Is it normal – Orris AI

Is it normal

I'll read the PDF file first to understand what you're asking about.

Reading File

Running Command

python3 -c " import pdfplumber with pdfplumber.open('/home/daytona/workspace/attachments/a0f79364-d0c8-4a25-a03b-5d7c19184704/Whatsapp Scan 8 July 2026 at 17.26.09.pdf') as pdf: print(f'Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() print(f'--- Page {i+1} ---') print(text) "

The PDF appears to be a scanned image (no extractable text). Let me analyze it visually.

Running Command

python3 -c " from pypdf import PdfReader import base64 reader = PdfReader('/home/daytona/workspace/attachments/a0f79364-d0c8-4a25-a03b-5d7c19184704/Whatsapp Scan 8 July 2026 at 17.26.09.pdf') print(f'Pages: {len(reader.pages)}') # Convert pages to images import subprocess result = subprocess.run(['pdftoppm', '-r', '150', '-png', '/home/daytona/workspace/attachments/a0f79364-d0c8-4a25-a03b-5d7c19184704/Whatsapp Scan 8 July 2026 at 17.26.09.pdf', '/home/daytona/workspace/attachments/scan_page'], capture_output=True, text=True) print('stdout:', result.stdout) print('stderr:', result.stderr) print('returncode:', result.returncode) import os files = os.listdir('/home/daytona/workspace/attachments/') print('Files:', files) "

Running Command

cd /home/daytona/workspace/attachments && python3 -c " import base64 with open('scan_page-1.png', 'rb') as f: data = base64.b64encode(f.read()).decode() print(f'Page 1 size: {len(data)} chars') with open('scan_page-2.png', 'rb') as f: data = base64.b64encode(f.read()).decode() print(f'Page 2 size: {len(data)} chars') "

Running Command

cd /home/daytona/workspace/attachments && python3 -c " # Serve the image via a simple HTTP approach - copy to a web-accessible location import shutil shutil.copy('scan_page-1.png', '/home/daytona/workspace/scan_page-1.png') shutil.copy('scan_page-2.png', '/home/daytona/workspace/scan_page-2.png') print('Copied') "

Reading File

Page 2 is the signature/end page. I can see this is a lab report from AIG Hospitals for a 48-year-old male. Page 1 (the actual results) is too large to render directly. Let me use OCR to extract the content.

Running Command

python3 -c " import pytesseract from PIL import Image img = Image.open('/home/daytona/workspace/attachments/scan_page-1.png') text = pytesseract.image_to_string(img) print(text) " 2>&1 | head -200

Now I have the full report. This is a serious histopathology result. Let me look up relevant medical information to give a thorough, accurate response.

Reading File

Finding Sources

Reading File

Finding Sources

I now have enough information to give a thorough, accurate, and compassionate response. Let me put this all together.

I have read the report carefully. This is a histopathology (biopsy) report from AIG Hospitals, Banjara Hills, for Mr. D. Ravinder, 48 years old, Male.

What the Report Says

The biopsy was taken via EUS-guided Fine Needle Biopsy (FNB) from a mass in the tail of the pancreas (3.4 x 3.1 x 3.5 cm). The pathologist examined the tissue under the microscope and found:

Dysplastic ductal epithelial cells arranged in a glandular pattern
Nuclear atypia (abnormal-looking cell nuclei)
Focal stromal invasion (cancer cells breaking into surrounding tissue)
Tumor tissue makes up ~30% of the sample

Impression: Positive for malignancy. Diagnosis: Ductal adenocarcinoma of the pancreas (PDAC)

Is This "Normal"? No - This Is a Serious Diagnosis

No, this is not normal. This is a confirmed cancer diagnosis - pancreatic ductal adenocarcinoma (PDAC), which is the most common type of pancreatic cancer. The report also notes a very elevated CA 19-9 of 2430 U/mL (normal is below ~37 U/mL), which strongly correlates with pancreatic cancer presence and is approximately 65x above the upper limit of normal.

Key Points to Understand

1. What is Ductal Adenocarcinoma? It is a malignant (cancerous) tumor arising from the ductal cells of the pancreas. Per the Current Surgical Therapy textbook: PDAC is projected to become the second leading cause of cancer deaths by 2030. It is known for being aggressive.

2. Location Matters (Tail of Pancreas - This is Actually Relatively Better) Tumors in the tail of the pancreas are often treated with a surgery called distal pancreatectomy (removal of the tail +/- spleen). The CT report notes the mass is encasing the distal splenic artery, but the radiology report described it as a possible inflammatory mass - the biopsy has now confirmed it is cancer, overriding that CT impression.

3. The IHC (Immunohistochemistry) Recommendation The pathologist has suggested additional staining with IMP3, Maspin, and S-100P - these are markers used to confirm adenocarcinoma and rule out other tumor types, and to better characterize the cancer. This is standard practice and important before treatment decisions are made.

4. Background Conditions Mr. Ravinder has EHPVO (Extra-hepatic Portal Vein Obstruction) and Chronic Pancreatitis - both of which complicate this further, as chronic pancreatitis is actually a known risk factor for developing pancreatic adenocarcinoma.

What Needs to Happen Next - Urgently

The treating oncology team at AIG should be consulted immediately. The typical next steps would include:

Complete the IHC panel (IMP3, Maspin, S-100P) as recommended
Staging workup - CT chest/abdomen/pelvis with contrast to determine if cancer has spread (liver, lung, lymph nodes)
Multidisciplinary Team (MDT) meeting - involving surgical oncology, medical oncology, and radiology
Surgical assessment - determine if the tumor is resectable (operable). Tail-of-pancreas tumors that have not spread distantly may be candidates for distal pancreatectomy
Oncology consultation - for chemotherapy planning (FOLFIRINOX or Gemcitabine + nab-Paclitaxel are standard regimens)

A Word of Caution

This is genuinely serious news, and the family/patient deserves to receive and process this with the full support of the treating medical team at AIG. The diagnosis was made by experienced pathologists (Dr. Ruchi Nagpal and Dr. Anuradha Sekaran, Chief Pathologist). The next steps should be discussed directly and urgently with Dr. Palle Manohar Reddy (the referring doctor) and a pancreatic oncology specialist.

