import math
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, MSO_CONNECTOR
from pptx.oxml.ns import qn
from lxml import etree

def C(h): return RGBColor.from_string(h)
NAVY, MAG, TEAL, LIGHT = C("1B2A41"), C("9D2A5B"), C("2A7F8E"), C("F6EFF3")
DARK, GREY, WHITE, PALE = C("222B38"), C("5A6270"), C("FFFFFF"), C("E8F1F3")
GREEN, YELLOW, ORANGE, RED, SLATE = C("2E8B57"), C("D9A404"), C("E67E22"), C("C0392B"), C("8A8F98")
FONT = "Calibri"

prs = Presentation()
prs.slide_width, prs.slide_height = Inches(13.333), Inches(7.5)
BLANK = prs.slide_layouts[6]
state = {"n": 0}

def tb(slide, x, y, w, h, text, size=14, bold=False, color=DARK, align=PP_ALIGN.LEFT,
       anchor=MSO_ANCHOR.TOP, italic=False):
    s = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = s.text_frame; tf.word_wrap = True; tf.vertical_anchor = anchor
    tf.margin_left = tf.margin_right = Inches(0.05); tf.margin_top = tf.margin_bottom = Inches(0.03)
    lines = text.split("\n")
    for i, ln in enumerate(lines):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = align
        r = p.add_run(); r.text = ln
        r.font.size = Pt(size); r.font.bold = bold; r.font.italic = italic
        r.font.color.rgb = color; r.font.name = FONT
    return s

def bullets(slide, x, y, w, h, items, size=14, color=DARK, space=5):
    s = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = s.text_frame; tf.word_wrap = True
    tf.margin_left = tf.margin_right = Inches(0.05); tf.margin_top = Inches(0.03)
    for i, it in enumerate(items):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.space_after = Pt(space)
        pPr = p._p.get_or_add_pPr()
        pPr.set("marL", str(int(Inches(0.22)))); pPr.set("indent", str(-int(Inches(0.22))))
        bu = etree.SubElement(pPr, qn("a:buChar")); bu.set("char", "\u2022")
        lead, rest = (it if isinstance(it, tuple) else (None, it))
        if lead:
            r = p.add_run(); r.text = lead + " "; r.font.bold = True
            r.font.size = Pt(size); r.font.color.rgb = MAG; r.font.name = FONT
        r = p.add_run(); r.text = rest
        r.font.size = Pt(size); r.font.color.rgb = color; r.font.name = FONT
    return s

def new_slide(title, source=None, subtitle=None):
    state["n"] += 1
    s = prs.slides.add_slide(BLANK)
    bar = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0), Inches(0.32), Inches(0.18), Inches(0.62))
    bar.fill.solid(); bar.fill.fore_color.rgb = MAG; bar.line.fill.background()
    tb(s, 0.4, 0.25, 12.5, 0.75, title, size=28, bold=True, color=NAVY, anchor=MSO_ANCHOR.MIDDLE)
    if subtitle:
        tb(s, 0.4, 0.92, 12.5, 0.35, subtitle, size=13, color=GREY, italic=True)
    ln = s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(0.4), Inches(7.05), Inches(12.93), Inches(7.05))
    ln.line.color.rgb = C("D5D8DE"); ln.line.width = Pt(0.75)
    if source:
        tb(s, 0.4, 7.07, 11.6, 0.35, "Source: " + source, size=9, color=GREY)
    tb(s, 12.2, 7.07, 0.75, 0.35, str(state["n"]), size=10, color=GREY, align=PP_ALIGN.RIGHT)
    return s

def box(slide, x, y, w, h, text, fill=NAVY, color=WHITE, size=12, bold=False,
        shape=MSO_SHAPE.ROUNDED_RECTANGLE, align=PP_ALIGN.CENTER, line=None):
    s = slide.shapes.add_shape(shape, Inches(x), Inches(y), Inches(w), Inches(h))
    s.fill.solid(); s.fill.fore_color.rgb = fill
    if line: s.line.color.rgb = line; s.line.width = Pt(1.25)
    else: s.line.fill.background()
    s.shadow.inherit = False
    if shape == MSO_SHAPE.ROUNDED_RECTANGLE:
        s.adjustments[0] = 0.12
    tf = s.text_frame; tf.word_wrap = True; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
    tf.margin_left = tf.margin_right = Inches(0.08); tf.margin_top = tf.margin_bottom = Inches(0.04)
    for i, ln in enumerate(text.split("\n")):
        p = tf.paragraphs[0] if i == 0 else tf.add_paragraph()
        p.alignment = align
        r = p.add_run(); r.text = ln; r.font.size = Pt(size); r.font.name = FONT
        r.font.color.rgb = color; r.font.bold = bold if i else (True if bold is None else bold)
    return s

def arrow(slide, x1, y1, x2, y2, color=GREY, width=1.75):
    c = slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2))
    c.line.color.rgb = color; c.line.width = Pt(width)
    ln = c.line._get_or_add_ln()
    t = etree.SubElement(ln, qn("a:tailEnd")); t.set("type", "triangle"); t.set("w", "med"); t.set("len", "med")
    return c

def table(slide, x, y, widths, rows, size=11, first_bold=True, first_fills=None, hdr_fill=NAVY, zebra=True):
    nr, nc = len(rows), len(widths)
    heights = []
    for ri, row in enumerate(rows):
        mx = 1
        for ci, cell in enumerate(row):
            cpl = max(4, (widths[ci] - 0.2) / (0.49 * size / 72))
            lines = sum(max(1, math.ceil(len(seg) / cpl)) for seg in cell.split("\n"))
            mx = max(mx, lines)
        heights.append(mx * size * 1.2 / 72 + 0.13)
    gs = slide.shapes.add_table(nr, nc, Inches(x), Inches(y), Inches(sum(widths)), Inches(sum(heights)))
    t = gs.table
    tblPr = t._tbl.tblPr
    for a in ("bandRow", "firstRow"): tblPr.set(a, "0")
    sid = tblPr.find(qn("a:tableStyleId"))
    if sid is not None: sid.text = "{5940675A-B579-460E-94D1-54222C63F5DA}"  # no style, table grid
    for ci, w in enumerate(widths): t.columns[ci].width = Inches(w)
    for ri, row in enumerate(rows):
        t.rows[ri].height = Inches(heights[ri])
        for ci, txt in enumerate(row):
            cell = t.cell(ri, ci)
            cell.margin_left = cell.margin_right = Inches(0.07)
            cell.margin_top = cell.margin_bottom = Inches(0.04)
            cell.vertical_anchor = MSO_ANCHOR.MIDDLE
            tf = cell.text_frame; tf.word_wrap = True
            for li, ln in enumerate(txt.split("\n")):
                p = tf.paragraphs[0] if li == 0 else tf.add_paragraph()
                r = p.add_run(); r.text = ln; r.font.size = Pt(size); r.font.name = FONT
                if ri == 0:
                    r.font.bold = True; r.font.color.rgb = WHITE
                else:
                    r.font.color.rgb = DARK
                    if ci == 0 and first_bold: r.font.bold = True
            cell.fill.solid()
            if ri == 0: cell.fill.fore_color.rgb = hdr_fill
            elif ci == 0 and first_fills and first_fills.get(ri):
                cell.fill.fore_color.rgb = first_fills[ri]
                for p in tf.paragraphs:
                    for r in p.runs: r.font.color.rgb = WHITE
            else:
                cell.fill.fore_color.rgb = LIGHT if (zebra and ri % 2 == 0) else WHITE
    bottom = y + sum(heights)
    print(f"slide {state['n']}: table bottom {bottom:.2f}")
    return bottom

