 25', risk: 'Low Risk', action: 'Routine gynaecology follow-up', riskPct: '< 3%', bg: C.bg, col: C.green },
    { score: '25 – 250', risk: 'Moderate Risk', action: 'Gynaecology unit — further assessment required', riskPct: '~20%', bg: C.lightGray, col: C.highlight },
    { score: '> 200 / > 250', risk: 'HIGH RISK', action: 'URGENT referral to Gynaecological Oncology Centre for MDT', riskPct: '~75%', bg: 'FFF0F0', col: 'C0392B' },
  ];

  const rhdrY = 3.52;
  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: rhdrY, w: 9.3, h: 0.32, fill: { color: C.header }, line: { color: C.header } });
  ['RMI Score','Risk Category','Clinical Action','Malignancy Risk'].forEach((h, i) => {
    const xs = [0.45, 1.95, 3.5, 8.2];
    const ws = [1.4, 1.45, 4.6, 1.35];
    sl.addText(h, { x: xs[i], y: rhdrY + 0.02, w: ws[i], h: 0.28, fontSize: 10.5, bold: true, color: C.white, valign: 'middle', margin: 0 });
  });

  rmiRows.forEach((row, i) => {
    const y = rhdrY + 0.34 + i * 0.38;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.36, fill: { color: row.bg }, line: { color: C.divider, width: 0.4 } });
    sl.addText(row.score, { x: 0.45, y: y + 0.04, w: 1.4, h: 0.28, fontSize: 11, bold: true, color: row.col, valign: 'middle', margin: 0 });
    sl.addText(row.risk, { x: 1.95, y: y + 0.04, w: 1.45, h: 0.28, fontSize: 11, bold: true, color: row.col, valign: 'middle', margin: 0 });
    sl.addText(row.action, { x: 3.5, y: y + 0.04, w: 4.6, h: 0.28, fontSize: 10.5, color: C.body, valign: 'middle', margin: 0 });
    sl.addText(row.riskPct, { x: 8.2, y: y + 0.04, w: 1.35, h: 0.28, fontSize: 11, bold: true, color: row.col, align: 'center', valign: 'middle', margin: 0 });
  });
}

// ===========================================
// SLIDE 11 — MANAGEMENT OVERVIEW
// ===========================================
{
  const sl = newSlide('Principles of Management');
  sectionBar(sl, 'Core Principle:  Cytoreductive Surgery  +  Platinum-based Chemotherapy', 0.82);

  const steps = [
    { n:'1', t:'Pre-operative Workup & MDT', b:'Full history + examination  |  CA-125, AFP, hCG, LDH, CEA, CA 19-9  |  CT staging  |  BRCA testing  |  Anaesthetic assessment  |  MDT planning', col: C.accent },
    { n:'2', t:'Surgical Staging / Cytoreduction', b:'Staging Laparotomy (midline incision): TAH + BSO + Omentectomy + Peritoneal biopsies + LN sampling + Washings  |  Goal: R0 (no macroscopic residual disease)', col: C.header },
    { n:'3', t:'Adjuvant Chemotherapy', b:'Carboplatin (AUC 5–6) + Paclitaxel (175 mg/m²) IV every 3 weeks × 6 cycles  |  IP chemotherapy for optimally debulked Stage III (GOG-172)  |  Bevacizumab addition in Stage III/IV', col: '1A5A7A' },
    { n:'4', t:'Targeted / Maintenance Therapy', b:'PARP inhibitors (Olaparib/Niraparib) for BRCA-mutated or HRD-positive disease  |  Bevacizumab maintenance (ICON7, GOG-0218)  |  Hormone therapy for low-grade serous', col: '6A3A8A' },
    { n:'5', t:'Follow-up & Recurrence', b:'CA-125 + clinical review 3-monthly × 2 yrs → 6-monthly  |  CT on clinical suspicion  |  Secondary cytoreduction ± further PARP inhibitor  |  Palliative care for platinum-resistant disease', col: C.green },
  ];

  const rowH = 0.72;
  steps.forEach((step, i) => {
    const y = 1.24 + i * rowH;
    const bg = i % 2 === 0 ? C.bg : C.lightGray;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.04, fill: { color: bg }, line: { color: C.divider, width: 0.4 } });
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.48, h: rowH - 0.04, fill: { color: step.col }, line: { color: step.col } });
    sl.addText(step.n, { x: 0.35, y: y + 0.05, w: 0.48, h: rowH - 0.14, fontSize: 17, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0 });
    sl.addText(step.t, { x: 0.88, y: y + 0.04, w: 2.3, h: rowH - 0.12, fontSize: 11, bold: true, color: step.col, valign: 'middle', margin: 0 });
    vline(sl, 3.22, y + 0.04, rowH - 0.12);
    sl.addText(step.b, { x: 3.3, y: y + 0.04, w: 6.27, h: rowH - 0.12, fontSize: 10, color: C.body, valign: 'middle', margin: [2,4] });
  });
}