If you have any specific questions about the report - what a particular finding means, what to ask the doctor, or what to expect - please ask and I will do my best to help you understand.

What are the typical treatment options for pancreatic cancer?

Treatment depends heavily on the stage. Surgery (if resectable) offers the only potential cure, while chemotherapy, radiation, and targeted therapy are used for advanced cases. For a tail-of-pancreas tumor like this one, distal pancreatectomy is the key surgical option if the cancer hasn't spread.

Searching sources...

Finding Sources

Searching PubMed

"pancreatic ductal adenocarcinoma"[MeSH Terms] AND "treatment"[MeSH Terms]

Finding Sources

Searching PubMed

"pancreatic cancer"[MeSH Terms] AND "chemotherapy"[MeSH Terms]

Reading File

Finding Sources

I now have comprehensive information from the textbooks to give a thorough answer. Here is a full breakdown:

Treatment Options for Pancreatic Ductal Adenocarcinoma (PDAC)

Treatment is organized around a single critical question: is the tumor resectable (surgically removable)? Everything flows from the answer to that.

1. Staging First - The Framework for All Decisions

Before any treatment, staging determines which path the patient takes:

Category	Definition	Proportion of Patients
Resectable	No major vessel involvement; can be surgically removed	~15-20%
Borderline Resectable	Tumor contacts (but doesn't surround) major vessels	~15-20%
Locally Advanced	Tumor wraps around major vessels (>180° of SMA, celiac artery, or aorta); no distant spread	~30-35%
Metastatic	Spread to liver, lungs, peritoneum	~50-55%

For Mr. Ravinder's case: the CT showed the mass encasing the distal splenic artery - this needs surgical review to determine if it's borderline or resectable, since for tail tumors, the splenic artery is routinely removed with the specimen (distal pancreatectomy), so this may still be operable.

2. Surgery - The Only Curative Option

Surgery is the only treatment that can cure pancreatic cancer. The 5-year survival with surgery drops to below 10% overall, but for screen-detected or early resected cases, it can reach 20-60%.

For tail of pancreas (like this case): Distal Pancreatectomy

Removal of the body and tail of the pancreas
Usually includes the spleen (splenectomy), though spleen-preserving surgery is possible in selected cases
Less complex than the Whipple procedure (used for head-of-pancreas tumors)
The splenic artery involvement in this case does not necessarily preclude surgery - it is often resected as part of the standard operation

For head of pancreas: Whipple Procedure (Pancreaticoduodenectomy)

Removal of the pancreatic head, duodenum, bile duct, and sometimes part of the stomach
Major operation with ~35% complication rate even at specialized centers

Neoadjuvant therapy (chemo before surgery) is now increasingly preferred over surgery first, because:

It treats presumed microscopic spread early
It identifies tumors with aggressive biology that wouldn't benefit from surgery
CA 19-9 response to neoadjuvant chemo is a strong prognostic marker
~70% of patients who start neoadjuvant therapy complete it and proceed to surgery

Adjuvant therapy (chemo after surgery) is recommended for all patients who undergo resection regardless of stage, because over 75% develop recurrence within 1 year after surgery alone. - Sabiston Textbook of Surgery

3. Chemotherapy Regimens

First-Line Options (NCCN-recommended, performance status dependent)

FOLFIRINOX (5-FU + Leucovorin + Irinotecan + Oxaliplatin)

The most active regimen for fit patients (ECOG 0-1)
Metastatic disease: median OS 11.1 months vs 6.8 months with gemcitabine alone (HR 0.57)
Response rate: 31.6% vs 9.4% for gemcitabine
More side effects: febrile neutropenia in ~5%, nausea, fatigue, neuropathy
Best studied in body/tail tumors (56% of trial patients had body/tail tumors)
Also used in adjuvant setting post-surgery (PRODIGE-24 trial: historic median OS of 54 months with modified FOLFIRINOX after surgery)

Gemcitabine + nab-Paclitaxel (Abraxane)

Good alternative, especially for patients who can't tolerate FOLFIRINOX
Improved OS vs gemcitabine alone
Easier to administer, better tolerated

Gemcitabine alone

For patients with poorer performance status
FDA-approved; remains a standard option

Second-Line Options (after first-line failure)

Nanoliposomal irinotecan (nal-IRI) + 5-FU + folinic acid - approved by FDA for gemcitabine-refractory disease (NAPOLI trial)
FOLFIRINOX (if gemcitabine was used first-line)
Gemcitabine-based combos (if FOLFIRINOX was used first-line)

4. Radiation Therapy

Used mainly in locally advanced disease, often combined with chemotherapy (chemoradiation)
Radiation alone is insufficient - local failure rates >70% with radiation alone
Chemoradiation (CRT) improves survival vs radiation alone (HR 0.69)
SBRT (Stereotactic Body Radiation Therapy) is a newer, more precise form used at specialized centers
Not routinely used after resection in current practice

5. Targeted Therapy & Immunotherapy

These apply to specific molecular subtypes - which is why germline testing and molecular profiling is now recommended for all locally advanced and metastatic PDAC:

Mutation/Marker	Drug	Notes
BRCA1/2 mutation	Olaparib (PARP inhibitor)	Maintenance therapy after platinum-based chemo
NTRK gene fusion	Larotrectinib or Entrectinib	Rare, ~1% of PDAC
MSI-High / dMMR	Pembrolizumab (immunotherapy)	Rare in PDAC (~1-2%), but responds well
KRAS G12C	Sotorasib / Adagrasib	Emerging trials

Since Mr. Ravinder's IHC (IMP3, Maspin, S-100P) is pending, and molecular/germline testing has not been mentioned yet, these tests should be requested as part of the workup.

