import json, base64
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.enum.shapes import MSO_SHAPE
from pptx.oxml.ns import qn

# ---------- Colors ----------
NAVY = RGBColor(0x1B, 0x2A, 0x4A)
TEAL = RGBColor(0x0E, 0x76, 0x7A)
ACCENT = RGBColor(0xC2, 0x38, 0x5A)   # magenta/pink accent (gyn-onc theme)
LIGHT = RGBColor(0xF4, 0xF6, 0xF8)
GRAY = RGBColor(0x5A, 0x63, 0x6E)
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
DARK = RGBColor(0x22, 0x22, 0x22)

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]

SW, SH = prs.slide_width, prs.slide_height

def add_slide():
    return prs.slides.add_slide(BLANK)

def bg(slide, color=WHITE):
    slide.background.fill.solid()
    slide.background.fill.fore_color.rgb = color

def rect(slide, x, y, w, h, color, line=False):
    shp = slide.shapes.add_shape(MSO_SHAPE.RECTANGLE, x, y, w, h)
    shp.fill.solid()
    shp.fill.fore_color.rgb = color
    if line:
        shp.line.color.rgb = color
    else:
        shp.line.fill.background()
    shp.shadow.inherit = False
    return shp

def textbox(slide, x, y, w, h, text, size=18, color=DARK, bold=False, italic=False,
            align=PP_ALIGN.LEFT, font="Calibri", anchor=None, line_spacing=None):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    if anchor:
        tf.vertical_anchor = anchor
    tf.margin_left = 0; tf.margin_right = 0; tf.margin_top = 0; tf.margin_bottom = 0
    lines = text.split("\n")
    for i, line in enumerate(lines):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.text = line
        p.alignment = align
        if line_spacing:
            p.line_spacing = line_spacing
        r = p.runs[0] if p.runs else p.add_run()
        r.font.size = Pt(size)
        r.font.bold = bold
        r.font.italic = italic
        r.font.name = font
        r.font.color.rgb = color
    return tb

def bullet_block(slide, x, y, w, h, items, size=15, color=DARK, bullet_color=None,
                  space_after=8, bold_first=False, font="Calibri"):
    """items: list of (text, level, bold) or plain strings"""
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = 0; tf.margin_right = 0; tf.margin_top = 0; tf.margin_bottom = 0
    bullet_color = bullet_color or ACCENT
    first = True
    for item in items:
        if isinstance(item, tuple):
            text, level, bold = (item + (False,))[:3] if len(item) == 2 else item
        else:
            text, level, bold = item, 0, False
        p = tf.paragraphs[0] if first else tf.add_paragraph()
        first = False
        p.level = level
        p.space_after = Pt(space_after)
        marker = "‣ " if level == 0 else "–  "
        r = p.add_run()
        r.text = (marker + text) if level <= 1 else text
        r.font.size = Pt(size - (2 if level > 0 else 0))
        r.font.bold = bold
        r.font.name = font
        r.font.color.rgb = color if level > 0 else DARK
    return tb

def header(slide, kicker, title, num, total=15):
    rect(slide, 0, 0, SW, Inches(1.15), NAVY)
    rect(slide, 0, Inches(1.15), SW, Pt(3), ACCENT)
    textbox(slide, Inches(0.55), Inches(0.14), Inches(9), Inches(0.35), kicker.upper(),
            size=13, color=RGBColor(0x9F, 0xC9, 0xCB), bold=True)
    textbox(slide, Inches(0.55), Inches(0.42), Inches(11.5), Inches(0.65), title,
            size=27, color=WHITE, bold=True)
    textbox(slide, Inches(12.55), Inches(7.12), Inches(0.6), Inches(0.3), f"{num}",
            size=11, color=GRAY, align=PP_ALIGN.RIGHT)
    textbox(slide, Inches(0.55), Inches(7.12), Inches(6), Inches(0.3),
            "Cervical Carcinoma: Complications & Treatment Guidelines", size=9, color=GRAY)

def footer_note(slide, text):
    textbox(slide, Inches(0.55), Inches(6.85), Inches(12.2), Inches(0.35), text,
            size=10.5, color=GRAY, italic=True)

def card(slide, x, y, w, h, title, body_items, title_color=TEAL, size=13.5):
    rect(slide, x, y, w, h, LIGHT)
    rect(slide, x, y, Inches(0.08), h, title_color)
    textbox(slide, x + Inches(0.25), y + Inches(0.12), w - Inches(0.4), Inches(0.4),
            title, size=15.5, color=title_color, bold=True)
    bullet_block(slide, x + Inches(0.25), y + Inches(0.58), w - Inches(0.45), h - Inches(0.7),
                 body_items, size=size, bullet_color=DARK, space_after=4)