// ===========================================
// SLIDE 12 — STAGING LAPAROTOMY
// ===========================================
{
  const sl = newSlide('Staging Laparotomy — Technique & Steps');
  sectionBar(sl, 'Indications for Staging Laparotomy', 0.82);
  addBullets(sl, [
    'USS-confirmed ovarian mass with elevated CA-125 / high RMI score',
    'CT-stage confirmed ovarian/peritoneal malignancy for primary surgical management',
    'Intraoperative finding of unsuspected ovarian malignancy',
  ], 0.35, 1.24, 9.3, 0.68, { fontSize: 11.5 });

  sectionBar(sl, 'Steps of Staging Laparotomy  (Bailey & Love / Berek & Novak)', 2.0);

  const steps2 = [
    'INCISION: Adequate midline laparotomy (pubis → xiphisternum) for optimal exposure',
    'WASHINGS: Collect peritoneal cytology from pelvis, right and left paracolic gutters, and right hemidiaphragm',
    'INSPECTION: Systematic examination of all peritoneal surfaces, bowel, mesentery, diaphragm, omentum, and liver',
    'PROCEDURE: Total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO)',
    'OMENTECTOMY: Infracolic omentectomy (omentum is a common site of occult metastasis)',
    'LYMPH NODES: Pelvic and para-aortic lymph node sampling/dissection',
    'BIOPSIES: Biopsy all suspicious lesions; Random biopsies — right hemidiaphragm, bladder peritoneum, cul-de-sac, paracolic gutters, both pelvic side walls',
    'APPENDICECTOMY: Performed routinely for mucinous tumours to exclude GI primary',
    'CYTOREDUCTION: Remove all visible tumour — goal is R0 (no macroscopic residual disease)',
  ];

  steps2.forEach((step, i) => {
    const y = 2.42 + i * 0.28;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.27, h: 0.23, fill: { color: C.accent }, line: { color: C.accent } });
    sl.addText(String(i + 1), { x: 0.35, y, w: 0.27, h: 0.23, fontSize: 9, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0 });
    sl.addText(step, { x: 0.67, y: y + 0.01, w: 8.98, h: 0.24, fontSize: 10.5, color: C.body, valign: 'middle', margin: 0 });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 5.08, w: 9.3, h: 0.2, fill: { color: 'FFF3CD' }, line: { color: C.highlight, width: 0.8 } });
  sl.addText('KEY PRINCIPLE: Degree of RESIDUAL DISEASE after surgery is the strongest predictor of survival in advanced ovarian cancer', {
    x: 0.4, y: 5.09, w: 9.2, h: 0.18, fontSize: 9, bold: true, color: '7B5800', align: 'center', margin: 0
  });
}

// ===========================================
// SLIDE 13 — CHEMOTHERAPY
// ===========================================
{
  const sl = newSlide('Chemotherapy & Targeted / Maintenance Therapy');
  sectionBar(sl, 'First-Line Chemotherapy', 0.82);

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.24, w: 9.3, h: 0.96, fill: { color: C.accentBg }, line: { color: C.accent, width: 1 } });
  sl.addText([
    { text: 'Standard IV Regimen: ', options: { bold: true, color: C.header } },
    { text: 'Carboplatin (AUC 5–6) + Paclitaxel (175 mg/m²) — every 3 weeks × 6 cycles\n', options: { color: C.body } },
    { text: 'Dose-Dense Regimen (JGOG 3016): ', options: { bold: true, color: C.header } },
    { text: 'Weekly paclitaxel + 3-weekly carboplatin — improved PFS in some cohorts\n', options: { color: C.body } },
    { text: 'IP Chemotherapy (GOG-172 trial): ', options: { bold: true, color: C.header } },
    { text: 'Intraperitoneal cisplatin + paclitaxel — survival benefit in optimally debulked Stage III', options: { color: C.body } },
  ], { x: 0.45, y: 1.29, w: 9.1, h: 0.88, fontSize: 11, valign: 'top', margin: [4, 8] });

  sectionBar(sl, 'Targeted / Maintenance Therapy', 2.27);