6. Palliative & Supportive Care

When cure is not possible, managing quality of life is the primary goal:

Biliary stenting (ERCP or EUS-guided) for jaundice from bile duct obstruction
Celiac plexus block for severe pancreatic pain - can dramatically reduce opiate requirements
Pancreatic enzyme replacement for exocrine insufficiency and malnutrition
Anticoagulation - pancreatic cancer has very high risk of blood clots (DVT/PE)
Nutritional support - cachexia is common and affects treatment tolerance
Palliative chemotherapy to extend survival and reduce symptoms

Summary for This Case (Tail of Pancreas, 3.5 cm, Splenic Artery Involvement)

The immediate priority is a formal staging CT (chest + abdomen + pelvis with contrast) and a multidisciplinary team (MDT) review at a pancreatic cancer center to determine:

Is it resectable (most important question)?
What is the best sequence - neoadjuvant chemo first, then surgery, or direct surgery?
Is germline/molecular testing warranted (BRCA, MSI status)?

The background of EHPVO and chronic pancreatitis will complicate surgical planning and will need specific expert input.

Sources: Current Surgical Therapy 14e; Yamada's Textbook of Gastroenterology 7e; Sabiston Textbook of Surgery; Fischer's Mastery of Surgery 8e

Create a summary guide of pancreatic cancer treatment options

Let me clarify the format before I start creating this.

Asking for Preferences

What format would you like the summary guide in? · Who is the intended audience?

Reading File

Running Command

mkdir -p /home/daytona/workspace/pancreatic-cancer-guide && ls /home/daytona/workspace/pancreatic-cancer-guide/

Writing File

~/pancreatic-cancer-guide/generate_guide.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, PageTemplate, Frame
from reportlab.pdfgen import canvas

OUTPUT = "/home/daytona/workspace/pancreatic-cancer-guide/Pancreatic_Cancer_Treatment_Guide.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
TEAL        = colors.HexColor("#006D77")
TEAL_LIGHT  = colors.HexColor("#E8F5F5")
ORANGE      = colors.HexColor("#E29148")
ORANGE_LIGHT= colors.HexColor("#FDF3E7")
GREY_DARK   = colors.HexColor("#2D3142")
GREY_MID    = colors.HexColor("#4F5D75")
GREY_LIGHT  = colors.HexColor("#F4F6F8")
GREY_RULE   = colors.HexColor("#D0D9E0")
WHITE       = colors.white
GREEN       = colors.HexColor("#2A9D8F")
GREEN_LIGHT = colors.HexColor("#E6F5F3")
PURPLE      = colors.HexColor("#6C4C9E")
PURPLE_LIGHT= colors.HexColor("#F2EDF9")
RED_SOFT    = colors.HexColor("#C0392B")

PAGE_W, PAGE_H = A4
MARGIN = 18 * mm

# ── Header / Footer canvas callback ─────────────────────────────────────────
def on_page(c: canvas.Canvas, doc):
    c.saveState()
    # header bar
    c.setFillColor(TEAL)
    c.rect(0, PAGE_H - 14*mm, PAGE_W, 14*mm, fill=1, stroke=0)
    c.setFillColor(WHITE)
    c.setFont("Helvetica-Bold", 9)
    c.drawString(MARGIN, PAGE_H - 9*mm, "PANCREATIC CANCER  |  TREATMENT GUIDE FOR PATIENTS & FAMILIES")
    # footer
    c.setFillColor(GREY_MID)
    c.setFont("Helvetica", 7.5)
    c.drawString(MARGIN, 8*mm, "This guide is for informational purposes only. Always follow your doctor's advice.")
    c.drawRightString(PAGE_W - MARGIN, 8*mm, f"Page {doc.page}")
    c.restoreState()

# ── Document setup ───────────────────────────────────────────────────────────
doc = BaseDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=MARGIN, rightMargin=MARGIN,
    topMargin=20*mm, bottomMargin=18*mm,
)
frame = Frame(MARGIN, 18*mm, PAGE_W - 2*MARGIN, PAGE_H - 38*mm, id="main")
template = PageTemplate(id="main", frames=[frame], onPage=on_page)
doc.addPageTemplates([template])

# ── Styles ───────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def S(name, parent="Normal", **kw):
    s = ParagraphStyle(name, parent=base[parent], **kw)
    return s

style_title = S("Title2", fontName="Helvetica-Bold", fontSize=22, textColor=TEAL,
                leading=28, spaceAfter=4)
style_subtitle = S("Sub", fontName="Helvetica", fontSize=11, textColor=GREY_MID,
                   leading=15, spaceAfter=12)
style_section = S("Section", fontName="Helvetica-Bold", fontSize=13, textColor=WHITE,
                  leading=17, spaceBefore=14, spaceAfter=4)
style_body = S("Body2", fontName="Helvetica", fontSize=9.5, textColor=GREY_DARK,
               leading=14, spaceAfter=5, alignment=TA_JUSTIFY)
style_body_small = S("BodySm", fontName="Helvetica", fontSize=8.5, textColor=GREY_DARK,
                     leading=13, spaceAfter=4, alignment=TA_JUSTIFY)
style_bullet = S("Bullet2", fontName="Helvetica", fontSize=9.5, textColor=GREY_DARK,
                 leading=14, spaceAfter=3, leftIndent=10, firstLineIndent=-10)
style_label = S("Label", fontName="Helvetica-Bold", fontSize=9, textColor=TEAL, leading=13)
style_note = S("Note", fontName="Helvetica-Oblique", fontSize=8, textColor=GREY_MID,
               leading=12, spaceAfter=6)
style_callout_title = S("CTitle", fontName="Helvetica-Bold", fontSize=10, textColor=TEAL,
                        leading=14, spaceAfter=2)
style_callout_body = S("CBody", fontName="Helvetica", fontSize=9, textColor=GREY_DARK,
                       leading=13, spaceAfter=3)
style_orange_title = S("OTitle", fontName="Helvetica-Bold", fontSize=10, textColor=ORANGE,
                       leading=14, spaceAfter=2)
style_toc_item = S("TOC", fontName="Helvetica", fontSize=9.5, textColor=TEAL,
                   leading=15, spaceAfter=1)

