const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ── Fetch images as base64 ──────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/b5b188885db55a5b1db8d8b37091818c37706dcaa8430d38a0dfc2d0617182ee.png", // Fig 8.10 Bronchial carcinoma left lower lobe
  "https://cdn.orris.care/cdss_images/22d2ffba5947511f15772f2b1c951117bd3d9ed23344b07357dbd7c3f72d8368.png", // Fig 8.11 Corona radiata
  "https://cdn.orris.care/cdss_images/da7f9af9f90e2ca566e1caa8cb623803e025e680978a63e6b9628184ed6723f2.png", // Fig 8.12 Lung cancer mimicking pneumonia
  "https://cdn.orris.care/cdss_images/e9acbec40153419d3749b75a92631392e1841e983a5c46550423e8103aa3cc31.png", // Fig 8.20 Mediastinal invasion
  "https://cdn.orris.care/cdss_images/d8de589ed7e7853314099ac121150229d5897d993c3d85d9b0eb677d091084e5.png", // Fig 8.21 MRI aortic invasion
  "https://cdn.orris.care/cdss_images/5a9529b356a0043abf0d26c0987f9094f3ee7c92b4fd416498073468f808b09e.png", // Fig 8.22 Pancoast tumour
  "https://cdn.orris.care/cdss_images/8ac4b47191dfa67e5aabd9543f62a708df5d5a6412baf4b43e6a86bcbf5dde5f.png", // Fig 8.23 Cavitating carcinoma
  "https://cdn.orris.care/cdss_images/f8c0ed2634bc4ebfa98aa0369058845c092b5b38d7156adc86a75ff3fe456f1d.png", // Fig 8.13 Cavitation CXR
];

let images = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  );
  images = JSON.parse(result.toString());
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imageUrls.map(u => ({ url: u, base64: null, error: e.message }));
}

function img(idx) {
  return images[idx] && images[idx].base64 ? images[idx].base64 : null;
}

// ── Colour palette ─────────────────────────────────────────────────────────
const DARK     = "0D1B2A"; // deep navy
const MID      = "1B4F72"; // mid blue
const ACCENT   = "E74C3C"; // clinical red
const GOLD     = "F39C12"; // warm amber
const LIGHT    = "D6EAF8"; // pale blue
const WHITE    = "FFFFFF";
const OFFWHITE = "F5F8FC";
const GRAY     = "5D6D7E";

let pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Radiology of Bronchogenic Carcinoma";
pres.author = "Grainger & Allison's Diagnostic Radiology";

// ── Helper: section divider ─────────────────────────────────────────────────
function addDivider(slide, colorHex, w) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.01, w: w || 13.3, h: 0.06, fill: { color: colorHex }, line: { color: colorHex } });
}

// ── Helper: footer ──────────────────────────────────────────────────────────
function addFooter(slide, label) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 7.2, w: 13.3, h: 0.3, fill: { color: DARK }, line: { color: DARK } });
  slide.addText(`Grainger & Allison's Diagnostic Radiology  |  ${label}`, {
    x: 0.3, y: 7.2, w: 12.7, h: 0.3,
    fontSize: 8, color: "AABCCE", italic: true, valign: "middle"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  // full background
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  // decorative left stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.25, h: 7.5, fill: { color: ACCENT }, line: { color: ACCENT } });
  // decorative right stripe
  s.addShape(pres.ShapeType.rect, { x: 13.05, y: 0, w: 0.25, h: 7.5, fill: { color: GOLD }, line: { color: GOLD } });
  // horizontal accent bar
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.8, w: 12.8, h: 0.06, fill: { color: ACCENT }, line: { color: ACCENT } });

  s.addText("RADIOLOGY OF", {
    x: 0.6, y: 1.2, w: 12.1, h: 0.8,
    fontSize: 30, color: LIGHT, bold: false, align: "center", charSpacing: 8, fontFace: "Calibri"
  });
  s.addText("BRONCHOGENIC CARCINOMA", {
    x: 0.6, y: 2.0, w: 12.1, h: 1.4,
    fontSize: 54, color: WHITE, bold: true, align: "center", charSpacing: 2, fontFace: "Calibri"
  });
  s.addText("Based on Grainger & Allison's Diagnostic Radiology", {
    x: 0.6, y: 4.0, w: 12.1, h: 0.5,
    fontSize: 18, color: GOLD, italic: true, align: "center", fontFace: "Calibri"
  });
  s.addText("A Textbook of Medical Imaging", {
    x: 0.6, y: 4.5, w: 12.1, h: 0.4,
    fontSize: 14, color: LIGHT, align: "center", fontFace: "Calibri"
  });
  s.addText("Chapter 8: Pulmonary Neoplasms", {
    x: 0.6, y: 6.4, w: 12.1, h: 0.4,
    fontSize: 13, color: GRAY, align: "center", fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 — OVERVIEW / OUTLINE
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, ACCENT);
  s.addText("OVERVIEW", { x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 26, bold: true, color: DARK, fontFace: "Calibri" });

  const topics = [
    { n: "01", title: "Epidemiology & Aetiology", sub: "Smoking, radon, asbestos, occupational factors" },
    { n: "02", title: "Pathological Classification", sub: "Squamous, adenocarcinoma, small cell, large cell" },
    { n: "03", title: "Screening & Early Detection", sub: "LDCT, NLST, Lung-RADS" },
    { n: "04", title: "Imaging Features", sub: "Peripheral & central tumours on CXR & CT" },
    { n: "05", title: "TNM Staging (8th Edition)", sub: "T, N, M descriptors" },
    { n: "06", title: "Intrathoracic Spread", sub: "Mediastinal, chest wall, pleural invasion" },
    { n: "07", title: "Extrathoracic Staging", sub: "Adrenals, brain, bone, liver, PET/CT" },
    { n: "08", title: "Imaging Protocols", sub: "CT, PET/CT, MRI roles" },
  ];