# =========================================================
# SLIDE 1 - TITLE
# =========================================================
s = add_slide()
bg(s, NAVY)
rect(s, 0, Inches(5.7), SW, Inches(1.8), TEAL)
rect(s, 0, Inches(5.62), SW, Pt(3), ACCENT)
textbox(s, Inches(0.9), Inches(2.1), Inches(11.5), Inches(0.5), "GYNECOLOGIC ONCOLOGY",
        size=16, color=RGBColor(0x9F, 0xC9, 0xCB), bold=True)
textbox(s, Inches(0.9), Inches(2.6), Inches(11.5), Inches(1.6), "Cervical Carcinoma",
        size=54, color=WHITE, bold=True)
textbox(s, Inches(0.9), Inches(3.75), Inches(11.5), Inches(1.0),
        "Complications and Current Treatment Guidelines", size=26, color=RGBColor(0xE8,0xE8,0xE8))
textbox(s, Inches(0.9), Inches(5.95), Inches(11), Inches(0.5),
        "NCCN v2.2026  |  FIGO 2018 Staging  |  ESGO / ESMO / SEOM 2023-2025  |  KEYNOTE-A18 / KEYNOTE-826",
        size=15, color=WHITE, bold=True)
textbox(s, Inches(0.9), Inches(6.45), Inches(11), Inches(0.4),
        "A clinical overview for education and practice reference", size=13, color=RGBColor(0xD8,0xE8,0xE8), italic=True)

# =========================================================
# SLIDE 2 - AGENDA
# =========================================================
s = add_slide(); bg(s)
header(s, "Overview", "Agenda", 2)
agenda = [
    ("01", "Disease Overview & Risk Factors", "Epidemiology, HPV etiology, screening context"),
    ("02", "FIGO 2018 Staging", "How stage drives treatment selection"),
    ("03", "Complications of Disease", "Local invasion, obstruction, hemorrhage, metastasis"),
    ("04", "Complications of Treatment", "Surgical and radiotherapy/chemotherapy morbidity"),
    ("05", "Treatment by Stage", "Latest NCCN / ESGO / ESMO / FIGO guideline recommendations"),
    ("06", "Advanced / Recurrent Disease", "Chemo-immunotherapy: pembrolizumab, bevacizumab, ADCs"),
    ("07", "Follow-up & Key Takeaways", "Surveillance schedules and summary"),
]
y = Inches(1.55)
for num, title, sub in agenda:
    rect(s, Inches(0.55), y, Inches(0.75), Inches(0.72), TEAL)
    textbox(s, Inches(0.55), y, Inches(0.75), Inches(0.72), num, size=20, color=WHITE, bold=True,
            align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    textbox(s, Inches(1.5), y + Inches(0.02), Inches(5.3), Inches(0.35), title, size=16.5, color=NAVY, bold=True)
    textbox(s, Inches(1.5), y + Inches(0.38), Inches(10.8), Inches(0.32), sub, size=12.5, color=GRAY)
    y += Inches(0.79)