# ------------------------------------------------------------------ 1 TITLE
state["n"] += 1
s = prs.slides.add_slide(BLANK)
bg = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, 0, 0, prs.slide_width, prs.slide_height)
bg.fill.solid(); bg.fill.fore_color.rgb = NAVY; bg.line.fill.background()
st = s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0.8), Inches(2.3), Inches(0.14), Inches(2.1))
st.fill.solid(); st.fill.fore_color.rgb = MAG; st.line.fill.background()
tb(s, 1.2, 2.2, 11, 1.1, "Endometrial Carcinoma", size=48, bold=True, color=WHITE)
tb(s, 1.2, 3.3, 11, 0.7, "Investigations, Staging and Management", size=28, color=C("F0C6D8"))
tb(s, 1.2, 4.0, 11, 0.5, "Updated to FIGO 2023 staging and ESGO-ESTRO-ESP 2025 guidelines", size=16, color=C("C9D3E0"))
tb(s, 1.2, 6.3, 11.5, 0.8, "References: ESGO-ESTRO-ESP 2025 guideline (Lancet Oncol); FIGO 2023 staging; Berek & Novak's Gynecology; "
   "Goldman-Cecil Medicine; Robbins Pathologic Basis of Disease; Grainger & Allison's Diagnostic Radiology", size=11, color=C("9FB0C6"))

# ------------------------------------------------------------------ 2 EPI / RISK
s = new_slide("Epidemiology and Risk Factors",
              "Goldman-Cecil Medicine (Ch. 184); Harrison's Principles of Internal Medicine 22E; ESGO-ESTRO-ESP 2025")
bullets(s, 0.4, 1.25, 5.6, 5.6, [
    ("Burden:", "6th most common cancer in women worldwide: about 417,000 new cases and 97,000 deaths in 2020."),
    ("Presentation stage:", "about 75% are stage I at diagnosis, because postmenopausal bleeding leads to early detection."),
    ("Trend:", "incidence rising with obesity, diabetes, lower parity and longer life expectancy."),
    ("Precursor:", "complex atypical hyperplasia carries about a 30-fold risk of later cancer."),
    ("Hereditary (3-5%):", "Lynch syndrome (MLH1, MSH2, MSH6, PMS2, EPCAM) gives up to 60% lifetime risk; Cowden syndrome (PTEN) 13-20%."),
    ("Protective:", "combined oral contraceptives, multiparity, LNG-IUS, physical activity."),
], size=14)
rows = [["Feature", "Type 1 (about 80%)", "Type 2 (10-20%)"],
        ["Driver", "Unopposed estrogen", "Estrogen independent"],
        ["Histology", "Endometrioid, low grade", "Serous, clear cell, carcinosarcoma"],
        ["Background", "Hyperplasia; obese, peri/postmenopausal", "Atrophic endometrium; older women"],
        ["Molecular", "PTEN loss, MSI, KRAS, CTNNB1; wild-type p53", "TP53 mutation, aneuploidy, HER2 amplification"],
        ["Receptors", "ER/PR positive", "ER/PR usually low or negative"],
        ["Behaviour", "Uterine-confined, good prognosis", "Early dissemination, poor prognosis"]]
b = table(s, 6.3, 1.3, [1.35, 2.7, 2.55], rows, size=12)
box(s, 6.3, b + 0.2, 6.6, 0.85,
    "The dualistic model is now refined by the four-group molecular classification (slide 4), which drives risk grouping.",
    fill=PALE, color=NAVY, size=12, line=TEAL)
tb(s, 0.4, 5.55, 5.6, 1.3,
   "Risk factor list: obesity, unopposed estrogen, early menarche or late menopause, nulliparity, diabetes, "
   "PCOS or anovulation, tamoxifen, family history.", size=12, color=GREY, italic=True)

# ------------------------------------------------------------------ 3 PATHOLOGY
s = new_slide("Pathology: Histotypes, Grade and Reporting",
              "Robbins Pathologic Basis of Disease; Goldman-Cecil Medicine; FIGO 2023; ESGO-ESTRO-ESP 2025")
rows = [["Histotype", "Features", "Behaviour"],
        ["Endometrioid", "Glandular; FIGO grade 1-2 (low) or 3 (high); most common", "Low grade: favourable; grade 3 behaves aggressively"],
        ["Serous", "Papillary, marked atypia, usually p53 abnormal; arises in atrophic endometrium", "Early peritoneal and nodal spread"],
        ["Clear cell", "Clear or hobnail cells; often p53 wild-type or MMRd", "Aggressive; prognosis varies with molecular class"],
        ["Carcinosarcoma", "Metaplastic carcinoma; epithelial and sarcomatous elements", "Very aggressive; treated as high-grade carcinoma"],
        ["Undifferentiated / dedifferentiated", "Sheets of undifferentiated cells; frequently MMRd", "Aggressive; ICI-responsive when MMRd"]]
b = table(s, 0.4, 1.3, [2.0, 3.3, 2.7], rows, size=12)
tb(s, 0.4, b + 0.12, 8.0, 0.9,
   "Grade: two-tier system (low = FIGO 1-2, high = FIGO 3) for endometrioid cancers. Serous, clear cell, "
   "carcinosarcoma, undifferentiated and mixed types are always high grade.", size=12, color=GREY, italic=True)
box(s, 8.7, 1.3, 4.25, 0.5, "Essential items in the pathology report", fill=MAG, size=14, bold=True)
bullets(s, 8.7, 1.9, 4.25, 4.9, [
    "Histotype and grade",
    "Depth of myometrial invasion (less than or at least 50%)",
    "LVSI: none, focal (under 5 vessels) or substantial (5 or more)",
    "Cervical stromal invasion",
    "Serosa, adnexa, parametrium, vagina",
    "Nodes: ITC, micrometastasis (0.2-2 mm), macrometastasis (over 2 mm)",
    "Molecular class: POLE, MMR IHC, p53 IHC, ER (HER2 in serous or p53abn)",
    "Margins and tumour size",
], size=13, space=4)