  const agents = [
    { name: 'Bevacizumab (Avastin)', mech: 'Anti-VEGF monoclonal antibody', use: 'Added to first-line chemo + maintenance in Stage III/IV disease (ICON7, GOG-0218 trials)', col: C.accent },
    { name: 'Olaparib (Lynparza)', mech: 'PARP inhibitor (PARPi)', use: 'BRCA1/2-mutated advanced OC — first-line maintenance (SOLO-1 trial; 48-month PFS improvement)', col: C.header },
    { name: 'Niraparib (Zejula)', mech: 'PARP inhibitor', use: 'HRD-positive tumours (BRCA-mutated or wild-type); PRIMA trial — all-comer maintenance benefit', col: '1A5A7A' },
    { name: 'Rucaparib (Rubraca)', mech: 'PARP inhibitor', use: 'BRCA-mutated recurrent OC after ≥2 prior lines of platinum-based chemotherapy (ARIEL3 trial)', col: '6A3A8A' },
  ];

  agents.forEach((a, i) => {
    const y = 2.68 + i * 0.58;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.54, fill: { color: i % 2 === 0 ? C.bg : C.lightGray }, line: { color: C.divider, width: 0.4 } });
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.1, h: 0.54, fill: { color: a.col }, line: { color: a.col } });
    sl.addText(a.name, { x: 0.5, y: y + 0.04, w: 2.7, h: 0.24, fontSize: 11, bold: true, color: a.col, margin: 0 });
    sl.addText(a.mech, { x: 0.5, y: y + 0.29, w: 2.7, h: 0.2, fontSize: 9.5, italic: true, color: C.subhead, margin: 0 });
    vline(sl, 3.25, y + 0.06, 0.42);
    sl.addText(a.use, { x: 3.34, y: y + 0.08, w: 6.21, h: 0.38, fontSize: 10.5, color: C.body, valign: 'middle', margin: 0 });
  });
}

// ===========================================
// SLIDE 14 — NON-EPITHELIAL TUMOURS
// ===========================================
{
  const sl = newSlide('Non-Epithelial Ovarian Tumours');
  colHeader(sl, 'GERM CELL TUMOURS (~5%)', 0.35, 0.85, 4.55, C.accent);
  colHeader(sl, 'SEX CORD–STROMAL TUMOURS (~5–8%)', 5.1, 0.85, 4.55, C.header);

  addBullets(sl, [
    'Occur predominantly in women < 30 years',
    'Types:',
    '  Dysgerminoma (most common; LDH elevated)',
    '  Yolk Sac Tumour / Endodermal Sinus Tumour (AFP+)',
    '  Immature Teratoma (AFP elevated; graded 1–3)',
    '  Choriocarcinoma (β-hCG elevated)',
    '  Mixed germ cell tumour',
    'Treatment: BEP chemotherapy (Bleomycin + Etoposide + Cisplatin)',
    'Fertility-sparing surgery possible in Stage IA',
    'Excellent prognosis with treatment (~90% cure rate)',
    'Serum markers used for monitoring response',
  ], 0.35, 1.28, 4.55, 3.8, { fontSize: 11 });

  addBullets(sl, [
    'Hormone-secreting tumours',
    'Types:',
    "  Granulosa Cell Tumour (Inhibin+, Oestrogen+)",
    "    → AUB, endometrial hyperplasia/carcinoma risk",
    "    → Call-Exner bodies on histology",
    "  Sertoli–Leydig Cell Tumour (Androgen+)",
    "    → Virilisation, acne, oligomenorrhoea",
    "  Thecoma / Fibrothecoma",
    "    → Fibrothecoma → Meigs' syndrome",
    "      (fibroma + ascites + pleural effusion)",
    'Generally low malignant potential; good prognosis',
    'Oestrogen excess → risk of endometrial carcinoma',
  ], 5.1, 1.28, 4.55, 3.8, { fontSize: 11 });
  vline(sl, 4.95, 1.28, 3.8);
}