# =========================================================
# SLIDE 3 - OVERVIEW & RISK FACTORS
# =========================================================
s = add_slide(); bg(s)
header(s, "Background", "Disease Overview & Risk Factors", 3)
card(s, Inches(0.55), Inches(1.55), Inches(6.0), Inches(5.1), "Epidemiology",
     [("4th most common cancer in women worldwide (GLOBOCAN)", 0),
      ("~660,000 new cases and ~350,000 deaths annually worldwide", 0),
      ("Marked disparity: incidence & mortality highest in low- and middle-income countries with limited HPV vaccination/screening access", 0),
      ("Median age at diagnosis 45-55 years; increasing incidence of adenocarcinoma in younger women", 0),
      ("Nearly all cases attributable to persistent high-risk HPV infection", 0)])
card(s, Inches(6.78), Inches(1.55), Inches(6.0), Inches(5.1), "Risk Factors & Etiology",
     [("Persistent high-risk HPV (16, 18 account for ~70%)", 0),
      ("Early coitarche, multiple sexual partners, high parity", 0),
      ("Cigarette smoking - cofactor for HPV persistence", 0),
      ("Immunosuppression (HIV infection, transplant recipients)", 0),
      ("Long-term combined oral contraceptive use (>5 yrs)", 0),
      ("Lack of HPV vaccination and inadequate cytology/HPV screening", 0),
      ("Histology: squamous cell carcinoma (~70-75%), adenocarcinoma (~20-25%), rarer neuroendocrine/small-cell types", 0)])
footer_note(s, "Sources: Robbins & Cotran Pathologic Basis of Disease; Berek & Novak's Gynecology; GLOBOCAN 2024 (CA Cancer J Clin 2026)")

# =========================================================
# SLIDE 4 - FIGO STAGING (with image)
# =========================================================
s = add_slide(); bg(s)
header(s, "Staging", "FIGO 2018 Staging System", 4)
stages = [
    ("I", "Confined to cervix", "IA: microscopic, ≤5mm depth  |  IB1 ≤2cm, IB2 >2-4cm, IB3 >4cm"),
    ("II", "Beyond uterus, not to pelvic wall/lower vagina", "IIA: upper 2/3 vagina  |  IIB: parametrial invasion"),
    ("III", "Extends to pelvic wall, lower 1/3 vagina, or nodes", "IIIA: lower vagina  |  IIIB: pelvic wall/hydronephrosis  |  IIIC: pelvic (C1)/para-aortic (C2) nodes*"),
    ("IVA", "Spread to bladder or rectal mucosa", "Biopsy-confirmed adjacent organ invasion"),
    ("IVB", "Distant metastasis", "Includes distant nodal spread, lung, liver, bone"),
]
x0 = Inches(0.55); y0 = Inches(1.55); w0 = Inches(7.4)
for stg, desc, detail in stages:
    rect(s, x0, y0, Inches(0.9), Inches(0.92), ACCENT)
    textbox(s, x0, y0, Inches(0.9), Inches(0.92), stg, size=19, color=WHITE, bold=True,
            align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    textbox(s, x0 + Inches(1.05), y0 + Inches(0.02), w0 - Inches(1.1), Inches(0.35), desc, size=14.5, color=NAVY, bold=True)
    textbox(s, x0 + Inches(1.05), y0 + Inches(0.38), w0 - Inches(1.1), Inches(0.5), detail, size=11.5, color=GRAY)
    y0 += Inches(1.02)
textbox(s, x0, y0+Inches(0.02), w0, Inches(0.4), "*Stage IIIC designated r (imaging) or p (pathology) per 2018 revision",
        size=10.5, color=GRAY, italic=True)

# staging image
try:
    data = json.loads(open("/tmp/workspace/cervical-cancer-ppt/assets/staging_img.json").read())
    b64 = data[0]["base64"]
    raw = base64.b64decode(b64.split(",")[1] if "," in b64 else b64)
    img_stream = BytesIO(raw)
    rect(s, Inches(8.15), Inches(1.55), Inches(4.6), Inches(4.95), WHITE)
    s.shapes.add_picture(img_stream, Inches(8.25), Inches(1.65), width=Inches(4.4))
    textbox(s, Inches(8.15), Inches(6.35), Inches(4.6), Inches(0.35),
            "FIGO staging IA/IB illustration", size=10.5, color=GRAY, italic=True, align=PP_ALIGN.CENTER)
except Exception as e:
    textbox(s, Inches(8.15), Inches(1.55), Inches(4.6), Inches(1), f"[image unavailable]", size=12, color=GRAY)
footer_note(s, "Source: Berek & Novak's Gynecology, FIGO Staging 2018 revision; NCCN Cervical Cancer Guidelines v2.2026")