# ── Helpers ──────────────────────────────────────────────────────────────────
def section_header(text, color=TEAL):
    """Coloured section header bar."""
    data = [[Paragraph(text, style_section)]]
    t = Table(data, colWidths=[PAGE_W - 2*MARGIN])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0, 0), (-1, -1), color),
        ("LEFTPADDING",  (0, 0), (-1, -1), 8),
        ("RIGHTPADDING", (0, 0), (-1, -1), 8),
        ("TOPPADDING",   (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def info_box(title, body_paras, bg=TEAL_LIGHT, title_color=TEAL):
    """Rounded info box."""
    content = [Paragraph(title, S("IBT", fontName="Helvetica-Bold", fontSize=10,
                                  textColor=title_color, leading=14))]
    for p in body_paras:
        content.append(Paragraph(p, style_callout_body))
    data = [[content]]
    t = Table(data, colWidths=[PAGE_W - 2*MARGIN])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0, 0), (-1, -1), bg),
        ("LEFTPADDING",  (0, 0), (-1, -1), 10),
        ("RIGHTPADDING", (0, 0), (-1, -1), 10),
        ("TOPPADDING",   (0, 0), (-1, -1), 8),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 8),
        ("BOX", (0, 0), (-1, -1), 0.5, title_color),
    ]))
    return t

def two_col(left_items, right_items, left_bg=TEAL_LIGHT, right_bg=ORANGE_LIGHT,
            left_title="", right_title="", col_w=None):
    if col_w is None:
        col_w = (PAGE_W - 2*MARGIN - 4*mm) / 2

    def make_cell(title, items, title_color):
        parts = []
        if title:
            parts.append(Paragraph(title, S("CT2", fontName="Helvetica-Bold", fontSize=9.5,
                                             textColor=title_color, leading=13, spaceAfter=3)))
        for item in items:
            parts.append(Paragraph(f"<bullet>\u2022</bullet> {item}", style_bullet))
        return parts

    data = [[make_cell(left_title, left_items, TEAL),
             make_cell(right_title, right_items, ORANGE)]]
    t = Table(data, colWidths=[col_w, col_w])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0, 0), (0, -1), left_bg),
        ("BACKGROUND", (1, 0), (1, -1), right_bg),
        ("LEFTPADDING",  (0, 0), (-1, -1), 8),
        ("RIGHTPADDING", (0, 0), (-1, -1), 8),
        ("TOPPADDING",   (0, 0), (-1, -1), 8),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 8),
        ("VALIGN", (0, 0), (-1, -1), "TOP"),
        ("BOX", (0, 0), (0, -1), 0.4, TEAL),
        ("BOX", (1, 0), (1, -1), 0.4, ORANGE),
        ("LINEAFTER", (0, 0), (0, -1), 1.5, WHITE),
    ]))
    return t

def bullet(text, color=TEAL):
    return Paragraph(f'<font color="{color.hexval()}">&#x25CF;</font>  {text}', style_bullet)

# ═══════════════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ═══════════════════════════════════════════════════════════════════════════
story = []

# ── COVER block ─────────────────────────────────────────────────────────────
story.append(Spacer(1, 6*mm))
story.append(Paragraph("Understanding Your Diagnosis", style_subtitle))
story.append(Paragraph("Pancreatic Cancer", style_title))
story.append(Paragraph("A Guide to Treatment Options for Patients &amp; Families",
                        S("ST2", fontName="Helvetica", fontSize=12, textColor=GREY_MID,
                          leading=16, spaceAfter=6)))
story.append(HRFlowable(width="100%", thickness=2, color=TEAL, spaceAfter=10))
story.append(Paragraph(
    "This guide explains, in plain language, the treatment options available for pancreatic "
    "cancer. Every patient's situation is different - this guide is meant to help you ask the "
    "right questions and understand what your doctors are discussing with you.",
    S("Intro", fontName="Helvetica", fontSize=10, textColor=GREY_DARK, leading=15,
      spaceAfter=6, alignment=TA_JUSTIFY)))
story.append(Spacer(1, 4*mm))

# ── Quick facts strip ────────────────────────────────────────────────────────
facts_data = [
    [Paragraph("<b>Most common type</b>", style_body_small),
     Paragraph("<b>Only cure</b>", style_body_small),
     Paragraph("<b>Key first step</b>", style_body_small)],
    [Paragraph("Ductal Adenocarcinoma\n(~90% of cases)", style_body_small),
     Paragraph("Surgery, when\nthe tumour can be removed", style_body_small),
     Paragraph("Staging scan (CT/MRI)\nto plan treatment", style_body_small)],
]
facts_w = (PAGE_W - 2*MARGIN) / 3
facts_t = Table(facts_data, colWidths=[facts_w]*3)
facts_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), TEAL),
    ("BACKGROUND", (0, 1), (-1, 1), TEAL_LIGHT),
    ("TEXTCOLOR",  (0, 0), (-1, 0), WHITE),
    ("TEXTCOLOR",  (0, 1), (-1, 1), GREY_DARK),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, -1), 9),
    ("ALIGN",      (0, 0), (-1, -1), "CENTER"),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("TOPPADDING", (0, 0), (-1, -1), 6),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 6),
    ("GRID",       (0, 0), (-1, -1), 0.4, WHITE),
]))
story.append(facts_t)
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 1 – WHAT IS PANCREATIC CANCER?
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("1.  What is Pancreatic Cancer?"))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "The pancreas is a gland behind the stomach that makes digestive juices and hormones "
    "(including insulin). Cancer starts when abnormal cells grow out of control inside it. "
    "The most common type - <b>ductal adenocarcinoma (PDAC)</b> - grows from the cells that "
    "line the small tubes (ducts) inside the pancreas.",
    style_body))
story.append(Paragraph(
    "The pancreas has three parts: the <b>head</b> (right side), <b>body</b> (middle), and "
    "<b>tail</b> (left side near the spleen). Where the tumour sits affects which operation "
    "is possible.",
    style_body))
story.append(Spacer(1, 4*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 2 – STAGING
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("2.  How is the Cancer Staged?", color=GREEN))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Staging means finding out how far the cancer has spread. This is the single most "
    "important step because it determines every treatment decision. A <b>CT scan</b> of the "
    "chest, abdomen and pelvis (with contrast dye) is the standard staging test.",
    style_body))
story.append(Spacer(1, 3*mm))