  const cols = 4;
  const bw = 2.9, bh = 1.35, gap = 0.25;
  const startX = 0.4, startY = 0.85;
  topics.forEach((t, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = startX + col * (bw + gap);
    const y = startY + row * (bh + gap);
    s.addShape(pres.ShapeType.rect, { x, y, w: bw, h: bh, fill: { color: WHITE }, line: { color: MID, pt: 1.2 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.5, h: bh, fill: { color: MID }, line: { color: MID } });
    s.addText(t.n, { x, y, w: 0.5, h: bh, fontSize: 14, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(t.title, { x: x + 0.55, y: y + 0.12, w: bw - 0.65, h: 0.45, fontSize: 12, bold: true, color: DARK, fontFace: "Calibri" });
    s.addText(t.sub, { x: x + 0.55, y: y + 0.58, w: bw - 0.65, h: 0.6, fontSize: 9.5, color: GRAY, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Overview");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 — EPIDEMIOLOGY & AETIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 4.2, h: 7.5, fill: { color: MID }, line: { color: MID } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: ACCENT }, line: { color: ACCENT } });

  s.addText("EPIDEMIOLOGY\n& AETIOLOGY", {
    x: 0.3, y: 1.5, w: 3.6, h: 2.0,
    fontSize: 26, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri"
  });
  s.addText("Grainger & Allison Ch. 8", {
    x: 0.3, y: 5.8, w: 3.6, h: 0.5,
    fontSize: 10, color: LIGHT, align: "center", italic: true, fontFace: "Calibri"
  });

  const points = [
    ["Smoking", "Major risk factor by a large margin; up to 60 identified carcinogens in tobacco smoke. Nicotine promotes tumour growth. Passive smoking increases lung cancer risk by 20-30%."],
    ["Adenocarcinoma Rise", "Prevalence of adenocarcinoma rising markedly; squamous & SCLC falling — linked to 'light' cigarettes with lower nicotine and perforated filters causing deeper inhalation."],
    ["Radon", "222Radon: second only to smoking as a cause of bronchogenic carcinoma. Geological variation determines exposure levels."],
    ["Asbestos", "Strong synergistic relationship with smoking; relative risk ~50x higher in smoking asbestos workers vs non-smoking, non-exposed individuals."],
    ["Other factors", "Air pollution (PM2.5), occupational exposures (nickel, chrome, arsenic, polycyclic hydrocarbons), prior lung disease (fibrosing alveolitis, TB)."],
  ];

  let y = 0.5;
  points.forEach(([title, text]) => {
    s.addShape(pres.ShapeType.rect, { x: 4.5, y, w: 0.12, h: 0.9, fill: { color: GOLD }, line: { color: GOLD } });
    s.addText(title, { x: 4.75, y: y, w: 8.2, h: 0.3, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(text, { x: 4.75, y: y + 0.3, w: 8.2, h: 0.65, fontSize: 10, color: LIGHT, fontFace: "Calibri", wrap: true });
    y += 1.1;
  });
  addFooter(s, "Epidemiology & Aetiology");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 — PATHOLOGICAL CLASSIFICATION
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, MID);
  s.addText("PATHOLOGICAL CLASSIFICATION", { x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 26, bold: true, color: DARK, fontFace: "Calibri" });

  const types = [
    { label: "Squamous Cell\nCarcinoma", pct: "~30%", color: "C0392B", details: ["Central origin (main/lobar bronchi)", "Cavitation most common in this type", "Pancoast tumours often squamous", "Declining with 'light' cigarettes"] },
    { label: "Adenocarcinoma", pct: "~40%", color: "1A5276", details: ["Peripheral origin; now most common", "Lepidic growth (ground-glass pattern)", "Strong EGFR/ALK mutation association", "Can mimic pneumonia on imaging"] },
    { label: "Small Cell\nLung Cancer", pct: "~15%", color: "117A65", details: ["Central, perihilar location", "Rapid growth; early metastasis", "Strongly smoking-related", "Limited vs extensive disease staging"] },
    { label: "Large Cell\nCarcinoma", pct: "~10%", color: "7D3C98", details: ["Peripheral, large bulky mass", "Diagnosis of exclusion", "No specific glandular/squamous features", "Poor prognosis"] },
  ];

  types.forEach((t, i) => {
    const x = 0.4 + i * 3.2;
    s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 3.0, h: 0.65, fill: { color: t.color }, line: { color: t.color } });
    s.addText(t.label, { x, y: 0.85, w: 3.0, h: 0.65, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x, y: 1.5, w: 3.0, h: 0.5, fill: { color: "F8F9FA" }, line: { color: t.color, pt: 1.5 } });
    s.addText(t.pct, { x, y: 1.5, w: 3.0, h: 0.5, fontSize: 22, bold: true, color: t.color, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x, y: 2.0, w: 3.0, h: 4.5, fill: { color: WHITE }, line: { color: t.color, pt: 1.2 } });
    t.details.forEach((d, j) => {
      s.addText([
        { text: "• ", options: { bold: true, color: t.color } },
        { text: d, options: { color: DARK } }
      ], { x: x + 0.1, y: 2.1 + j * 0.75, w: 2.8, h: 0.7, fontSize: 10.5, fontFace: "Calibri", wrap: true });
    });
  });