# ------------------------------------------------------------------ 4 MOLECULAR
s = new_slide("Molecular Classification (TCGA / ProMisE)",
              "Goldman-Cecil Medicine (Fig. 184-1); ESGO-ESTRO-ESP 2025; WHO 2020")
rows = [["Class", "Frequency", "Genomic features", "Test", "Prognosis"],
        ["POLEmut", "5-10%", "Ultramutated; pathogenic POLE exonuclease-domain variant", "POLE NGS", "Excellent"],
        ["MMRd", "25-30%", "MSI-hypermutated; MLH1 methylation or germline Lynch", "IHC: MLH1, PMS2, MSH2, MSH6", "Intermediate; ICI-sensitive"],
        ["NSMP", "40-50%", "Copy-number low; often ER+, CTNNB1 variants", "Negative for the other three", "Intermediate; heterogeneous"],
        ["p53abn", "10-15%", "Copy-number high; serous-like; TP53 mutation", "p53 IHC (overexpression, null, cytoplasmic)", "Poor; benefits from chemotherapy"]]
fills = {1: GREEN, 2: ORANGE, 3: SLATE, 4: RED}
b = table(s, 0.4, 1.25, [1.4, 1.1, 4.2, 3.4, 2.4], rows, size=12, first_fills=fills)
tb(s, 0.4, b + 0.15, 12.5, 0.4, "Diagnostic algorithm (hierarchical order)", size=15, bold=True, color=NAVY)
y = b + 0.65; h = 0.95; w = 2.55; gap = 0.5
xs = [0.4 + i * (w + gap) for i in range(4)]
box(s, xs[0], y, w, h, "POLE sequencing\n(pathogenic variant?)", fill=NAVY, size=12, bold=None)
box(s, xs[1], y, w, h, "MMR IHC\n(loss of any protein?)", fill=NAVY, size=12, bold=None)
box(s, xs[2], y, w, h, "p53 IHC\n(abnormal pattern?)", fill=NAVY, size=12, bold=None)
box(s, xs[3], y, w, h, "None of the three\n= NSMP", fill=SLATE, size=12, bold=None)
for i in range(3): arrow(s, xs[i] + w, y + h / 2, xs[i + 1], y + h / 2)
labels = [("YES: POLEmut", GREEN), ("YES: MMRd", ORANGE), ("YES: p53abn", RED)]
for i, (t_, c_) in enumerate(labels):
    box(s, xs[i], y + h + 0.45, w, 0.5, t_, fill=c_, size=12, bold=True)
    arrow(s, xs[i] + w / 2, y + h, xs[i] + w / 2, y + h + 0.45)
tb(s, 0.4, y + h + 1.05, 12.5, 0.6,
   "Multiple classifiers: POLEmut + MMRd or p53abn is classified as POLEmut. Report FIGO stage with suffix m and subtype (e.g. IAm POLEmut).",
   size=12, color=GREY, italic=True)

# ------------------------------------------------------------------ 5 DIAGNOSTIC PATHWAY
s = new_slide("Clinical Presentation and Diagnostic Pathway",
              "Grainger & Allison's Diagnostic Radiology; Berek & Novak's Gynecology; ESGO-ESTRO-ESP 2025")
w = 2.15; gap = 0.5; y = 1.3; h = 1.65
texts = [("Presentation", "Postmenopausal bleeding (most cases), abnormal uterine bleeding, pyometra, thickened endometrium on imaging", NAVY),
         ("Transvaginal US", "Double-layer endometrial thickness above 4-5 mm in PMB, or focal lesion, needs sampling", TEAL),
         ("Tissue sampling", "Pipelle or hysteroscopic biopsy; D&C if inadequate sample or cervical stenosis", TEAL),
         ("Histology", "Carcinoma vs atypical hyperplasia / EIN vs benign endometrium", NAVY),
         ("If carcinoma", "Histotype, grade, MMR / p53 / POLE / ER, then staging work-up", MAG)]
xs = [0.3 + i * (w + gap) for i in range(5)]
for i, (hd, tx, col) in enumerate(texts):
    box(s, xs[i], y, w, h, hd + "\n" + tx, fill=col, size=11, bold=None)
    if i: arrow(s, xs[i - 1] + w, y + h / 2, xs[i], y + h / 2)
box(s, 3.2, 3.35, 4.4, 0.75, "Persistent bleeding with negative or inadequate biopsy: hysteroscopy with directed biopsy",
    fill=PALE, color=NAVY, size=11, line=TEAL)
arrow(s, 5.4, 2.95, 5.4, 3.35)
box(s, 0.3, 3.35, 2.6, 0.75, "Endometrial thickness under 4 mm and no bleeding: no sampling", fill=PALE, color=NAVY, size=11, line=TEAL)
arrow(s, 1.6, 2.95, 1.6, 3.35)
box(s, 0.4 + 6.9, 3.35, 5.6, 0.75, "Atypical hyperplasia on biopsy: carries about 30-40% risk of coexisting carcinoma; manage as presumed early cancer pathway",
    fill=PALE, color=NAVY, size=11, line=TEAL)
box(s, 0.4, 4.4, 6.1, 0.45, "Clinical assessment", fill=MAG, size=14, bold=True)
bullets(s, 0.4, 4.9, 6.1, 2.1, [
    "History: bleeding pattern, estrogen exposure, tamoxifen, family history of Lynch cancers",
    "Examination: BMI, abdominal and pelvic exam, speculum view of cervix and vagina",
    "Fitness for surgery: comorbidities, ECOG, anaesthetic review",
], size=12, space=3)
box(s, 6.8, 4.4, 6.1, 0.45, "Pitfalls", fill=MAG, size=14, bold=True)
bullets(s, 6.8, 4.9, 6.1, 2.1, [
    "Cervical cytology is not a diagnostic test for endometrial cancer",
    "Blind biopsy can miss focal lesions (polyp-based cancer)",
    "Premenopausal women with obesity or PCOS and persistent AUB need sampling",
    "Hematometra or pyometra in elderly women can mask the lesion",
], size=12, space=3)