stage_data = [
    [Paragraph("<b>Stage</b>", style_body_small),
     Paragraph("<b>What it means</b>", style_body_small),
     Paragraph("<b>Proportion</b>", style_body_small)],
    [Paragraph("Resectable", S("G", fontName="Helvetica-Bold", fontSize=9, textColor=GREEN, leading=13)),
     Paragraph("Tumour has not grown into major blood vessels. Surgery is possible.", style_body_small),
     Paragraph("~15-20%", style_body_small)],
    [Paragraph("Borderline\nResectable", S("O", fontName="Helvetica-Bold", fontSize=9, textColor=ORANGE, leading=13)),
     Paragraph("Tumour touches (but does not fully surround) major vessels. "
               "Chemotherapy first, then surgery may become possible.", style_body_small),
     Paragraph("~15-20%", style_body_small)],
    [Paragraph("Locally\nAdvanced", S("R", fontName="Helvetica-Bold", fontSize=9, textColor=RED_SOFT, leading=13)),
     Paragraph("Tumour wraps around major vessels but has NOT spread to other organs. "
               "Surgery is usually not possible straight away.", style_body_small),
     Paragraph("~30-35%", style_body_small)],
    [Paragraph("Metastatic", S("Rd", fontName="Helvetica-Bold", fontSize=9, textColor=RED_SOFT, leading=13)),
     Paragraph("Cancer has spread to the liver, lungs, or lining of the abdomen.", style_body_small),
     Paragraph("~50-55%", style_body_small)],
]
col_ws = [32*mm, PAGE_W - 2*MARGIN - 32*mm - 20*mm, 20*mm]
stage_t = Table(stage_data, colWidths=col_ws)
stage_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), TEAL),
    ("TEXTCOLOR",  (0, 0), (-1, 0), WHITE),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, -1), 9),
    ("ROWBACKGROUNDS", (0, 1), (-1, -1), [WHITE, GREY_LIGHT]),
    ("TOPPADDING", (0, 0), (-1, -1), 5),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
    ("LEFTPADDING", (0, 0), (-1, -1), 7),
    ("RIGHTPADDING",(0, 0), (-1, -1), 7),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("GRID",       (0, 0), (-1, -1), 0.3, GREY_RULE),
    ("BOX",        (0, 0), (-1, -1), 0.5, TEAL),
]))
story.append(stage_t)
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 3 – SURGERY
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("3.  Surgery - The Only Potential Cure"))
story.append(Spacer(1, 3*mm))
story.append(info_box(
    "Why Surgery Matters",
    ["Surgery is the only treatment that can permanently remove the cancer and offer a chance "
     "of cure. For patients whose tumour is fully removed, 5-year survival is 20-60% depending "
     "on whether it was caught early. Without surgery it is less than 10%."],
    bg=TEAL_LIGHT, title_color=TEAL))
story.append(Spacer(1, 4*mm))

ops_data = [
    [Paragraph("<b>Operation</b>", style_body_small),
     Paragraph("<b>Used for</b>", style_body_small),
     Paragraph("<b>What is removed</b>", style_body_small)],
    [Paragraph("Distal\nPancreatectomy", S("Op", fontName="Helvetica-Bold", fontSize=9, textColor=TEAL, leading=13)),
     Paragraph("Body or tail of pancreas", style_body_small),
     Paragraph("Tail (and usually body) of pancreas + spleen", style_body_small)],
    [Paragraph("Whipple\nProcedure\n(Pancreaticoduodenectomy)", S("Op", fontName="Helvetica-Bold", fontSize=9, textColor=TEAL, leading=13)),
     Paragraph("Head of pancreas", style_body_small),
     Paragraph("Pancreatic head, duodenum (first part of small bowel), part of bile duct, "
               "sometimes part of stomach", style_body_small)],
    [Paragraph("Total\nPancreatectomy", S("Op", fontName="Helvetica-Bold", fontSize=9, textColor=TEAL, leading=13)),
     Paragraph("Tumour involving entire pancreas", style_body_small),
     Paragraph("Entire pancreas + spleen + duodenum. Patient will need insulin injections "
               "for life.", style_body_small)],
]
ops_t = Table(ops_data, colWidths=[35*mm, 35*mm, PAGE_W - 2*MARGIN - 70*mm])
ops_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), TEAL),
    ("TEXTCOLOR",  (0, 0), (-1, 0), WHITE),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, -1), 9),
    ("ROWBACKGROUNDS", (0, 1), (-1, -1), [WHITE, GREY_LIGHT]),
    ("TOPPADDING", (0, 0), (-1, -1), 5),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
    ("LEFTPADDING", (0, 0), (-1, -1), 7),
    ("RIGHTPADDING",(0, 0), (-1, -1), 7),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("GRID",       (0, 0), (-1, -1), 0.3, GREY_RULE),
    ("BOX",        (0, 0), (-1, -1), 0.5, TEAL),
]))
story.append(ops_t)
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "<b>Neoadjuvant therapy</b> (chemotherapy given <i>before</i> surgery) is now often "
    "recommended first - it shrinks the tumour, treats any microscopic spread early, and "
    "helps doctors confirm the cancer is responding before a major operation.",
    style_body))
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 4 – CHEMOTHERAPY
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("4.  Chemotherapy", color=PURPLE))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Chemotherapy uses medicines to kill cancer cells or stop them dividing. It is used "
    "before surgery (neoadjuvant), after surgery (adjuvant), or as the main treatment when "
    "surgery is not possible.",
    style_body))
story.append(Spacer(1, 4*mm))