  // NSCLC vs SCLC banner
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 6.7, w: 12.5, h: 0.5, fill: { color: DARK }, line: { color: DARK } });
  s.addText("NSCLC (Squamous + Adenocarcinoma + Large Cell) = ~85%   |   SCLC = ~15%", {
    x: 0.4, y: 6.7, w: 12.5, h: 0.5, fontSize: 11.5, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri", bold: true
  });
  addFooter(s, "Pathological Classification");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 — LUNG CANCER SCREENING
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: GOLD }, line: { color: GOLD } });

  s.addText("LUNG CANCER SCREENING", {
    x: 0.4, y: 0.2, w: 12.5, h: 0.65, fontSize: 30, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.85, w: 12.5, h: 0.04, fill: { color: GOLD }, line: { color: GOLD } });

  // Left column: CXR screening
  s.addText("Chest X-Ray Screening", { x: 0.4, y: 1.0, w: 5.8, h: 0.4, fontSize: 15, bold: true, color: GOLD, fontFace: "Calibri" });
  const cxrPoints = [
    "PLCO trial (154,000 patients): no reduction in lung cancer mortality with CXR alone",
    "Mayo Lung Project RCT: stage shift in more frequent screeners but no overall survival benefit at 20 years",
    "Conclusion: CXR alone has no useful role in lung cancer screening"
  ];
  cxrPoints.forEach((p, i) => {
    s.addText("• " + p, { x: 0.4, y: 1.5 + i * 0.8, w: 5.8, h: 0.75, fontSize: 10.5, color: LIGHT, fontFace: "Calibri", wrap: true });
  });

  // Right column: CT screening
  s.addShape(pres.ShapeType.rect, { x: 6.6, y: 1.0, w: 6.5, h: 5.8, fill: { color: MID }, line: { color: MID } });
  s.addText("Low-Dose CT (LDCT) Screening", { x: 6.8, y: 1.05, w: 6.1, h: 0.45, fontSize: 15, bold: true, color: WHITE, fontFace: "Calibri" });
  const ctPoints = [
    "NLST (National Lung Screening Trial): 20% reduction in lung cancer mortality with annual LDCT vs CXR",
    "NELSON trial (Europe): 24-26% reduction in lung cancer mortality",
    "Eligibility: age 55-74, ≥30 pack-year history, current/former smoker",
    "ELCAP project: LDCT detects lung cancers at earlier (curable) stage",
    "Nodule management: Lung-RADS/Fleischner Society guidelines",
    "Volumetric CT with nodule volume doubling time assessment"
  ];
  ctPoints.forEach((p, i) => {
    s.addText("• " + p, { x: 6.8, y: 1.55 + i * 0.82, w: 6.0, h: 0.78, fontSize: 10, color: WHITE, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Lung Cancer Screening");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 — PERIPHERAL TUMOURS: IMAGING FEATURES
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, ACCENT);
  s.addText("PERIPHERAL TUMOURS — IMAGING FEATURES", {
    x: 0.4, y: 0.15, w: 9.0, h: 0.55, fontSize: 22, bold: true, color: DARK, fontFace: "Calibri"
  });
  s.addText("~40% of bronchial carcinomas", {
    x: 9.5, y: 0.2, w: 3.4, h: 0.45, fontSize: 12, color: ACCENT, bold: true, align: "right", fontFace: "Calibri"
  });

  // Image panel left
  if (img(0)) {
    s.addImage({ data: img(0), x: 0.3, y: 0.85, w: 4.5, h: 3.2 });
    s.addText("Fig 8.10 — Bronchial carcinoma left lower lobe: rounded, lobular configuration with posterior notch", {
      x: 0.3, y: 4.05, w: 4.5, h: 0.5, fontSize: 8.5, color: GRAY, italic: true, fontFace: "Calibri"
    });
  }
  if (img(1)) {
    s.addImage({ data: img(1), x: 0.3, y: 4.6, w: 4.5, h: 2.4 });
    s.addText("Fig 8.11 — Corona radiata sign: spiculated edges radiating into adjacent lung", {
      x: 0.3, y: 7.0, w: 4.5, h: 0.38, fontSize: 8.5, color: GRAY, italic: true, fontFace: "Calibri"
    });
  }

  const feats = [
    ["Shape & Margins", "Approximately spherical/oval; lobulation indicates uneven growth; corona radiata (fine spicules) highly suggestive of malignancy; smooth margins rare"],
    ["Cavitation", "Any size; squamous cell most common; wall thickness ≥8mm; irregular inner wall; fluid levels; best seen on CT"],
    ["Calcification", "6-10% on CT; engulfed granulomatous calcification; dystrophic amorphous calcification <10%"],
    ["Pleural Tail", "Peripheral line/tail from mass to pleura; represents atelectasis or lymphatic obstruction"],
    ["Ground-Glass", "Lepidic adenocarcinoma: air bronchogram ± ground-glass halo; mimics pneumonia"],
    ["Size / Growth", "Doubling time 20-400 days; malignancy likely if doubling in <400 days; size >3cm warrants urgent evaluation"],
  ];