# ------------------------------------------------------------------ 6 INVESTIGATIONS TABLE
s = new_slide("Investigations and Pre-operative Work-up",
              "Grainger & Allison's Diagnostic Radiology (Table 34.1); ESGO-ESTRO-ESP 2025; Berek & Novak's Gynecology")
rows = [["Domain", "Investigation", "Purpose / key point"],
        ["Tissue diagnosis", "Pipelle, hysteroscopic biopsy, D&C", "Histotype and grade; mandatory before definitive surgery"],
        ["Biomarkers", "MMR IHC, p53 IHC, POLE NGS, ER; HER2 if serous or p53abn", "Molecular class, risk group, immunotherapy and HER2-directed options"],
        ["Pelvic imaging", "Expert TVUS or pelvic MRI", "Myometrial and cervical stromal invasion, adnexa, pelvic nodes"],
        ["Distant staging", "CT thorax / abdomen / pelvis (or PET-CT)", "Indicated for high-risk histology (serous, clear cell, carcinosarcoma), suspected stage III-IV or recurrence"],
        ["Laboratory", "CBC, renal and liver function, glucose / HbA1c, group and save", "Fitness for surgery; anaemia from bleeding; diabetes screening"],
        ["Tumour marker", "CA-125 (optional)", "May be raised with extrauterine disease; limited role in routine staging"],
        ["Genetics", "MLH1 methylation, germline testing, counselling", "For dMMR tumours (Lynch syndrome), family history, early onset"],
        ["Fitness", "ECG, chest X-ray, anaesthetic review, BMI", "Choice of surgical approach; unfit women need alternatives"]]
table(s, 0.4, 1.3, [1.9, 4.3, 6.3], rows, size=12)

# ------------------------------------------------------------------ 7 MRI
s = new_slide("Role of MRI in Local Staging",
              "Grainger & Allison's Diagnostic Radiology; images from the Orris medical image library (PMC open access figures)")
s.shapes.add_picture("/tmp/workspace/endometrial-ppt/assets/mri0.jpg", Inches(0.4), Inches(1.3), Inches(3.4), Inches(3.4))
s.shapes.add_picture("/tmp/workspace/endometrial-ppt/assets/mri1.jpg", Inches(3.95), Inches(1.3), Inches(5.1), Inches(3.4))
tb(s, 0.4, 4.72, 3.4, 0.6, "T2 sagittal: thickened endometrium; junctional zone obscured (myometrial invasion)", size=10, color=GREY, italic=True)
tb(s, 3.95, 4.72, 5.1, 0.6, "Serous carcinoma FIGO IIIC1: deep invasion, cervical stromal disruption, enlarged iliac node, diffusion restriction", size=10, color=GREY, italic=True)
box(s, 9.3, 1.3, 3.65, 0.45, "What MRI adds", fill=MAG, size=14, bold=True)
bullets(s, 9.3, 1.8, 3.65, 3.5, [
    "Depth of myometrial invasion (T2, DWI, dynamic contrast)",
    "Cervical stromal invasion",
    "Origin: endometrial vs endocervical primary",
    "Tumour size, parametrial and adnexal extension",
    "Enlarged pelvic nodes",
    "Brachytherapy planning",
], size=12, space=3)
rows = [["Intact junctional zone or under 50% invasion", "50% or more myometrial invasion", "Cervical stroma disrupted", "Serosa, adnexa, vagina, nodes, bladder or bowel"],
        ["Stage IA", "Stage IB", "Stage II", "Stage III-IV"]]
table(s, 0.4, 5.5, [3.1, 3.0, 2.9, 3.5], rows, size=12, first_bold=False)
tb(s, 0.4, 6.6, 12.5, 0.4, "Pre-operative MRI is a surrogate; final stage is surgico-pathological. PET-CT is reserved for equivocal or recurrent disease.", size=11, color=GREY, italic=True)

# ------------------------------------------------------------------ 8 LYNCH FLOW
s = new_slide("Lynch Syndrome Screening Pathway",
              "Goldman-Cecil Medicine (Ch. 184); ESGO-ESTRO-ESP 2025")
box(s, 4.3, 1.25, 4.7, 0.7, "Endometrial carcinoma specimen:\nMMR IHC (MLH1, PMS2, MSH2, MSH6)", fill=NAVY, size=12, bold=None)
box(s, 0.5, 2.45, 3.7, 0.8, "Retained (pMMR): Lynch unlikely;\ntest only if strong family history", fill=GREEN, size=12, bold=None)
box(s, 6.0, 2.45, 3.6, 0.65, "Loss of expression (dMMR)", fill=ORANGE, size=13, bold=True)
arrow(s, 5.5, 1.95, 2.35, 2.45); arrow(s, 7.8, 1.95, 7.8, 2.45)
box(s, 4.6, 3.6, 3.5, 0.7, "MLH1 + PMS2 loss", fill=NAVY, size=12, bold=True)
box(s, 9.0, 3.6, 3.9, 0.7, "MSH2 + MSH6 loss, or isolated MSH6 / PMS2 loss", fill=NAVY, size=12, bold=True)
arrow(s, 7.3, 3.1, 6.35, 3.6); arrow(s, 8.6, 3.1, 10.9, 3.6)
box(s, 4.6, 4.65, 3.5, 0.65, "MLH1 promoter methylation test", fill=TEAL, size=12, bold=True)
arrow(s, 6.35, 4.3, 6.35, 4.65)
box(s, 4.4, 5.8, 2.1, 0.95, "Methylated:\nsporadic, no germline test", fill=SLATE, size=11, bold=None)
box(s, 6.7, 5.8, 2.4, 0.95, "Unmethylated:\ngermline testing and counselling", fill=MAG, size=11, bold=None)
arrow(s, 5.9, 5.3, 5.45, 5.8); arrow(s, 6.9, 5.3, 7.9, 5.8)
box(s, 9.0, 4.65, 3.9, 0.95, "Germline testing for Lynch syndrome\n(MLH1, MSH2, MSH6, PMS2, EPCAM)", fill=MAG, size=12, bold=None)
arrow(s, 10.95, 4.3, 10.95, 4.65)
box(s, 0.5, 3.6, 3.7, 3.15, "If Lynch syndrome is confirmed", fill=PALE, color=NAVY, size=12, bold=True, line=TEAL)
bullets(s, 0.6, 4.05, 3.5, 2.7, [
    "Risk-reducing hysterectomy + BSO by minimally invasive surgery after childbearing",
    "Preferably before age 40 for MLH1, MSH2, MSH6; at menopause for PMS2",
    "Colonoscopy surveillance and cascade testing of relatives",
    "Estrogen replacement can be offered after BSO",
], size=11, space=3)