# =========================================================
# SLIDE 5 - COMPLICATIONS OF DISEASE
# =========================================================
s = add_slide(); bg(s)
header(s, "Complications I", "Complications of Disease Progression", 5)
card(s, Inches(0.55), Inches(1.55), Inches(4.0), Inches(5.1), "Local / Regional",
     [("Ureteral obstruction → hydronephrosis → post-renal (obstructive) renal failure - a leading cause of death in untreated/advanced disease", 0),
      ("Vesicovaginal and rectovaginal fistulae from direct tumor invasion", 0),
      ("Parametrial and pelvic sidewall invasion causing pelvic/sciatic-type pain", 0),
      ("Lymphatic obstruction → lower-limb lymphedema", 0)])
card(s, Inches(4.78), Inches(1.55), Inches(4.0), Inches(5.1), "Hemorrhage & Infection",
     [("Acute vaginal hemorrhage from friable exophytic tumor - can be life-threatening, may need emergent vaginal packing/embolization", 0),
      ("Pyometra and hematometra from cervical canal obstruction", 0),
      ("Secondary pelvic infection/abscess", 0),
      ("Anemia from chronic blood loss", 0)])
card(s, Inches(9.0), Inches(1.55), Inches(3.78), Inches(5.1), "Metastatic Spread",
     [("Pelvic and para-aortic lymph node metastases (nodal status = major prognostic factor)", 0),
      ("Hematogenous spread to lung, liver, bone", 0),
      ("Peritoneal/omental spread (less common)", 0),
      ("Bladder/rectal mucosal invasion (Stage IVA)", 0),
      ("Paraneoplastic thromboembolism (elevated VTE risk)", 0)])
footer_note(s, "Sources: Robbins & Cotran Pathologic Basis of Disease; Brenner & Rector's The Kidney; Berek & Novak's Gynecology")

# =========================================================
# SLIDE 6 - COMPLICATIONS OF TREATMENT (SURGERY)
# =========================================================
s = add_slide(); bg(s)
header(s, "Complications II", "Complications of Treatment - Surgery", 6)
card(s, Inches(0.55), Inches(1.55), Inches(6.0), Inches(5.1), "Radical Hysterectomy / Lymphadenectomy",
     [("Vesicovaginal fistula: ~0.3% in large series", 0),
      ("Ureterovaginal fistula: ~1% (higher with prior radiation)", 0),
      ("Bladder atony / voiding dysfunction from autonomic nerve injury (~4-10 weeks recovery, sometimes permanent)", 0),
      ("Ureteral injury or stricture", 0),
      ("Lower-limb and genital lymphedema after pelvic lymphadenectomy (up to 20-25%)", 0),
      ("Intraoperative hemorrhage, venous thromboembolism", 0),
      ("Sexual dysfunction, vaginal shortening", 0)])
card(s, Inches(6.78), Inches(1.55), Inches(6.0), Inches(5.1), "Fertility-Sparing Surgery (Trachelectomy/Conization)",
     [("Cervical stenosis, dysmenorrhea", 0),
      ("Second-trimester pregnancy loss, cervical incompetence requiring cerclage", 0),
      ("Preterm birth in subsequent pregnancies", 0),
      ("Infertility from cervical mucus factor", 0),
      ("Risk of occult nodal disease if inadequate staging performed first", 0)])
footer_note(s, "Sources: Berek & Novak's Gynecology; Campbell-Walsh-Wein Urology (Fistula chapter); ESGO 2023 Fertility-Sparing Guidelines")