  feats.forEach(([h, t], i) => {
    const y = 0.88 + i * 1.02;
    s.addShape(pres.ShapeType.rect, { x: 5.1, y, w: 7.8, h: 0.97, fill: { color: WHITE }, line: { color: LIGHT, pt: 0.8 } });
    s.addShape(pres.ShapeType.rect, { x: 5.1, y, w: 0.12, h: 0.97, fill: { color: ACCENT }, line: { color: ACCENT } });
    s.addText(h, { x: 5.28, y: y + 0.05, w: 7.5, h: 0.3, fontSize: 11.5, bold: true, color: DARK, fontFace: "Calibri" });
    s.addText(t, { x: 5.28, y: y + 0.36, w: 7.5, h: 0.55, fontSize: 9.5, color: GRAY, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Peripheral Tumours");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 — CENTRAL TUMOURS & COLLAPSE / CONSOLIDATION
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: GOLD }, line: { color: GOLD } });

  s.addText("CENTRAL TUMOURS", {
    x: 0.4, y: 0.2, w: 7.5, h: 0.65, fontSize: 30, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.85, w: 12.5, h: 0.04, fill: { color: GOLD }, line: { color: GOLD } });

  // 2-column layout
  const leftItems = [
    ["Definition", "Arising in main, lobar, or segmental bronchi at or close to the hilum"],
    ["CXR — Direct Signs", "Hilar mass; hilar enlargement; peribronchial tumour (thickening around bronchus)"],
    ["Bronchial Obstruction", "Lobar/segmental collapse (Golden S sign in RUL), obstructive consolidation, atelectasis"],
    ["Golden S Sign", "Right upper lobe collapse with central obstructing mass creating reversed S curve; pathognomonic for central obstructing tumour"],
    ["Air Trapping", "Air trapping distal to partial obstruction; expiratory CT for confirmation"],
  ];
  const rightItems = [
    ["Post-obstructive Changes", "Mucous plugging → bronchiectasis → obstructive pneumonitis; volume loss of affected lobe"],
    ["CT Bronchoscopy", "Multiplanar CT reconstructions map extent of endobronchial disease; virtual bronchoscopy"],
    ["Endobronchial Lesions", "Best assessed with CT (multiplanar reformat); squamous most common; direct mucosal involvement"],
    ["Hilar Vessels", "CT with contrast distinguishes hilar vascular structures from hilar lymphadenopathy or mass"],
    ["PET/CT Value", "FDG avidity differentiates post-obstructive consolidation from tumour extension"],
  ];

  leftItems.forEach(([h, t], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.0 + i * 1.2, w: 6.1, h: 1.12, fill: { color: MID }, line: { color: MID } });
    s.addText(h, { x: 0.55, y: 1.05 + i * 1.2, w: 5.8, h: 0.35, fontSize: 12, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(t, { x: 0.55, y: 1.4 + i * 1.2, w: 5.8, h: 0.65, fontSize: 10, color: WHITE, fontFace: "Calibri", wrap: true });
  });

  rightItems.forEach(([h, t], i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.8, y: 1.0 + i * 1.2, w: 6.1, h: 1.12, fill: { color: "0E3460" }, line: { color: "0E3460" } });
    s.addText(h, { x: 6.95, y: 1.05 + i * 1.2, w: 5.8, h: 0.35, fontSize: 12, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(t, { x: 6.95, y: 1.4 + i * 1.2, w: 5.8, h: 0.65, fontSize: 10, color: WHITE, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Central Tumours");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 — LUNG CANCER MIMICS & SPECIAL PATTERNS
// ─────────────────────────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, ACCENT);
  s.addText("SPECIAL PATTERNS & MIMICS", {
    x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 26, bold: true, color: DARK, fontFace: "Calibri"
  });

  if (img(2)) {
    s.addImage({ data: img(2), x: 0.3, y: 0.85, w: 6.0, h: 3.5 });
    s.addText("Fig 8.12 — (A) Squamous cell carcinoma resembling pneumonia in right upper zone. (B) Apical adenocarcinoma with ground-glass margins and air bronchogram.", {
      x: 0.3, y: 4.35, w: 6.0, h: 0.6, fontSize: 8.5, color: GRAY, italic: true, fontFace: "Calibri"
    });
  }

  const items = [
    ["Lung Cancer Mimicking Pneumonia", "Some adenocarcinomas present with consolidation and air bronchograms — indistinguishable from pneumonia on imaging. Key clue: no clinical response to antibiotics after 6 weeks → biopsy."],
    ["Pancoast / Superior Sulcus Tumour", "Apex tumour resembling apical pleural thickening. Associated with Horner syndrome, brachial plexus invasion. MRI superior for assessing chest wall and nerve involvement (T1/T2 triplanar)."],
    ["Cavitating Carcinoma", "Thick irregular cavity wall (>8mm) with tumour nodules. Squamous most common. Must differentiate from lung abscess (smooth thin wall, fever) and TB."],
    ["Solitary Pulmonary Nodule", "Malignancy probability based on size, morphology, growth rate. PET/CT: SUV >2.5 suggests malignancy. Fleischner/Lung-RADS guidelines guide management."],
  ];

  items.forEach(([h, t], i) => {
    const y = 0.88 + i * 1.6;
    s.addShape(pres.ShapeType.rect, { x: 6.6, y, w: 6.4, h: 1.5, fill: { color: WHITE }, line: { color: MID, pt: 1 } });
    s.addShape(pres.ShapeType.rect, { x: 6.6, y, w: 0.15, h: 1.5, fill: { color: ACCENT }, line: { color: ACCENT } });
    s.addText(h, { x: 6.85, y: y + 0.08, w: 6.0, h: 0.38, fontSize: 12, bold: true, color: DARK, fontFace: "Calibri" });
    s.addText(t, { x: 6.85, y: y + 0.45, w: 6.0, h: 1.0, fontSize: 9.5, color: GRAY, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Special Patterns & Mimics");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 — TNM STAGING 8th EDITION
// ─────────────────────────────────────────────────────────────────────────────
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  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: ACCENT }, line: { color: ACCENT } });

  s.addText("TNM STAGING — 8th EDITION (2016)", {
    x: 0.4, y: 0.15, w: 12.5, h: 0.65, fontSize: 28, bold: true, color: WHITE, fontFace: "Calibri"
  });