# ------------------------------------------------------------------ 9 FIGO I-II
s = new_slide("FIGO 2023 Staging: Stages I and II",
              "FIGO 2023 staging of endometrial cancer (Berek et al., Int J Gynaecol Obstet 2023); ESGO-ESTRO-ESP 2025")
rows = [["Stage", "Definition"],
        ["I", "Confined to the uterine corpus and ovary"],
        ["IA", "Non-aggressive histology, limited to endometrium or under 50% myometrial invasion, no or focal LVSI; or good-prognosis disease"],
        ["IA1", "Non-aggressive type limited to an endometrial polyp or confined to endometrium"],
        ["IA2", "Non-aggressive type with under 50% myometrial invasion and no or focal LVSI"],
        ["IA3", "Low-grade endometrioid with synchronous low-grade ovarian tumour (under 10 mm, no other spread)"],
        ["IB", "Non-aggressive type with 50% or more myometrial invasion, no or focal LVSI"],
        ["IC", "Aggressive histology limited to a polyp or confined to endometrium"],
        ["II", "Invasion of cervical stroma without extrauterine extension, or substantial LVSI, or aggressive type with myometrial invasion"],
        ["IIA", "Invasion of cervical stroma, non-aggressive type"],
        ["IIB", "Substantial LVSI, non-aggressive type"],
        ["IIC", "Aggressive histology with any myometrial involvement"]]
fills = {1: NAVY, 8: NAVY}
table(s, 0.4, 1.25, [1.0, 7.0], rows, size=12, first_fills=fills)
box(s, 8.7, 1.25, 4.25, 0.45, "Definitions", fill=MAG, size=14, bold=True)
bullets(s, 8.7, 1.8, 4.25, 3.3, [
    ("Aggressive histology:", "high-grade endometrioid, serous, clear cell, mixed, undifferentiated, carcinosarcoma, mesonephric-like, gastrointestinal-type mucinous."),
    ("Substantial LVSI:", "5 or more vessels involved."),
    ("Non-aggressive:", "low-grade (grade 1-2) endometrioid."),
], size=12, space=4)
box(s, 8.7, 5.1, 4.25, 1.75,
    "Molecular stages\nIAm POLEmut: stage I-II with pathogenic POLE variant\nIICm p53abn: stage I-II, p53abn with myometrial invasion",
    fill=PALE, color=NAVY, size=12, line=TEAL)

# ------------------------------------------------------------------ 10 FIGO III-IV
s = new_slide("FIGO 2023 Staging: Stages III and IV",
              "FIGO 2023 staging of endometrial cancer (Berek et al., Int J Gynaecol Obstet 2023); ESGO-ESTRO-ESP 2025")
rows = [["Stage", "Definition"],
        ["III", "Local and/or regional spread of any histological subtype"],
        ["IIIA1", "Spread to ovary or fallopian tube (except IA3)"],
        ["IIIA2", "Involvement of uterine subserosa or spread through serosa"],
        ["IIIB1", "Spread to vagina and/or parametria"],
        ["IIIB2", "Metastasis to pelvic peritoneum"],
        ["IIIC1", "Pelvic node metastasis: i = micrometastasis, ii = macrometastasis"],
        ["IIIC2", "Para-aortic node metastasis up to renal vessels, with or without pelvic nodes: i = micro, ii = macro"],
        ["IV", "Spread to bladder or bowel mucosa and/or distant metastasis"],
        ["IVA", "Invasion of bladder mucosa and/or intestinal / bowel mucosa"],
        ["IVB", "Abdominal peritoneal metastasis beyond the pelvis"],
        ["IVC", "Distant metastasis: nodes above renal vessels, lung, liver, brain, bone"]]
table(s, 0.4, 1.25, [1.1, 6.9], rows, size=12, first_fills={1: NAVY, 8: NAVY})
box(s, 8.7, 1.25, 4.25, 0.45, "Key changes from FIGO 2009", fill=MAG, size=14, bold=True)
bullets(s, 8.7, 1.8, 4.25, 5.1, [
    "Histotype, LVSI and molecular class now incorporated",
    "New subcategories: IA1-IA3, IC, IIB, IIC",
    "Peritoneal washings no longer part of staging",
    "Nodal disease split into micro (i) and macro (ii) metastasis; isolated tumour cells do not upstage",
    "Peritoneal disease split into pelvic (IIIB2) and abdominal (IVB)",
    "Report stage with molecular annotation (suffix m)",
], size=12, space=4)

# ------------------------------------------------------------------ 11 RISK GROUPS
s = new_slide("ESGO-ESTRO-ESP 2025 Prognostic Risk Groups",
              "ESGO-ESTRO-ESP guidelines for endometrial carcinoma: update 2025 (Lancet Oncol 2025; Fig. 3). Simplified; check the full figure for edge cases")
rows = [["Risk group", "5-year recurrence", "Typical FIGO 2023 + molecular profile", "Adjuvant approach"],
        ["Low", "Under 8%", "IAm POLEmut (stage I-II); IA1-IA3 MMRd or NSMP low-grade ER+", "No adjuvant therapy"],
        ["Intermediate", "8-14%", "IBm MMRd or NSMP low-grade ER+, and selected IA disease", "Vaginal brachytherapy; observation in selected cases"],
        ["High-intermediate", "15-24%", "Deeper or more extensive early disease, e.g. stage II MMRd / NSMP low-grade, substantial LVSI", "EBRT; vaginal brachytherapy if pN0; none if pN0, low grade, no substantial LVSI"],
        ["High", "25% or more", "IA2-IB or II NSMP high-grade / ER-negative or p53abn; stage III-IVA non-POLEmut", "Chemoradiotherapy (chemo plus EBRT), with immunotherapy in advanced disease"],
        ["Uncertain", "Insufficient data", "IA1 / IC with p53abn or NSMP high-grade; stage III-IVA POLEmut", "Individualised, MDT decision"]]
fills = {1: GREEN, 2: YELLOW, 3: ORANGE, 4: RED, 5: SLATE}
b = table(s, 0.4, 1.25, [1.9, 1.6, 4.7, 4.3], rows, size=12, first_fills=fills)
box(s, 0.4, b + 0.25, 12.5, 0.9,
    "Without molecular classification, risk grouping is less accurate, especially in high-grade histologies. "
    "All patients should have molecular profiling and lymph node assessment (sentinel node in uterine-confined disease).",
    fill=PALE, color=NAVY, size=13, line=TEAL)