# =========================================================
# SLIDE 7 - COMPLICATIONS OF TREATMENT (RT/CHEMO)
# =========================================================
s = add_slide(); bg(s)
header(s, "Complications III", "Complications of Treatment - Radiotherapy & Chemotherapy", 7)
card(s, Inches(0.55), Inches(1.55), Inches(4.0), Inches(5.1), "Acute RT Effects",
     [("Radiation cystitis, diarrhea, proctitis", 0),
      ("Skin desquamation in treatment field", 0),
      ("Myelosuppression (with concurrent chemo)", 0),
      ("Fatigue, nausea", 0)])
card(s, Inches(4.78), Inches(1.55), Inches(4.0), Inches(5.1), "Chronic RT Morbidity",
     [("Recto-vaginal fistula: ~1.4-5.3% after pelvic RT", 0),
      ("Bowel stricture/obstruction - risk roughly doubled vs. surgery alone", 0),
      ("Chronic radiation cystitis, hemorrhagic cystitis", 0),
      ("Vaginal stenosis and dyspareunia", 0),
      ("Ovarian failure / premature menopause if ovaries in field", 0),
      ("Secondary pelvic malignancy (rare, long-term)", 0)])
card(s, Inches(9.0), Inches(1.55), Inches(3.78), Inches(5.1), "Cisplatin-Based Chemo & Novel Agents",
     [("Nephrotoxicity, ototoxicity, peripheral neuropathy (cisplatin)", 0),
      ("Myelosuppression, nausea/vomiting", 0),
      ("Bevacizumab: hypertension, GI perforation, fistula, thromboembolism, impaired wound healing", 0),
      ("Immune-related adverse events with pembrolizumab (colitis, pneumonitis, endocrinopathy)", 0)])
footer_note(s, "Sources: Campbell-Walsh-Wein Urology; Yamada's Textbook of Gastroenterology; KEYNOTE-A18/826 safety data")

# =========================================================
# SLIDE 8 - TREATMENT OVERVIEW / ALGORITHM
# =========================================================
s = add_slide(); bg(s)
header(s, "Treatment", "Treatment Overview by Stage (NCCN v2.2026 / FIGO)", 8)
rows = [
    ("IA1", "Conization (fertility-sparing) or simple/extrafascial hysterectomy; sentinel node mapping if LVSI+", TEAL),
    ("IA2 - IB2", "Radical hysterectomy (Type C) + pelvic lymphadenectomy, OR radical trachelectomy if fertility desired & criteria met", TEAL),
    ("IB3 - IIA2", "Definitive concurrent chemoradiation (cisplatin) + brachytherapy preferred in US; radical surgery an alternative for select IB3", ACCENT),
    ("IIB - IVA", "Concurrent chemoradiation + brachytherapy; ADD pembrolizumab (high-risk LACC per KEYNOTE-A18)", ACCENT),
    ("IVB / Metastatic / Recurrent", "Systemic therapy: platinum-doublet + bevacizumab ± pembrolizumab (PD-L1+); tisotumab vedotin after progression", NAVY),
]
y = Inches(1.6)
for stage, plan, color in rows:
    rect(s, Inches(0.55), y, Inches(2.15), Inches(0.86), color)
    textbox(s, Inches(0.55), y, Inches(2.15), Inches(0.86), stage, size=14.5, color=WHITE, bold=True,
            align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    rect(s, Inches(2.8), y, Inches(9.95), Inches(0.86), LIGHT)
    textbox(s, Inches(3.0), y+Inches(0.05), Inches(9.6), Inches(0.76), plan, size=13, color=DARK,
            anchor=MSO_ANCHOR.MIDDLE)
    y += Inches(0.98)
footer_note(s, "Radical hysterectomy Type C preferred over simple hysterectomy - wider parametrial/paracervical margin. Treatment decided by multidisciplinary tumor board.")

# =========================================================
# SLIDE 9 - EARLY STAGE TREATMENT DETAIL
# =========================================================
s = add_slide(); bg(s)
header(s, "Treatment Detail", "Early-Stage Disease: Surgery & Fertility Preservation", 9)
card(s, Inches(0.55), Inches(1.55), Inches(6.0), Inches(5.1), "Radical Hysterectomy (Type C)",
     [("Preferred for FIGO IB1-IB3 and IIA1-IIA2", 0),
      ("Wider excision of paracervix, includes cardinal/uterosacral ligaments, upper vagina, pelvic ± para-aortic nodes", 0),
      ("Sentinel lymph node (SLN) mapping increasingly used (NCCN, ESGO) in tumors <2cm", 0),
      ("Minimally invasive (laparoscopic/robotic) approach now discouraged for tumors ≥2cm after LACC trial showed inferior survival vs. open surgery - open radical hysterectomy is now standard of care", 0),
      ("Adjuvant chemoradiation added if high-risk features post-op: positive margins, parametrial invasion, positive nodes (Sedlis criteria)", 0)])
card(s, Inches(6.78), Inches(1.55), Inches(6.0), Inches(5.1), "Fertility-Sparing Options",
     [("Cone biopsy / simple trachelectomy: Stage IA1 without LVSI", 0),
      ("Radical trachelectomy + pelvic lymphadenectomy: select IA2-IB1 (<2cm), negative margins, no aggressive histology", 0),
      ("Negative pelvic nodal status is a precondition (ESGO 2023) - nodal assessment performed first", 0),
      ("Not recommended for small-cell neuroendocrine tumors, gastric-type adenocarcinoma, or minimal deviation adenocarcinoma", 0),
      ("Cerclage placement addressed by ESGO/BGCS guidance to reduce preterm birth risk", 0)])
footer_note(s, "Sources: NCCN Cervical Cancer v2.2026; ESGO 2023 Fertility-Sparing Guidelines; Cancers 2024;16:2541 (guideline comparison)")