  // T descriptor
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.95, w: 3.9, h: 0.42, fill: { color: ACCENT }, line: { color: ACCENT } });
  s.addText("T — PRIMARY TUMOUR", { x: 0.4, y: 0.95, w: 3.9, h: 0.42, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
  const tItems = [
    ["T1a", "≤1 cm surrounded by lung"],
    ["T1b", ">1 to ≤2 cm"],
    ["T1c", ">2 to ≤3 cm"],
    ["T2a", ">3 to ≤4 cm or main bronchus/visceral pleura/atelectasis"],
    ["T2b", ">4 to ≤5 cm"],
    ["T3", ">5 to ≤7 cm or chest wall/pericardium/phrenic nerve"],
    ["T4", ">7 cm or mediastinum/heart/great vessels/carina/trachea"],
  ];
  tItems.forEach(([t, d], i) => {
    const y = 1.45 + i * 0.78;
    s.addShape(pres.ShapeType.rect, { x: 0.4, y, w: 0.7, h: 0.72, fill: { color: ACCENT }, line: { color: ACCENT } });
    s.addText(t, { x: 0.4, y, w: 0.7, h: 0.72, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: 1.1, y, w: 3.2, h: 0.72, fill: { color: MID }, line: { color: MID } });
    s.addText(d, { x: 1.15, y, w: 3.1, h: 0.72, fontSize: 9.5, color: WHITE, valign: "middle", fontFace: "Calibri", wrap: true });
  });

  // N descriptor
  s.addShape(pres.ShapeType.rect, { x: 4.6, y: 0.95, w: 3.9, h: 0.42, fill: { color: "117A65" }, line: { color: "117A65" } });
  s.addText("N — NODAL STATUS", { x: 4.6, y: 0.95, w: 3.9, h: 0.42, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
  const nItems = [
    ["N0", "No regional node metastasis"],
    ["N1", "Ipsilateral peribronchial/hilar nodes"],
    ["N2", "Ipsilateral mediastinal/subcarinal nodes"],
    ["N3", "Contralateral mediastinal/hilar or scalene/supraclavicular nodes"],
  ];
  nItems.forEach(([n, d], i) => {
    const y = 1.45 + i * 1.2;
    s.addShape(pres.ShapeType.rect, { x: 4.6, y, w: 0.7, h: 1.12, fill: { color: "117A65" }, line: { color: "117A65" } });
    s.addText(n, { x: 4.6, y, w: 0.7, h: 1.12, fontSize: 14, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: 5.3, y, w: 3.2, h: 1.12, fill: { color: "0E6655" }, line: { color: "0E6655" } });
    s.addText(d, { x: 5.35, y, w: 3.1, h: 1.12, fontSize: 10, color: WHITE, valign: "middle", fontFace: "Calibri", wrap: true });
  });

  // M descriptor
  s.addShape(pres.ShapeType.rect, { x: 8.8, y: 0.95, w: 4.2, h: 0.42, fill: { color: GOLD }, line: { color: GOLD } });
  s.addText("M — METASTASIS", { x: 8.8, y: 0.95, w: 4.2, h: 0.42, fontSize: 13, bold: true, color: DARK, align: "center", valign: "middle", fontFace: "Calibri" });
  const mItems = [
    ["M0", "No distant metastasis"],
    ["M1a", "Separate tumour nodule in contralateral lobe; pleural/pericardial nodules; malignant pleural/pericardial effusion"],
    ["M1b", "Single extrathoracic metastasis"],
    ["M1c", "Multiple extrathoracic metastases (≥1 organ)"],
  ];
  mItems.forEach(([m, d], i) => {
    const y = 1.45 + i * 1.2;
    s.addShape(pres.ShapeType.rect, { x: 8.8, y, w: 0.7, h: 1.12, fill: { color: "B7950B" }, line: { color: "B7950B" } });
    s.addText(m, { x: 8.8, y, w: 0.7, h: 1.12, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: 9.5, y, w: 3.5, h: 1.12, fill: { color: "7D6608" }, line: { color: "7D6608" } });
    s.addText(d, { x: 9.55, y, w: 3.4, h: 1.12, fontSize: 9.5, color: WHITE, valign: "middle", fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "TNM Staging 8th Edition");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 — INTRATHORACIC STAGING: MEDIASTINAL INVASION
// ─────────────────────────────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, MID);
  s.addText("INTRATHORACIC STAGING: MEDIASTINAL INVASION", {
    x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 22, bold: true, color: DARK, fontFace: "Calibri"
  });