# ------------------------------------------------------------------ 12 MGMT OVERVIEW FLOW
s = new_slide("Management Overview", "ESGO-ESTRO-ESP 2025; Berek & Novak's Gynecology; Goldman-Cecil Medicine")
box(s, 3.9, 1.2, 5.5, 0.65, "Confirmed endometrial carcinoma:\nhistology + molecular class + imaging", fill=NAVY, size=12, bold=None)
cols = [(0.5, "Presumed uterus-confined (stage I-II)", TEAL,
         "Minimally invasive hysterectomy + BSO\nSentinel node biopsy\nOmentectomy if serous, carcinosarcoma, undifferentiated"),
        (4.7, "Suspected advanced (stage III-IV)", ORANGE,
         "MDT review\nSurgery if complete resection is feasible\nOtherwise systemic therapy +/- RT"),
        (8.9, "Fertility wish or medically unfit", SLATE,
         "Fertility: progestin +/- LNG-IUS with hysteroscopy\nUnfit: vaginal hysterectomy or definitive RT, hormonal therapy")]
for x, hd, col, body in cols:
    box(s, x, 2.3, 3.9, 0.55, hd, fill=col, size=13, bold=True)
    arrow(s, 6.65, 1.85, x + 1.95, 2.3)
    box(s, x, 3.05, 3.9, 1.85, body, fill=LIGHT, color=DARK, size=12, line=col)
    arrow(s, x + 1.95, 2.85, x + 1.95, 3.05)
    arrow(s, x + 1.95, 4.9, 6.65, 5.3)
box(s, 2.2, 5.3, 8.9, 0.65, "Final pathology + molecular class: FIGO 2023 stage and prognostic risk group", fill=MAG, size=13, bold=True)
arrow(s, 6.65, 5.95, 6.65, 6.25)
box(s, 2.2, 6.25, 8.9, 0.65, "Adjuvant therapy by risk group, then structured follow-up", fill=NAVY, size=13, bold=True)

# ------------------------------------------------------------------ 13 SURGERY
s = new_slide("Surgical Management", "ESGO-ESTRO-ESP 2025; Berek & Novak's Gynecology (laparoscopy and robotics in endometrial cancer)")
rows = [["Element", "Recommendation"],
        ["Approach", "Minimally invasive surgery is preferred, including for high-risk disease (level I, A). Robotics may help in morbidly obese patients; laparoscopy gives less blood loss, shorter stay and equal survival vs laparotomy"],
        ["Standard procedure", "Total hysterectomy + bilateral salpingo-oophorectomy + lymph node staging (stage I-II)"],
        ["Tumour handling", "Avoid intraperitoneal spillage, uterine rupture or morcellation (even in a bag); use mini-laparotomy or endobag if vaginal extraction is risky"],
        ["Omentectomy", "Infracolic omentectomy for clinical stage I-II serous, carcinosarcoma and undifferentiated carcinoma; not needed for other types"],
        ["Cervical involvement", "No routine radical hysterectomy; extend only if needed for free margins"],
        ["Ovarian preservation", "May be considered in carefully selected young, low-risk stage I women; discuss Lynch and family history"],
        ["Advanced disease", "Cytoreduction to no residual disease if feasible; palliative surgery for bleeding, fistula or obstruction"],
        ["Medically unfit", "Vaginal hysterectomy + BSO if feasible; otherwise definitive radiotherapy"],
        ["Peritoneal washings", "Not part of staging since FIGO 2009 and not required"]]
table(s, 0.4, 1.25, [2.5, 10.0], rows, size=12)

# ------------------------------------------------------------------ 14 SLN FLOW
s = new_slide("Sentinel Lymph Node Algorithm", "ESGO-ESTRO-ESP 2025; FIRES trial (Berek & Novak's Gynecology)")
box(s, 0.4, 1.3, 3.0, 1.0, "Presumed uterus-confined disease", fill=NAVY, size=13, bold=True)
box(s, 4.0, 1.3, 3.3, 1.0, "Cervical injection of indocyanine green (preferred tracer)", fill=TEAL, size=12, bold=None)
box(s, 7.9, 1.3, 2.4, 1.0, "Pelvic mapping", fill=TEAL, size=13, bold=True)
box(s, 10.9, 1.3, 2.0, 1.0, "Bilateral detection?", fill=MAG, size=13, bold=True)
arrow(s, 3.4, 1.8, 4.0, 1.8); arrow(s, 7.3, 1.8, 7.9, 1.8); arrow(s, 10.3, 1.8, 10.9, 1.8)
box(s, 9.0, 3.0, 3.9, 1.2, "YES: remove sentinel nodes and ultrastage\n(no further lymphadenectomy)", fill=GREEN, size=12, bold=None)
arrow(s, 11.9, 2.3, 11.9, 3.0)
box(s, 4.0, 3.0, 4.4, 1.2, "NO: re-inject tracer; if still failed, side-specific lymphadenectomy in non-low-risk disease (low risk: MDT may omit)", fill=ORANGE, size=11, bold=None)
arrow(s, 11.4, 2.3, 6.2, 3.0)
box(s, 0.4, 3.0, 3.2, 1.2, "Suspicious or bulky nodes: remove regardless of mapping", fill=RED, size=12, bold=None)
arrow(s, 9.1, 2.3, 2.0, 3.0)
box(s, 0.4, 4.6, 12.5, 0.45, "Nodal result and FIGO 2023 category", fill=MAG, size=14, bold=True)
rows = [["Finding", "Size", "Stage / action"],
        ["Isolated tumour cells (ITC)", "Up to 0.2 mm", "pN0(i+); does not upstage; treat according to risk group"],
        ["Micrometastasis", "0.2 to 2 mm", "IIIC1i (pelvic) or IIIC2i (para-aortic)"],
        ["Macrometastasis", "Over 2 mm", "IIIC1ii or IIIC2ii; adjuvant chemotherapy +/- RT"]]
table(s, 0.4, 5.15, [3.6, 2.3, 6.6], rows, size=12)
tb(s, 0.4, 6.75, 12.5, 0.3, "Ultrastaging: serial sections at 2 or more levels with H&E and cytokeratin IHC. Lymphadenectomy after total hysterectomy is considered only if it changes treatment.",
   size=10, color=GREY, italic=True)