# Chemo regimens table
chemo_data = [
    [Paragraph("<b>Regimen</b>", style_body_small),
     Paragraph("<b>Drugs included</b>", style_body_small),
     Paragraph("<b>When used</b>", style_body_small),
     Paragraph("<b>Key fact</b>", style_body_small)],
    [Paragraph("FOLFIRINOX\n(or mFOLFIRINOX)", S("CR", fontName="Helvetica-Bold", fontSize=9, textColor=PURPLE, leading=13)),
     Paragraph("5-FU, Leucovorin,\nIrinotecan, Oxaliplatin", style_body_small),
     Paragraph("Fit patients\n(good health,\nECOG 0-1)", style_body_small),
     Paragraph("Most active regimen. Median survival 11 months in advanced disease; "
               "up to 54 months after surgery (PRODIGE-24 trial).", style_body_small)],
    [Paragraph("Gemcitabine +\nnab-Paclitaxel\n(Abraxane)", S("CR", fontName="Helvetica-Bold", fontSize=9, textColor=PURPLE, leading=13)),
     Paragraph("Gemcitabine\n+ nab-Paclitaxel", style_body_small),
     Paragraph("Fit patients;\nalternative to\nFOLFIRINOX", style_body_small),
     Paragraph("Easier to tolerate than FOLFIRINOX. Good option for older patients or "
               "those with certain health conditions.", style_body_small)],
    [Paragraph("Gemcitabine\nalone", S("CR", fontName="Helvetica-Bold", fontSize=9, textColor=PURPLE, leading=13)),
     Paragraph("Gemcitabine", style_body_small),
     Paragraph("Patients with\nweaker health\n(ECOG 2+)", style_body_small),
     Paragraph("First chemotherapy drug approved specifically for pancreatic cancer. "
               "Less side effects but also less potent.", style_body_small)],
    [Paragraph("2nd-line:\nnal-IRI +\n5-FU/Leucovorin", S("CR", fontName="Helvetica-Bold", fontSize=9, textColor=PURPLE, leading=13)),
     Paragraph("Nanoliposomal\nIrinotecan + 5-FU", style_body_small),
     Paragraph("After\ngemcitabine\nhas stopped working", style_body_small),
     Paragraph("FDA-approved second-line option (NAPOLI trial). Improves survival vs "
               "5-FU alone when gemcitabine fails.", style_body_small)],
]
chemo_t = Table(chemo_data, colWidths=[30*mm, 30*mm, 28*mm, PAGE_W - 2*MARGIN - 88*mm])
chemo_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), PURPLE),
    ("TEXTCOLOR",  (0, 0), (-1, 0), WHITE),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, -1), 8.5),
    ("ROWBACKGROUNDS", (0, 1), (-1, -1), [WHITE, PURPLE_LIGHT]),
    ("TOPPADDING", (0, 0), (-1, -1), 5),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
    ("LEFTPADDING", (0, 0), (-1, -1), 6),
    ("RIGHTPADDING",(0, 0), (-1, -1), 6),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("GRID",       (0, 0), (-1, -1), 0.3, GREY_RULE),
    ("BOX",        (0, 0), (-1, -1), 0.5, PURPLE),
]))
story.append(chemo_t)
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "<b>Common side effects of chemotherapy:</b> Tiredness, nausea, hair thinning, low "
    "blood counts (risk of infection), tingling in hands/feet (neuropathy). Your team will "
    "give you medicines to manage these.",
    style_note))
story.append(Spacer(1, 6*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 5 – RADIATION
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("5.  Radiation Therapy", color=ORANGE))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Radiation uses high-energy X-rays to destroy cancer cells. It is <b>not used alone</b> "
    "in pancreatic cancer (local failure rates exceed 70% with radiation alone). It is always "
    "combined with chemotherapy - called <b>chemoradiation (CRT)</b>.",
    style_body))
story.append(Spacer(1, 3*mm))
story.append(two_col(
    left_items=[
        "Combined with chemotherapy (chemoradiation)",
        "Locally advanced cancer that cannot be surgically removed",
        "Sometimes used before surgery to shrink borderline-resectable tumours",
        "Can reduce local recurrence after surgery in some cases",
    ],
    right_items=[
        "<b>SBRT</b> (Stereotactic Body Radiation Therapy) - newer, very precise, fewer sessions",
        "<b>IMRT</b> (Intensity Modulated RT) - standard external beam, shaped to tumour",
        "<b>Proton therapy</b> - available at specialist centres; spares surrounding tissue",
    ],
    left_title="When radiation is used",
    right_title="Types of radiation",
))
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 6 – TARGETED & IMMUNOTHERAPY
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("6.  Targeted Therapy &amp; Immunotherapy"))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Unlike chemotherapy (which affects all fast-dividing cells), targeted therapies attack "
    "specific features of the cancer cell. These only work if the tumour has the specific "
    "genetic change - which is why <b>molecular testing of the biopsy</b> is now recommended "
    "for all patients with locally advanced or metastatic disease.",
    style_body))
story.append(Spacer(1, 4*mm))

target_data = [
    [Paragraph("<b>Genetic change</b>", style_body_small),
     Paragraph("<b>How common</b>", style_body_small),
     Paragraph("<b>Drug(s) available</b>", style_body_small),
     Paragraph("<b>Plain explanation</b>", style_body_small)],
    [Paragraph("BRCA1 or BRCA2\nmutation", style_body_small),
     Paragraph("~5-7%\nof PDAC", style_body_small),
     Paragraph("Olaparib\n(PARP inhibitor)", style_body_small),
     Paragraph("Inherited gene change (can run in families). Olaparib is a maintenance "
               "pill taken after platinum-based chemotherapy responds.", style_body_small)],
    [Paragraph("MSI-High /\ndMMR", style_body_small),
     Paragraph("~1-2%\nof PDAC", style_body_small),
     Paragraph("Pembrolizumab\n(immunotherapy)", style_body_small),
     Paragraph("The tumour has a faulty DNA repair system. Immunotherapy (which "
               "boosts the body's own defences) works very well in these cases.", style_body_small)],
    [Paragraph("NTRK gene\nfusion", style_body_small),
     Paragraph("Very rare\n(~1%)", style_body_small),
     Paragraph("Larotrectinib\nor Entrectinib", style_body_small),
     Paragraph("A specific chromosomal rearrangement that these targeted pills can block. "
               "Works regardless of where the cancer originated.", style_body_small)],
    [Paragraph("KRAS G12C\nmutation", style_body_small),
     Paragraph("~1-2%\nof PDAC", style_body_small),
     Paragraph("Sotorasib,\nAdagrasib\n(clinical trials)", style_body_small),
     Paragraph("A newly targetable form of the most common mutation in pancreatic cancer. "
               "Drugs are available in trials.", style_body_small)],
]
target_t = Table(target_data, colWidths=[32*mm, 20*mm, 30*mm, PAGE_W - 2*MARGIN - 82*mm])
target_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, 0), TEAL),
    ("TEXTCOLOR",  (0, 0), (-1, 0), WHITE),
    ("FONTNAME",   (0, 0), (-1, 0), "Helvetica-Bold"),
    ("FONTSIZE",   (0, 0), (-1, -1), 8.5),
    ("ROWBACKGROUNDS", (0, 1), (-1, -1), [WHITE, TEAL_LIGHT]),
    ("TOPPADDING", (0, 0), (-1, -1), 5),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 5),
    ("LEFTPADDING", (0, 0), (-1, -1), 6),
    ("RIGHTPADDING",(0, 0), (-1, -1), 6),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("GRID",       (0, 0), (-1, -1), 0.3, GREY_RULE),
    ("BOX",        (0, 0), (-1, -1), 0.5, TEAL),
]))
story.append(target_t)
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "<i>Ask your doctor: \"Has my tumour been tested for BRCA, MSI status, and NTRK "
    "fusions?\" This testing is now a standard recommendation.</i>",
    style_note))
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 7 – SUPPORTIVE / PALLIATIVE CARE
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("7.  Supportive &amp; Palliative Care", color=GREEN))
story.append(Spacer(1, 3*mm))
story.append(Paragraph(
    "Supportive care does NOT mean giving up - it means actively managing the symptoms and "
    "side effects of cancer and its treatment. It can be given alongside curative treatment "
    "and improves both quality of life and, in many studies, survival.",
    style_body))
story.append(Spacer(1, 4*mm))