# =========================================================
# SLIDE 10 - LOCALLY ADVANCED TREATMENT
# =========================================================
s = add_slide(); bg(s)
header(s, "Treatment Detail", "Locally Advanced Disease: Chemoradiation + Brachytherapy", 10)
card(s, Inches(0.55), Inches(1.55), Inches(6.0), Inches(5.1), "Standard of Care",
     [("Definitive concurrent chemoradiotherapy (CCRT): external beam RT + weekly cisplatin (40 mg/m2)", 0),
      ("Followed by intracavitary/interstitial brachytherapy boost to cervix/parametria", 0),
      ("Total treatment time goal: <=8 weeks (delays worsen local control)", 0),
      ("Image-guided adaptive brachytherapy (IGABT/MRI-based) now recommended over 2D planning where available (ESGO/ESTRO/ABS/GEC)", 0),
      ("Extended-field RT to para-aortic nodes if PET/CT-positive nodes", 0)])
card(s, Inches(6.78), Inches(1.55), Inches(6.0), Inches(5.1), "Practice-Changing Update: Immunotherapy Addition",
     [("KEYNOTE-A18/ENGOT-cx11/GOG-3047 (Lancet 2024): pembrolizumab + CCRT then maintenance pembrolizumab vs. CCRT alone in high-risk locally advanced cervical cancer", 0),
      ("Significant improvement in progression-free AND overall survival", 0),
      ("FDA-approved (Jan 2024); incorporated into NCCN v2.2026 as a category 1 option for high-risk LACC (node-positive or Stage III-IVA)", 0),
      ("Cost-effectiveness debated (JAMA Netw Open 2025) but panel consensus favors offering it", 0)])
footer_note(s, "Sources: Lorusso et al. Lancet 2024;403:1341 & Lancet 2024;404:1321 (KEYNOTE-A18); NCCN Cervical Cancer v2.2026")

# =========================================================
# SLIDE 11 - RECURRENT / METASTATIC
# =========================================================
s = add_slide(); bg(s)
header(s, "Treatment Detail", "Recurrent, Persistent & Metastatic Disease", 11)
card(s, Inches(0.55), Inches(1.55), Inches(4.0), Inches(5.1), "Central Recurrence",
     [("Pelvic exenteration if isolated central recurrence after RT, no distant disease", 0),
      ("5-year survival 30-60% in well-selected candidates", 0),
      ("Reirradiation ± surgery for select cases", 0)])
card(s, Inches(4.78), Inches(1.55), Inches(4.0), Inches(5.1), "Systemic First-Line",
     [("Platinum-based doublet (cisplatin/carboplatin + paclitaxel) + bevacizumab (GOG-240)", 0),
      ("Add pembrolizumab if PD-L1 CPS ≥1 (KEYNOTE-826, NEJM 2021) - now standard first-line regimen", 0),
      ("Improves OS and PFS vs. chemo ± bevacizumab alone", 0)])
card(s, Inches(9.0), Inches(1.55), Inches(3.78), Inches(5.1), "Beyond First-Line",
     [("Tisotumab vedotin (antibody-drug conjugate, tissue factor-directed) after progression on chemo", 0),
      ("Pembrolizumab monotherapy for MSI-H/dMMR or TMB-high tumors regardless of line", 0),
      ("Clinical trial enrollment strongly encouraged", 0)])
footer_note(s, "Sources: NCCN v2.2026; KEYNOTE-826 (NEJM 2021); GOG-240; Colombo et al.; SEOM-GEICO 2023 Guidelines")