# ------------------------------------------------------------------ 15 ADJUVANT
s = new_slide("Adjuvant Therapy by Risk Group", "ESGO-ESTRO-ESP 2025 (Fig. 5 algorithms); PORTEC-2, PORTEC-3, PORTEC-4a")
rows = [["Risk group", "Option", "Details"],
        ["Low", "Observation", "No adjuvant therapy (includes POLEmut stage I-II)"],
        ["Intermediate", "Vaginal brachytherapy (VBT)", "e.g. 21 Gy in 3 fractions of 7 Gy; omission can be considered in selected cases"],
        ["High-intermediate", "EBRT, or VBT if pN0", "EBRT for optimal pelvic control (II, A); VBT alternative after nodal staging pN0; no treatment if pN0, low grade, no substantial LVSI"],
        ["High", "Chemoradiotherapy", "EBRT with chemotherapy (concurrent and/or sequential); p53abn and serous gain most"],
        ["Stage III-IVA", "Chemotherapy +/- EBRT +/- immunotherapy", "Carboplatin-paclitaxel; dostarlimab or other ICI in selected settings; MDT-based"],
        ["Uncertain", "Individualised", "MDT decision, e.g. POLEmut stage III-IVA or p53abn IA1 without invasion"]]
fills = {1: GREEN, 2: YELLOW, 3: ORANGE, 4: RED, 5: RED, 6: SLATE}
b = table(s, 0.4, 1.25, [2.1, 3.1, 7.3], rows, size=12, first_fills=fills)
box(s, 0.4, b + 0.25, 12.5, 0.45, "Reference doses and regimens", fill=MAG, size=14, bold=True)
bullets(s, 0.4, b + 0.78, 12.5, 1.5, [
    ("EBRT:", "45-50.4 Gy in 1.8 Gy fractions to the pelvis (extended field if para-aortic nodes are involved)."),
    ("Chemotherapy:", "carboplatin AUC 5 + paclitaxel 175 mg/m2 every 3 weeks, 4-6 cycles (six cycles is standard in advanced disease)."),
    ("Principle:", "treat on integrated molecular risk, not on stage alone; POLEmut can be de-escalated, p53abn escalated."),
], size=12, space=3)

# ------------------------------------------------------------------ 16 TRIALS ADJUVANT
s = new_slide("Key Adjuvant Trials", "PORTEC-1/2/3/4a, GOG-99, GOG-258 primary publications; ESGO-ESTRO-ESP 2025; Berek & Novak's Gynecology")
rows = [["Trial", "Population", "Comparison", "Main finding"],
        ["PORTEC-1 / GOG-99", "Intermediate-risk stage I", "Pelvic EBRT vs observation", "Fewer locoregional relapses; no overall survival benefit"],
        ["PORTEC-2", "High-intermediate risk", "VBT vs EBRT", "Equivalent vaginal control (about 98%); less GI toxicity with VBT"],
        ["PORTEC-3", "High-risk and stage III", "Chemoradiotherapy vs EBRT alone", "5-year OS 81.4% vs 76.1%; greatest benefit in p53abn, stage III and serous"],
        ["GOG-258", "Stage III-IVA", "Chemoradiotherapy vs chemotherapy alone", "No RFS gain; fewer pelvic and vaginal relapses with RT"],
        ["PORTEC-4a", "High-intermediate risk", "Molecular-profile-based vs standard adjuvant therapy", "Profile-guided treatment safe and effective; 46% spared adjuvant therapy"],
        ["RUBY", "Stage III-IV, recurrent", "Carboplatin-paclitaxel +/- dostarlimab", "PFS benefit, strongest in dMMR (HR about 0.28); OS benefit overall"]]
b = table(s, 0.4, 1.3, [2.2, 2.6, 3.6, 4.1], rows, size=12)
box(s, 0.4, b + 0.3, 12.5, 0.9,
    "Take-home: radiotherapy improves local control without clear survival gain in low-intermediate disease; "
    "chemotherapy adds benefit in p53abn, serous and node-positive disease; molecular profiling allows safe de-escalation.",
    fill=PALE, color=NAVY, size=13, line=TEAL)
tb(s, 0.4, b + 1.35, 12.5, 0.5, "Trial figures are quoted from the primary reports as recalled; verify exact values against the original publications before citing.",
   size=10, color=GREY, italic=True)

# ------------------------------------------------------------------ 17 ADVANCED / RECURRENT
s = new_slide("Advanced and Recurrent Disease: Systemic Therapy", "ESGO-ESTRO-ESP 2025; KEYNOTE-775, RUBY, NRG-GY018, DUO-E")
box(s, 0.4, 1.2, 7.4, 0.7, "Stage III-IV or recurrent EC: MDT review, biopsy relapse, repeat MMR / p53 / POLE / ER / HER2", fill=NAVY, size=12, bold=None)
bx = [(0.4, "Resectable or localised:\nsurgery to no residual disease +/- RT; vaginal relapse: EBRT + brachytherapy", TEAL),
      (2.925, "Unresectable or disseminated:\nMMR-guided chemo-immunotherapy", MAG),
      (5.45, "Low-grade, ER+, low volume or slow:\nendocrine therapy (progestin, letrozole)", SLATE)]
for x, t_, c_ in bx:
    box(s, x, 2.25, 2.35, 1.2, t_, fill=c_, size=11, bold=None)
    arrow(s, x + 1.17, 1.9, x + 1.17, 2.25)
box(s, 0.4, 3.9, 3.6, 1.45, "MMRd: carboplatin-paclitaxel + dostarlimab or durvalumab (or pembrolizumab); ICI alone is an option", fill=ORANGE, size=11, bold=None)
box(s, 4.2, 3.9, 3.6, 1.45, "pMMR / non-MMRd: carboplatin-paclitaxel + ICI (dostarlimab, durvalumab +/- olaparib, pembrolizumab)", fill=NAVY, size=11, bold=None)
arrow(s, 4.1, 3.45, 2.2, 3.9); arrow(s, 4.1, 3.45, 6.0, 3.9)
box(s, 0.4, 5.7, 7.4, 1.2,
    "After progression: MMRd, ICI-naive: dostarlimab or pembrolizumab. Non-MMRd: pembrolizumab + lenvatinib (I, A). "
    "HER2 3+: carboplatin-paclitaxel + trastuzumab. Others: doxorubicin, weekly paclitaxel, platinum, endocrine. Palliative RT and supportive care.",
    fill=LIGHT, color=DARK, size=11, line=NAVY)
arrow(s, 4.1, 5.35, 4.1, 5.7)
rows = [["Trial", "Setting", "Key result"],
        ["KEYNOTE-775", "2L: pembrolizumab + lenvatinib vs chemo", "Better PFS and OS (OS HR about 0.65)"],
        ["RUBY", "1L: + dostarlimab", "PFS HR about 0.28 in dMMR; OS benefit overall"],
        ["NRG-GY018", "1L: + pembrolizumab", "PFS HR about 0.30 dMMR, 0.54 pMMR"],
        ["DUO-E", "1L: + durvalumab +/- olaparib", "PFS gain in dMMR; olaparib adds in pMMR"]]
b = table(s, 8.1, 1.25, [1.4, 1.8, 1.65], rows, size=10)
tb(s, 8.1, b + 0.15, 4.85, 1.2, "Values approximate (primary reports). ICI approvals and reimbursement differ by country and label; confirm locally.",
   size=10, color=GREY, italic=True)