// ===========================================
// SLIDE 15 — BORDERLINE TUMOURS
// ===========================================
{
  const sl = newSlide('Borderline Ovarian Tumours (Tumours of Low Malignant Potential)');
  sectionBar(sl, 'Definition & Features', 0.82);
  addBullets(sl, [
    'Atypical epithelial proliferation WITHOUT destructive stromal invasion',
    'Most common: Serous borderline (~50–55%) and Mucinous borderline (~40–45%)',
    'Average age at diagnosis: ~46 years (younger than invasive OC)',
    'Most present at Stage I; excellent prognosis (5-yr survival Stage I: ~99%)',
    'Peritoneal implants in advanced cases: non-invasive implants (good prognosis) vs invasive implants (poorer outcome)',
  ], 0.35, 1.24, 9.3, 1.35, { fontSize: 12 });

  sectionBar(sl, 'Management', 2.67);
  colHeader(sl, 'FERTILITY DESIRED (young/premenopausal)', 0.35, 3.1, 4.55, C.accent);
  colHeader(sl, 'FERTILITY NOT DESIRED / POSTMENOPAUSAL', 5.1, 3.1, 4.55, C.header);

  addBullets(sl, [
    'Unilateral salpingo-oophorectomy (USO)',
    'Staging: peritoneal washings, omental biopsy, peritoneal biopsies',
    'Cystectomy only in very young: high recurrence rate',
    'Close surveillance: USS + CA-125 every 6 months',
    'Subsequent completion surgery after childbearing',
  ], 0.35, 3.52, 4.55, 1.6, { fontSize: 11 });

  addBullets(sl, [
    'TAH + BSO + complete surgical staging',
    'Omentectomy + peritoneal biopsies',
    'No adjuvant chemotherapy for Stage I BOT',
    'Chemotherapy only if invasive implants',
    'Regular long-term surveillance (late recurrence possible)',
  ], 5.1, 3.52, 4.55, 1.6, { fontSize: 11 });
  vline(sl, 4.95, 3.52, 1.6);
}

// ===========================================
// SLIDE 16 — PROGNOSIS
// ===========================================
{
  const sl = newSlide('Prognosis & Prognostic Factors');
  sectionBar(sl, '5-Year Survival by FIGO Stage', 0.82);

  const survData = [
    { s:'Stage I', v:'~90%', pct:90, col:'1A8A4A' },
    { s:'Stage II', v:'~70–80%', pct:75, col:'1A7A8A' },
    { s:'Stage III', v:'~30–40%', pct:35, col:C.highlight },
    { s:'Stage IV', v:'~15–25%', pct:20, col:'C0392B' },
  ];

  survData.forEach((row, i) => {
    const y = 1.24 + i * 0.65;
    sl.addText(row.s, { x: 0.35, y: y + 0.15, w: 1.1, h: 0.3, fontSize: 12, bold: true, color: C.subhead, valign: 'middle', margin: 0 });
    sl.addShape(pres.ShapeType.rect, { x: 1.5, y, w: 6.5, h: 0.55, fill: { color: 'E8E0F0' }, line: { color: C.divider, width: 0.4 } });
    sl.addShape(pres.ShapeType.rect, { x: 1.5, y, w: (row.pct / 100) * 6.5, h: 0.55, fill: { color: row.col }, line: { color: row.col } });
    sl.addText(row.v, { x: 8.1, y: y + 0.1, w: 1.55, h: 0.35, fontSize: 13, bold: true, color: row.col, valign: 'middle', margin: 0 });
  });

  sectionBar(sl, 'Key Prognostic Factors', 3.92);

  addBullets(sl, [
    'FIGO Stage (most critical factor)',
    'Residual disease after cytoreductive surgery',
    'Histological grade',
    'Histological type (clear cell = worst; germ cell = best)',
    'Patient performance status',
  ], 0.35, 4.34, 4.55, 0.88, { fontSize: 11 });

  addBullets(sl, [
    'BRCA1/2 mutation status (better response to platinum)',
    'Response to first-line platinum chemotherapy',
    'CA-125 nadir after first-line chemo',
    'Age at diagnosis',
    'Platinum-free interval at recurrence',
  ], 5.1, 4.34, 4.55, 0.88, { fontSize: 11 });
  vline(sl, 4.95, 4.34, 0.88);
}

// ===========================================
// SLIDE 17 — SUMMARY TABLE
// ===========================================
{
  const sl = newSlide('Summary — OG 34.2 Ovarian Cancer at a Glance');