# =========================================================
# SLIDE 12 - GUIDELINE COMPARISON
# =========================================================
s = add_slide(); bg(s)
header(s, "Guidelines", "How Major Societies Compare (2023-2026)", 12)
data = [
    ("NCCN (USA)", "v2.2026", "Open radical hysterectomy for early stage; CCRT+brachytherapy + pembrolizumab (cat.1) for high-risk LACC; SLN mapping accepted"),
    ("FIGO Cancer Report", "2021 (update pending)", "Staging reference (2018 revision); NACT favored where RT resources limited"),
    ("ESGO (Europe)", "2023", "Mandates negative pelvic nodes before fertility-sparing surgery; recommends SLN biopsy; individualized follow-up"),
    ("ESMO", "2023", "Surgery an option after neoadjuvant chemo in IB2-IIIB in select cases; pelvic exenteration option in IVA"),
    ("SEOM-GEICO (Spain)", "2023", "Aligns with NCCN on immunotherapy incorporation; detailed screening/HPV vaccination guidance"),
    ("Korean Society Gyn Onc", "2025", "Updated Delphi-based consensus incorporating pembrolizumab-CCRT data"),
]
y = Inches(1.55)
colw = [Inches(2.5), Inches(1.5), Inches(8.35)]
headers_ = ["Society", "Version", "Key Distinguishing Points"]
x = Inches(0.55)
for i, htext in enumerate(headers_):
    rect(s, x, y, colw[i], Inches(0.45), NAVY)
    textbox(s, x+Inches(0.1), y, colw[i]-Inches(0.2), Inches(0.45), htext, size=13, color=WHITE, bold=True, anchor=MSO_ANCHOR.MIDDLE)
    x += colw[i]
y += Inches(0.45)
for idx, (soc, ver, pts) in enumerate(data):
    rowcolor = LIGHT if idx % 2 == 0 else WHITE
    x = Inches(0.55)
    rh = Inches(0.83)
    for i, val in enumerate([soc, ver, pts]):
        rect(s, x, y, colw[i], rh, rowcolor)
        textbox(s, x+Inches(0.1), y+Inches(0.05), colw[i]-Inches(0.2), rh-Inches(0.1), val,
                size=11.5 if i==2 else 12.5, color=DARK, bold=(i==0), anchor=MSO_ANCHOR.MIDDLE)
        x += colw[i]
    y += rh
footer_note(s, "Source: Restaino et al. Management for Cervical Cancer Patients: Comparison of Guidelines. Cancers 2024;16(14):2541")

# =========================================================
# SLIDE 13 - FOLLOW-UP / SURVEILLANCE
# =========================================================
s = add_slide(); bg(s)
header(s, "Surveillance", "Follow-up After Primary Treatment", 13)
card(s, Inches(0.55), Inches(1.55), Inches(6.0), Inches(5.1), "Standard Follow-up Schedule",
     [("Physical & pelvic exam every 3-4 months for first 2 years", 0),
      ("Every 6-12 months from years 3-5", 0),
      ("Annual exam after year 5", 0),
      ("Cervical/vaginal cytology per society-specific interval - not all guidelines mandate routine cytology after treatment", 0),
      ("Patient education: symptoms of recurrence (bleeding, pain, leg swelling, weight loss)", 0)])
card(s, Inches(6.78), Inches(1.55), Inches(6.0), Inches(5.1), "Imaging & Special Considerations",
     [("Imaging only if clinically indicated (ESMO/ESGO) - not routine surveillance imaging in most", 0),
      ("NCCN: PET-CT at 3-6 months post-adjuvant therapy for Stage IB3+ or those requiring adjuvant treatment", 0),
      ("Pelvic organ toxicity screening emphasized in RT-treated patients (bladder, bowel, vaginal health)", 0),
      ("HPV vaccination counseling for partners/family; survivorship care planning", 0),
      ("Sexual health, lymphedema, and fertility counseling integrated into follow-up", 0)])
footer_note(s, "Sources: NCCN v2.2026; ESGO 2023; ESMO Clinical Practice Guidelines; Cancers 2024;16:2541")