  // images
  if (img(3)) {
    s.addImage({ data: img(3), x: 0.3, y: 0.85, w: 4.5, h: 3.0 });
    s.addText("Fig 8.20 — CT mediastinal windows: NSCLC invading right main bronchus, pulmonary artery, SVC (stented), and aorta.", {
      x: 0.3, y: 3.85, w: 4.5, h: 0.55, fontSize: 8.5, italic: true, color: GRAY, fontFace: "Calibri"
    });
  }
  if (img(4)) {
    s.addImage({ data: img(4), x: 0.3, y: 4.5, w: 4.5, h: 2.7 });
    s.addText("Fig 8.21 — MRI: LLL tumour directly invading aortic wall (altered signal).", {
      x: 0.3, y: 7.2, w: 4.5, h: 0.3, fontSize: 8.5, italic: true, color: GRAY, fontFace: "Calibri"
    });
  }

  const points = [
    ["CT Criteria for Mediastinal Invasion", "Obliteration of fat plane; >180° contact with aorta; compression/displacement of SVC; direct invasion of pericardium or great vessels (T4)"],
    ["CT Limitations", "Cannot definitively exclude mediastinal invasion when fat plane present; specificity ~50% for mediastinal invasion"],
    ["MRI Advantages", "Superior soft-tissue contrast; assesses aortic wall invasion (altered T1/T2 signal); dynamic cine for fixation; preferred for Pancoast tumours"],
    ["Pericardial Invasion", "T3 descriptor; pericardial effusion alone insufficient; direct extension shown by pericardial thickening/nodularity on CT"],
    ["Nodal Criteria (CT)", "Short axis >1 cm in mediastinal nodes = enlarged; however, enlarged does not always mean malignant (sensitivity 60-70%)"],
    ["PET/CT for Nodes", "Higher sensitivity than CT alone; however, histological confirmation still required before denying surgery"],
  ];

  points.forEach(([h, t], i) => {
    const y = 0.88 + i * 1.08;
    s.addShape(pres.ShapeType.rect, { x: 5.1, y, w: 8.0, h: 1.0, fill: { color: WHITE }, line: { color: LIGHT, pt: 0.8 } });
    s.addShape(pres.ShapeType.rect, { x: 5.1, y, w: 0.12, h: 1.0, fill: { color: MID }, line: { color: MID } });
    s.addText(h, { x: 5.28, y: y + 0.05, w: 7.7, h: 0.32, fontSize: 11.5, bold: true, color: DARK, fontFace: "Calibri" });
    s.addText(t, { x: 5.28, y: y + 0.37, w: 7.7, h: 0.58, fontSize: 9.5, color: GRAY, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Intrathoracic Staging: Mediastinal Invasion");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 — CHEST WALL & PLEURAL INVASION / PANCOAST
// ─────────────────────────────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: ACCENT }, line: { color: ACCENT } });

  s.addText("CHEST WALL & PLEURAL INVASION — PANCOAST TUMOUR", {
    x: 0.4, y: 0.2, w: 12.5, h: 0.6, fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.8, w: 12.5, h: 0.04, fill: { color: ACCENT }, line: { color: ACCENT } });

  // image: Pancoast
  if (img(5)) {
    s.addImage({ data: img(5), x: 0.4, y: 0.92, w: 5.5, h: 3.5 });
    s.addText("Fig 8.22 — Pancoast tumour: (A) axial T1, (B) coronal T2 MRI, (C) CT — chest wall and left 2nd rib involvement.", {
      x: 0.4, y: 4.45, w: 5.5, h: 0.55, fontSize: 8.5, italic: true, color: LIGHT, fontFace: "Calibri"
    });
  }
  // image: cavitation
  if (img(6)) {
    s.addImage({ data: img(6), x: 0.4, y: 5.1, w: 5.5, h: 2.2 });
    s.addText("Fig 8.23 — Cavitating carcinoma: preserved extrapleural fat plane — chest wall likely spared.", {
      x: 0.4, y: 7.3, w: 5.5, h: 0.2, fontSize: 8.5, italic: true, color: LIGHT, fontFace: "Calibri"
    });
  }

  const items = [
    ["Chest Wall Invasion — CT Signs", "Bone destruction or soft tissue mass = definitive. Contact/pleural thickening is equivocal. Obliteration of extrapleural fat plane increases suspicion."],
    ["MRI for Chest Wall", "More accurate than CT for chest wall invasion; T1/T2 triplanar with respiratory gating; dynamic cine sequences for fixation"],
    ["Pancoast Tumour (T3/T4)", "Superior sulcus tumour; clinically: shoulder pain, Horner syndrome (ptosis, miosis, anhidrosis), brachial plexus neuralgia; MRI mandatory"],
    ["Pleural Invasion (T2)", "Visceral pleural invasion = T2; parietal pleural/chest wall = T3. Malignant pleural effusion = M1a"],
    ["Clinical Rule", "Chest wall pain is the single most specific indicator of parietal pleural or chest wall invasion — more reliable than imaging alone"],
    ["Surgical Implications", "Chest wall invasion does not preclude surgery but requires en-bloc resection; increases morbidity/mortality; 5-year survival significantly reduced"],
  ];

  items.forEach(([h, t], i) => {
    const y = 0.92 + i * 1.08;
    s.addShape(pres.ShapeType.rect, { x: 6.2, y, w: 6.8, h: 1.0, fill: { color: MID }, line: { color: MID } });
    s.addText(h, { x: 6.35, y: y + 0.05, w: 6.5, h: 0.32, fontSize: 11.5, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(t, { x: 6.35, y: y + 0.38, w: 6.5, h: 0.57, fontSize: 9.5, color: WHITE, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Chest Wall, Pleural & Pancoast Tumour");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 — NODAL STAGING & PET/CT
// ─────────────────────────────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, ACCENT);
  s.addText("NODAL STAGING & ROLE OF PET/CT", {
    x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 26, bold: true, color: DARK, fontFace: "Calibri"
  });