  const rows = [
    { t:'Incidence', c:'6th commonest cancer in women; peak 56–65 yrs; 70% present at advanced stage (III/IV)' },
    { t:'Aetiology', c:'BRCA1/2 (most important hereditary risk); nulliparity; HRT; endometriosis; OCP is protective' },
    { t:'Histology', c:'Epithelial 90% (HGSOC >> endometrioid > clear cell > mucinous); Germ cell 5%; Sex cord–stromal 5%' },
    { t:'Classification', c:'Type I (low-grade, KRAS/BRAF, slow, step-wise) vs Type II (high-grade, TP53/BRCA, de novo STIC)' },
    { t:'FIGO Staging', c:'I = ovary confined; II = pelvic extension; III = peritoneal spread; IV = distant/pleural/parenchymal mets' },
    { t:'Clinical Features', c:'Bloating, abdominal pain, urinary frequency, ascites, solid fixed adnexal mass — often vague & late' },
    { t:'Investigations', c:'TVS/USS (first line) → RMI score + CA-125 → CT staging; BRCA testing; ascites cytology' },
    { t:'Management', c:'MDT → Staging laparotomy (TAH+BSO+omentectomy+LN sampling+washings) → Carboplatin+Paclitaxel × 6 cycles' },
    { t:'Staging Lap', c:'Midline incision; peritoneal washings; inspect all surfaces; TAH+BSO; omentectomy; LN dissection; biopsies; appendicectomy (mucinous)' },
    { t:'Targeted Rx', c:'PARP inhibitors (olaparib/niraparib) for BRCA-mutated/HRD+ disease; Bevacizumab for Stage III/IV' },
  ];

  const rowH = 0.45;
  rows.forEach((row, i) => {
    const y = 0.78 + i * rowH;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: rowH - 0.02, fill: { color: i % 2 === 0 ? C.bg : C.lightGray }, line: { color: C.divider, width: 0.4 } });
    sl.addText(row.t, { x: 0.45, y: y + 0.04, w: 1.85, h: rowH - 0.1, fontSize: 10.5, bold: true, color: C.header, valign: 'middle', margin: 0 });
    vline(sl, 2.35, y + 0.04, rowH - 0.1);
    sl.addText(row.c, { x: 2.45, y: y + 0.04, w: 7.1, h: rowH - 0.1, fontSize: 10, color: C.body, valign: 'middle', margin: 0 });
  });
}

// ===========================================
// SLIDE 18 — THANK YOU / REFERENCES
// ===========================================
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: 'EDE8F5' }, line: { color: 'EDE8F5' } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.85, fill: { color: C.header }, line: { color: C.header } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.0, w: 10, h: 0.625, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('Thank You', {
    x: 0.5, y: 0.2, w: 9, h: 0.8, fontSize: 38, bold: true, color: C.white, align: 'center', valign: 'middle', margin: 0
  });
  sl.addText('Questions & Discussion Welcome', {
    x: 0.5, y: 1.1, w: 9, h: 0.45, fontSize: 16, italic: true, color: 'D4B8EA', align: 'center', valign: 'middle', margin: 0
  });

  sl.addShape(pres.ShapeType.rect, { x: 0.35, y: 2.0, w: 9.3, h: 0.34, fill: { color: C.accent }, line: { color: C.accent } });
  sl.addText('References', { x: 0.45, y: 2.02, w: 9.1, h: 0.3, fontSize: 12.5, bold: true, color: C.white, valign: 'middle', margin: 0 });

  const refs = [
    "Berek JS. Berek & Novak's Gynecology. 16th ed. Lippincott Williams & Wilkins; 2019.",
    "Bailey H, Love M. Bailey & Love's Short Practice of Surgery. 28th ed. CRC Press; 2022.",
    "Shaw RW, Luesley D, Monga AK. Gynaecology. 4th ed. Churchill Livingstone Elsevier.",
    "Schwartz. Schwartz's Principles of Surgery. 11th ed. McGraw-Hill; 2019.",
    "FIGO Staging of Ovarian Cancer (2014 revised). Int J Gynecol Obstet. 2014;124(1):1–5.",
    "NCCN Clinical Practice Guidelines: Ovarian Cancer (Version 2.2024). www.nccn.org.",
    "Kurman RJ, Shih IM. The dualistic model of ovarian carcinogenesis. Am J Pathol. 2016;186(4):733–747.",
  ];

  refs.forEach((ref, i) => {
    sl.addText(`${i + 1}.  ${ref}`, {
      x: 0.4, y: 2.4 + i * 0.32, w: 9.2, h: 0.28, fontSize: 9.5, color: C.subhead, margin: 0
    });
  });

  sl.addText('OG 34.2  |  Undergraduate Gynaecology  |  Ovarian Cancer', {
    x: 0.4, y: 5.03, w: 9.2, h: 0.38, fontSize: 10.5, color: C.white, align: 'center', valign: 'middle', margin: 0
  });
}

// ── WRITE FILE ──
pres.writeFile({ fileName: '/home/daytona/workspace/ovarian-cancer-ppt/Ovarian_Cancer_OG34.2.pptx' })
  .then(() => console.log('SUCCESS: PPT created!'))
  .catch(err => { console.error('ERROR:', err); process.exit(1); });