# =========================================================
# SLIDE 14 - KEY TAKEAWAYS
# =========================================================
s = add_slide(); bg(s)
header(s, "Summary", "Key Takeaways", 14)
pts = [
    "Cervical carcinoma is an HPV-driven disease; prevention via vaccination and screening remains the highest-impact intervention.",
    "Complications range from local (fistula, ureteral obstruction, hemorrhage) to treatment-related morbidity (surgical fistula, radiation proctitis/cystitis, chemo/immunotherapy toxicity).",
    "FIGO 2018 staging (clinical + imaging/pathology) drives treatment selection.",
    "Early-stage disease: open radical hysterectomy (Type C) or fertility-sparing surgery in selected patients; minimally invasive surgery no longer preferred for tumors >=2cm.",
    "Locally advanced disease: concurrent cisplatin-based chemoradiation + brachytherapy remains standard; addition of pembrolizumab (KEYNOTE-A18) is the major 2024-2026 practice change for high-risk disease.",
    "Metastatic/recurrent disease: platinum + bevacizumab ± pembrolizumab (PD-L1+) first-line; tisotumab vedotin and clinical trials thereafter.",
    "Multidisciplinary care, individualized follow-up, and survivorship support are guideline-endorsed across NCCN, ESGO, ESMO, FIGO, and SEOM.",
]
y = Inches(1.6)
for i, pt in enumerate(pts, 1):
    rect(s, Inches(0.55), y, Inches(0.5), Inches(0.5), ACCENT)
    textbox(s, Inches(0.55), y, Inches(0.5), Inches(0.5), str(i), size=16, color=WHITE, bold=True,
            align=PP_ALIGN.CENTER, anchor=MSO_ANCHOR.MIDDLE)
    textbox(s, Inches(1.25), y+Inches(0.02), Inches(11.5), Inches(0.6), pt, size=13.5, color=DARK,
            anchor=MSO_ANCHOR.MIDDLE)
    y += Inches(0.72)

# =========================================================
# SLIDE 15 - REFERENCES
# =========================================================
s = add_slide(); bg(s)
header(s, "References", "Key Sources & Further Reading", 15)
refs = [
    "NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer, Version 2.2026. J Natl Compr Canc Netw.",
    "Lorusso D, et al. Pembrolizumab + chemoradiotherapy for high-risk locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18). Lancet 2024;403:1341-1350; overall survival results Lancet 2024;404:1321-1332.",
    "Colombo N, et al. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer (KEYNOTE-826). N Engl J Med 2021.",
    "Restaino S, et al. Management for Cervical Cancer Patients: Comparison of Guidelines (ESGO-NCCN-ASCO-AIOM-FIGO-BGCS-SEOM-ESMO-JSGO). Cancers 2024;16(14):2541.",
    "Manso L, et al. SEOM-GEICO Clinical Guidelines on Cervical Cancer (2023). Clin Transl Oncol 2024.",
    "Yoo JG, et al. Clinical Practice Guidelines for Cervical Cancer: Korean Society of Gynecologic Oncology update. J Gynecol Oncol 2025.",
    "Berek & Novak's Gynecology, 17th ed. - Cervical Cancer chapters (Staging, Treatment, Chronic Morbidity).",
    "Robbins, Cotran & Kumar - Pathologic Basis of Disease - Cervical Carcinoma.",
    "Goldman-Cecil Medicine, International Edition - Cervical Cancer Treatment and Prognosis.",
    "Campbell-Walsh-Wein Urology - Oncologic and Radiation Fistulae; Combination Therapies.",
]
bullet_block(s, Inches(0.55), Inches(1.6), Inches(12.2), Inches(5.2), refs, size=13.5, space_after=10)
textbox(s, Inches(0.55), Inches(7.0), Inches(12), Inches(0.3),
        "Prepared for educational purposes. Always confirm current recommendations against the live NCCN/ESGO/ESMO portals before clinical use.",
        size=10.5, color=GRAY, italic=True)

prs.save("/tmp/workspace/cervical-cancer-ppt/Cervical_Carcinoma_Complications_and_Treatment_Guidelines.pptx")
print("SAVED OK")