  // nodal stations visual (text-based)
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.88, w: 5.8, h: 6.35, fill: { color: WHITE }, line: { color: MID, pt: 1.2 } });
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.88, w: 5.8, h: 0.42, fill: { color: MID }, line: { color: MID } });
  s.addText("NODAL STATION GROUPS", { x: 0.4, y: 0.88, w: 5.8, h: 0.42, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });

  const stations = [
    ["N1 Nodes (ipsilateral)", "• 10: Hilar\n• 11: Interlobar\n• 12: Lobar\n• 13: Segmental\n• 14: Subsegmental"],
    ["N2 Nodes (ipsilateral mediastinal)", "• 1: Highest mediastinal\n• 2: Upper paratracheal\n• 3: Pre/retrovascular\n• 4: Lower paratracheal\n• 5: Subaortic (AP window)\n• 6: Para-aortic\n• 7: Subcarinal\n• 8: Para-oesophageal\n• 9: Pulmonary ligament"],
    ["N3 Nodes (contralateral)", "• Contralateral mediastinal\n• Contralateral hilar\n• Scalene / supraclavicular"],
  ];
  let y2 = 1.4;
  stations.forEach(([h, t]) => {
    s.addText(h, { x: 0.55, y: y2, w: 5.5, h: 0.38, fontSize: 11.5, bold: true, color: MID, fontFace: "Calibri" });
    s.addShape(pres.ShapeType.rect, { x: 0.55, y: y2 + 0.38, w: 0.04, h: 0.04 }); // spacer
    s.addText(t, { x: 0.55, y: y2 + 0.4, w: 5.5, h: 1.4, fontSize: 9.5, color: DARK, fontFace: "Calibri", wrap: true });
    y2 += 2.0;
  });

  const petItems = [
    ["CT Criteria for Nodal Involvement", "Short axis >1 cm in mediastinal nodes; poor specificity — enlarged nodes may be reactive; normal-sized nodes may harbour micrometastases"],
    ["PET/CT Advantages", "FDG uptake identifies metabolically active nodal disease; detects occult mediastinal disease not visible on CT; SUV threshold varies"],
    ["PET/CT — Key Stats", "Detects occult metastatic disease in 11-14% of patients planned for curative resection; alters management in up to 40%"],
    ["Endoscopic Staging", "EBUS-TBNA / EUS-FNA: tissue sampling of mediastinal nodes; gold standard when imaging equivocal"],
    ["Mediastinoscopy", "Required to confirm nodal involvement before denying surgery; PET positivity alone insufficient for excluding resection"],
    ["No Enlarged Nodes + Normal PET", "Likelihood of nodal involvement so low that mediastinoscopy can be omitted for peripheral tumours"],
  ];

  petItems.forEach(([h, t], i) => {
    const y = 0.88 + i * 1.07;
    s.addShape(pres.ShapeType.rect, { x: 6.5, y, w: 6.5, h: 1.0, fill: { color: WHITE }, line: { color: LIGHT, pt: 0.8 } });
    s.addShape(pres.ShapeType.rect, { x: 6.5, y, w: 0.12, h: 1.0, fill: { color: ACCENT }, line: { color: ACCENT } });
    s.addText(h, { x: 6.7, y: y + 0.05, w: 6.2, h: 0.32, fontSize: 11.5, bold: true, color: DARK, fontFace: "Calibri" });
    s.addText(t, { x: 6.7, y: y + 0.37, w: 6.2, h: 0.58, fontSize: 9.5, color: GRAY, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Nodal Staging & PET/CT");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13 — EXTRATHORACIC STAGING & IMAGING PROTOCOLS
// ─────────────────────────────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK }, line: { color: DARK } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: GOLD }, line: { color: GOLD } });

  s.addText("EXTRATHORACIC STAGING & IMAGING PROTOCOLS", {
    x: 0.4, y: 0.2, w: 12.5, h: 0.6, fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.82, w: 12.5, h: 0.04, fill: { color: GOLD }, line: { color: GOLD } });

  // Left: metastatic sites
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 0.92, w: 5.8, h: 0.42, fill: { color: ACCENT }, line: { color: ACCENT } });
  s.addText("COMMON METASTATIC SITES", { x: 0.4, y: 0.92, w: 5.8, h: 0.42, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
  const metSites = [
    ["Adrenal Glands", "Most common; included in standard chest CT (extend to upper abdomen with portal venous phase)"],
    ["Brain", "Especially SCLC and adenocarcinoma; MRI brain superior to CT for detection; prophylactic cranial irradiation in SCLC"],
    ["Bones", "Bone scan or PET/CT; lytic or mixed lesions; vertebral metastases may cause cord compression"],
    ["Liver", "Included in extended chest CT; PET/CT sensitive for hepatic FDG-avid metastases"],
    ["Distant Nodes", "Supraclavicular, retroperitoneal, iliac; FDG-PET most sensitive"],
  ];
  metSites.forEach(([h, t], i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.4 + i * 1.18, w: 5.8, h: 1.1, fill: { color: MID }, line: { color: MID } });
    s.addText(h, { x: 0.55, y: 1.45 + i * 1.18, w: 5.5, h: 0.32, fontSize: 11.5, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(t, { x: 0.55, y: 1.77 + i * 1.18, w: 5.5, h: 0.65, fontSize: 9.5, color: WHITE, fontFace: "Calibri", wrap: true });
  });