supp_left = [
    "<b>Pain:</b> Celiac plexus nerve block is a procedure that can dramatically reduce "
    "severe pancreatic pain and reduce the need for strong painkillers",
    "<b>Jaundice:</b> A small metal tube (stent) placed in the bile duct by endoscopy (ERCP) "
    "relieves blockage and yellowing",
    "<b>Nutrition:</b> Pancreatic enzyme tablets taken with meals replace digestive enzymes "
    "the damaged pancreas can no longer make",
]
supp_right = [
    "<b>Blood clots:</b> Pancreatic cancer increases clot risk significantly. Blood-thinning "
    "injections (low-molecular-weight heparin) are often prescribed",
    "<b>Blood sugar:</b> If the pancreas is damaged or removed, insulin may be needed to "
    "control blood sugar (diabetes)",
    "<b>Emotional support:</b> Counselling, support groups, and palliative care teams help "
    "patients and families cope",
]
story.append(two_col(
    left_items=supp_left,
    right_items=supp_right,
    left_title="Physical symptom management",
    right_title="Other important support",
    left_bg=GREEN_LIGHT, right_bg=ORANGE_LIGHT,
))
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 8 – TREATMENT OVERVIEW FLOWCHART (text-based)
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("8.  Treatment Decision Overview", color=GREY_DARK))
story.append(Spacer(1, 4*mm))

flow_data = [
    [Paragraph("<b>STAGING SCANS (CT Chest + Abdomen + Pelvis)</b>",
               S("FH", fontName="Helvetica-Bold", fontSize=9.5, textColor=WHITE,
                 leading=13, alignment=TA_CENTER))],
]
flow_t = Table(flow_data, colWidths=[PAGE_W - 2*MARGIN])
flow_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, -1), TEAL),
    ("TOPPADDING", (0, 0), (-1, -1), 7),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 7),
    ("LEFTPADDING", (0, 0), (-1, -1), 10),
]))
story.append(flow_t)

arrow_row = [
    Paragraph("&#x2193;", S("AR", fontName="Helvetica-Bold", fontSize=18, textColor=TEAL,
                             alignment=TA_CENTER)),
    Paragraph("&#x2193;", S("AR", fontName="Helvetica-Bold", fontSize=18, textColor=ORANGE,
                             alignment=TA_CENTER)),
    Paragraph("&#x2193;", S("AR", fontName="Helvetica-Bold", fontSize=18, textColor=RED_SOFT,
                             alignment=TA_CENTER)),
    Paragraph("&#x2193;", S("AR", fontName="Helvetica-Bold", fontSize=18, textColor=RED_SOFT,
                             alignment=TA_CENTER)),
]
arrow_t = Table([arrow_row], colWidths=[(PAGE_W - 2*MARGIN)/4]*4)
arrow_t.setStyle(TableStyle([("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2)]))
story.append(arrow_t)

box_colors = [GREEN, ORANGE, colors.HexColor("#E67E22"), RED_SOFT]
box_titles = ["Resectable", "Borderline\nResectable", "Locally\nAdvanced", "Metastatic"]
box_texts  = [
    "Direct surgery\nOR\nNeoadjuvant chemo\n+ then surgery\n+\nAdjuvant chemo after",
    "Chemotherapy first\n(FOLFIRINOX or Gem/nab-P)\nRe-stage after 4-6 cycles\n-\nSurgery if possible",
    "Chemotherapy\n+/- Radiation therapy\n(Chemoradiation)\nRe-assess for surgery",
    "Chemotherapy to\ncontrol cancer &\nimprove quality of life\n+\nFull supportive care",
]
boxes_data = [[
    Paragraph(f"<b>{t}</b>", S(f"BT{i}", fontName="Helvetica-Bold", fontSize=9,
                                textColor=WHITE, leading=12, alignment=TA_CENTER))
    for i, t in enumerate(box_titles)
],[
    Paragraph(txt, S(f"BB{i}", fontName="Helvetica", fontSize=8.5,
                     textColor=GREY_DARK, leading=13, alignment=TA_CENTER))
    for i, txt in enumerate(box_texts)
]]
box_t = Table(boxes_data, colWidths=[(PAGE_W - 2*MARGIN)/4]*4)
box_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (0, 0), GREEN),
    ("BACKGROUND", (1, 0), (1, 0), ORANGE),
    ("BACKGROUND", (2, 0), (2, 0), colors.HexColor("#E67E22")),
    ("BACKGROUND", (3, 0), (3, 0), RED_SOFT),
    ("BACKGROUND", (0, 1), (0, 1), GREEN_LIGHT),
    ("BACKGROUND", (1, 1), (1, 1), ORANGE_LIGHT),
    ("BACKGROUND", (2, 1), (2, 1), colors.HexColor("#FDEBD0")),
    ("BACKGROUND", (3, 1), (3, 1), colors.HexColor("#FADBD8")),
    ("TOPPADDING", (0, 0), (-1, -1), 6),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 6),
    ("LEFTPADDING", (0, 0), (-1, -1), 5),
    ("RIGHTPADDING",(0, 0), (-1, -1), 5),
    ("VALIGN",     (0, 0), (-1, -1), "MIDDLE"),
    ("GRID",       (0, 0), (-1, -1), 1, WHITE),
]))
story.append(box_t)
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 9 – QUESTIONS TO ASK YOUR DOCTOR
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("9.  Questions to Ask Your Doctor"))
story.append(Spacer(1, 3*mm))

questions = [
    "What is the exact stage of my cancer, and which organs or blood vessels are involved?",
    "Has my tumour been tested for BRCA, MSI status, NTRK fusions, and KRAS mutations?",
    "Is surgery possible for me, either now or after chemotherapy?",
    "What chemotherapy regimen do you recommend, and why?",
    "Are there any clinical trials I might be eligible for?",
    "What supportive care services (dietitian, pain specialist, counsellor) are available?",
    "What are the signs that the treatment is working? How will we check (scans, CA 19-9)?",
    "If surgery is done, what is the recovery time, and what changes to daily life should I expect?",
]

q_items = []
for i, q in enumerate(questions, 1):
    q_items.append(Paragraph(
        f'<font color="{TEAL.hexval()}"><b>{i}.</b></font>  {q}',
        S(f"QA{i}", fontName="Helvetica", fontSize=9.5, textColor=GREY_DARK,
          leading=14, spaceAfter=5, leftIndent=12, firstLineIndent=-12)
    ))

q_data = [[q_items]]
q_t = Table(q_data, colWidths=[PAGE_W - 2*MARGIN])
q_t.setStyle(TableStyle([
    ("BACKGROUND", (0, 0), (-1, -1), TEAL_LIGHT),
    ("LEFTPADDING", (0, 0), (-1, -1), 12),
    ("RIGHTPADDING",(0, 0), (-1, -1), 12),
    ("TOPPADDING",  (0, 0), (-1, -1), 10),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 10),
    ("BOX",         (0, 0), (-1, -1), 0.5, TEAL),
]))
story.append(q_t)
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# SECTION 10 – KEY TERMS GLOSSARY
# ─────────────────────────────────────────────────────────────────────────────
story.append(section_header("10.  Key Terms Glossary", color=GREY_MID))
story.append(Spacer(1, 3*mm))

glossary = [
    ("Adenocarcinoma", "Cancer that starts in gland-forming cells. The most common type of pancreatic cancer."),
    ("Adjuvant therapy", "Treatment (usually chemotherapy) given after surgery to reduce the chance of the cancer coming back."),
    ("Biopsy / FNB", "A small sample of tissue taken from the tumour using a needle to confirm the diagnosis under a microscope."),
    ("CA 19-9", "A protein released by some cancer cells. A blood test that measures it is used to track how well treatment is working."),
    ("Chemoradiation", "Chemotherapy and radiation given together at the same time, which makes each treatment more effective."),
    ("ECOG Performance Status", "A scale (0-5) that measures how well a patient can carry out daily activities. Guides which chemotherapy is safe to use."),
    ("FOLFIRINOX", "A combination of four chemotherapy drugs. The most powerful regimen for fit patients with pancreatic cancer."),
    ("MDT (Multidisciplinary Team)", "A team of specialists - surgeons, oncologists, radiologists, pathologists - who review each patient together before decisions are made."),
    ("Metastasis", "When cancer spreads from the original tumour to other organs, most commonly the liver or lungs."),
    ("Neoadjuvant therapy", "Treatment given before surgery to shrink the tumour."),
    ("PARP inhibitor", "A targeted drug (like Olaparib) that works in cancers with BRCA gene changes."),
    ("Resectable", "A tumour that surgeons can completely remove with an operation."),
]

gloss_data = [[
    Paragraph(f"<b>{term}</b>", S("GT", fontName="Helvetica-Bold", fontSize=8.5,
                                   textColor=TEAL, leading=13)),
    Paragraph(defn, S("GD", fontName="Helvetica", fontSize=8.5, textColor=GREY_DARK,
                       leading=13)),
] for term, defn in glossary]

g_t = Table(gloss_data, colWidths=[42*mm, PAGE_W - 2*MARGIN - 42*mm])
g_t.setStyle(TableStyle([
    ("ROWBACKGROUNDS", (0, 0), (-1, -1), [WHITE, GREY_LIGHT]),
    ("TOPPADDING",  (0, 0), (-1, -1), 4),
    ("BOTTOMPADDING",(0, 0), (-1, -1), 4),
    ("LEFTPADDING", (0, 0), (-1, -1), 7),
    ("RIGHTPADDING",(0, 0), (-1, -1), 7),
    ("VALIGN",      (0, 0), (-1, -1), "TOP"),
    ("GRID",        (0, 0), (-1, -1), 0.3, GREY_RULE),
    ("BOX",         (0, 0), (-1, -1), 0.5, GREY_MID),
]))
story.append(g_t)
story.append(Spacer(1, 8*mm))

# ─────────────────────────────────────────────────────────────────────────────
# DISCLAIMER
# ─────────────────────────────────────────────────────────────────────────────
story.append(HRFlowable(width="100%", thickness=1, color=GREY_RULE, spaceAfter=4))
story.append(Paragraph(
    "<b>Important notice:</b> This guide is for educational purposes only and does not "
    "replace professional medical advice. Treatment decisions must always be made by your "
    "medical team based on your individual situation. Sources: <i>Current Surgical Therapy "
    "14e, Yamada's Textbook of Gastroenterology 7e, Sabiston Textbook of Surgery, "
    "Fischer's Mastery of Surgery 8e.</i>",
    S("Disc", fontName="Helvetica-Oblique", fontSize=7.5, textColor=GREY_MID,
      leading=11, alignment=TA_JUSTIFY)))

# ─── BUILD ───────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")

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