  // Right: imaging protocols
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0.92, w: 6.5, h: 0.42, fill: { color: GOLD }, line: { color: GOLD } });
  s.addText("IMAGING MODALITY ROLES", { x: 6.5, y: 0.92, w: 6.5, h: 0.42, fontSize: 13, bold: true, color: DARK, align: "center", valign: "middle", fontFace: "Calibri" });
  const protocols = [
    ["CT Chest + Abdomen", "Primary modality; 1-3mm collimation multidetector CT; isotropic voxels for MPR; extended to liver and adrenals; portal venous phase"],
    ["PET/CT (FDG)", "Skull base to upper thigh; 5-7 bed positions; ~35 min; detects occult disease altering management in 40%; now routine before radical therapy in Europe"],
    ["MRI Thorax", "Problem-solving: Pancoast, aortic invasion, diaphragm integrity; DWI differentiates tumour vs collapse; dynamic cine for fixation"],
    ["MRI Brain", "Mandatory for SCLC; recommended for stage III/IV NSCLC; gadolinium-enhanced; superior to CT for small metastases"],
    ["Bone Scan", "Symptomatic patients; superseded by PET/CT where available; MRI for vertebral metastasis assessment"],
  ];
  protocols.forEach(([h, t], i) => {
    s.addShape(pres.ShapeType.rect, { x: 6.5, y: 1.4 + i * 1.18, w: 6.5, h: 1.1, fill: { color: "0E3460" }, line: { color: "0E3460" } });
    s.addText(h, { x: 6.65, y: 1.45 + i * 1.18, w: 6.2, h: 0.32, fontSize: 11.5, bold: true, color: GOLD, fontFace: "Calibri" });
    s.addText(t, { x: 6.65, y: 1.77 + i * 1.18, w: 6.2, h: 0.65, fontSize: 9.5, color: WHITE, fontFace: "Calibri", wrap: true });
  });
  addFooter(s, "Extrathoracic Staging & Imaging Protocols");
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 14 — SMALL CELL LUNG CANCER (SCLC)
// ─────────────────────────────────────────────────────────────────────────────
{
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: OFFWHITE }, line: { color: OFFWHITE } });
  addDivider(s, "117A65");
  s.addText("SMALL CELL LUNG CANCER (SCLC)", {
    x: 0.4, y: 0.15, w: 12.5, h: 0.55, fontSize: 26, bold: true, color: DARK, fontFace: "Calibri"
  });

  const sclcData = [
    { heading: "Epidemiology", color: "117A65", items: ["~15% of all lung cancers", "Almost exclusively smoking-related", "More common in men; rising in women"] },
    { heading: "Imaging Features", color: "1A5276", items: ["Central/perihilar bulky mediastinal mass", "Rapid growth with early hilar/mediastinal adenopathy", "Peripheral primary rare (<5%)", "Superior vena cava obstruction common"] },
    { heading: "Staging (Veterans System)", color: "7D3C98", items: ["Limited Disease: confined to one hemithorax ± ipsilateral nodes; can be encompassed in radiation field", "Extensive Disease: beyond hemithorax, distant metastases, malignant effusion"] },
    { heading: "Imaging Protocol", color: "C0392B", items: ["CT chest/abdomen/pelvis for staging", "MRI brain: mandatory in all patients", "PET/CT increasing use", "Bone marrow biopsy where clinically indicated"] },
    { heading: "Biomarkers", color: "B7950B", items: ["Biomarker testing NOT required (unlike NSCLC)", "No druggable mutations targeted by oral kinase inhibitors", "Response to chemo-radiation usually rapid"] },
    { heading: "Key Clinical Points", color: "5D6D7E", items: ["Rapid progression; median survival without treatment ~3 months", "Chemotherapy mainstay; prophylactic cranial irradiation (limited disease)", "Re-biopsy at progression becoming standard"] },
  ];

  const cols2 = 3;
  sclcData.forEach((d, i) => {
    const col = i % cols2;
    const row = Math.floor(i / cols2);
    const x = 0.4 + col * 4.3;
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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 15 — SUMMARY & KEY TAKE-HOMES
// ─────────────────────────────────────────────────────────────────────────────
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    "Corona radiata on CT is highly suggestive of bronchogenic carcinoma; smooth spherical nodules are rare",
    "Squamous cell carcinoma is most likely to cavitate; adenocarcinoma most likely to mimic pneumonia",
    "TNM 8th edition: T descriptors in 1 cm increments up to 5 cm; measurement = solid component",
    "CT has poor specificity (~50%) for mediastinal invasion; MRI is preferred for Pancoast and aortic involvement",
    "Enlarged nodes on CT do NOT confirm malignancy; biopsy (EBUS/mediastinoscopy) required before denying surgery",
    "PET/CT detects occult metastatic disease in 11-14%; alters management in up to 40% of patients",
    "Normal CT nodes + normal PET: mediastinoscopy can be omitted for peripheral NSCLC",
    "LDCT screening (NLST): 20% mortality reduction; NELSON trial: 24-26% — now recommended in high-risk smokers",
    "SCLC staging: Limited vs Extensive; MRI brain mandatory in ALL SCLC patients",
    "Chest wall pain is the single most specific clinical indicator of parietal pleural/chest wall invasion",
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