# ------------------------------------------------------------------ 18 SPECIAL SITUATIONS
s = new_slide("Special Situations", "ESGO/ESHRE/ESGE fertility-sparing guideline 2023; Berek & Novak's Gynecology; PMID 39878274 (2025 systematic review)")
cards = [("Fertility-sparing treatment", TEAL, [
            "Selected: young, grade 1 endometrioid, stage IA on MRI (no deep invasion), no extrauterine disease, strong wish for fertility",
            "Counselling on risks; hysteroscopic resection of lesion",
            "Megestrol acetate or MPA and/or LNG-IUS, GnRH analogue +/- ",
            "Biopsy every 3-6 months; if complete response, pursue pregnancy early (ART)",
            "Hysterectomy after childbearing or if no response by about 6-12 months",
            "Molecular profile (POLE, MMR, p53) predicts response (2025 meta-analysis)"]),
         ("Medically unfit", ORANGE, [
            "Vaginal hysterectomy + BSO if feasible",
            "Definitive radiotherapy (EBRT + brachytherapy) when surgery is contraindicated",
            "Progestin or LNG-IUS as palliative or bridging option",
            "Elderly: assess frailty; tailor adjuvant treatment"]),
         ("Incidental finding after hysterectomy", MAG, [
            "Review pathology and complete molecular profile",
            "Imaging (MRI / CT) to exclude residual disease",
            "Low risk: observe",
            "Not low risk: nodal assessment or adjuvant therapy per MDT; re-surgery for serous / carcinosarcoma with omentectomy if it changes treatment"])]
x = 0.4
for hd, col, items in cards:
    box(s, x, 1.25, 4.05, 0.55, hd, fill=col, size=14, bold=True)
    bullets(s, x, 1.9, 4.05, 5.0, items, size=12, space=5)
    x += 4.225

# ------------------------------------------------------------------ 19 FOLLOW-UP
s = new_slide("Follow-up and Recurrence", "ESGO-ESTRO-ESP 2025; Berek & Novak's Gynecology. Schedules vary by centre; follow local protocol")
rows = [["Item", "Recommendation"],
        ["Low / intermediate risk", "Clinical review about every 6 months for 3 years, then yearly to 5 years"],
        ["High-intermediate / high risk", "Review every 3-4 months for the first 2-3 years, then 6-monthly to 5 years"],
        ["Each visit", "Symptom review, pelvic and vaginal examination, toxicity and quality of life"],
        ["Tests", "Imaging only if symptoms or findings suggest relapse; routine CA-125 is not recommended"],
        ["Support", "Weight loss, exercise, diabetes control, vaginal dilators, sexual health; HRT may be considered in low-risk disease"]]
b = table(s, 0.4, 1.25, [2.9, 4.0], rows, size=11)
rows = [["Recurrence", "Management"],
        ["Isolated vaginal", "EBRT + brachytherapy if RT-naive; surgery or brachytherapy if irradiated"],
        ["Isolated pelvic or nodal", "Surgery (exenteration in selected) and/or RT; systemic therapy"],
        ["Distant or multiple", "Systemic therapy per MMR status (slide 17); palliative RT"],
        ["Low-grade ER+ slow", "Endocrine therapy"]]
table(s, 7.6, 1.25, [1.8, 3.5], rows, size=11)
box(s, 0.4, b + 0.25, 12.5, 0.45, "Prognosis (5-year survival by FIGO stage, approximate)", fill=MAG, size=14, bold=True)
rows = [["Stage I", "Stage II", "Stage III", "Stage IV"], ["About 90%", "About 70-80%", "About 50-60%", "About 15-25%"]]
table(s, 0.4, b + 0.8, [3.125, 3.125, 3.125, 3.125], rows, size=14, first_bold=False)

# ------------------------------------------------------------------ 20 SUMMARY
s = new_slide("Key Takeaways and References")
bullets(s, 0.4, 1.2, 7.4, 5.7, [
    "Postmenopausal bleeding mandates endometrial sampling; TVUS above 4-5 mm needs biopsy.",
    "MRI defines myometrial and cervical invasion; CT or PET-CT for high-risk or advanced disease.",
    "FIGO 2023 integrates histotype, LVSI and molecular class; report with suffix m.",
    "All tumours need POLE, MMR, p53 (and ER) testing; MMRd tumours need Lynch triage.",
    "Standard surgery: minimally invasive hysterectomy + BSO + sentinel node; omentectomy for serous-type tumours.",
    "Adjuvant therapy follows integrated risk: observe (low), VBT (intermediate), EBRT (high-intermediate), chemoradiotherapy (high).",
    "Advanced disease: carboplatin-paclitaxel with immunotherapy; pembrolizumab + lenvatinib after chemotherapy; endocrine therapy for slow ER+ disease.",
    "Fertility-sparing hormonal therapy is only for carefully selected grade 1 stage IA disease.",
], size=14, space=6)
box(s, 8.1, 1.2, 4.85, 0.45, "References", fill=MAG, size=14, bold=True)
bullets(s, 8.1, 1.75, 4.85, 5.2, [
    "Concin N et al. ESGO-ESTRO-ESP guidelines for endometrial carcinoma: update 2025. Lancet Oncol 2025 (PMID 40744042).",
    "Berek JS et al. FIGO staging of endometrial cancer 2023. Int J Gynaecol Obstet 2023.",
    "Berek & Novak's Gynecology.",
    "Goldman-Cecil Medicine, Ch. 184.",
    "Robbins Pathologic Basis of Disease.",
    "Grainger & Allison's Diagnostic Radiology, Ch. 34.",
    "Recent reviews: PMIDs 39878274, 39839791, 38578538 (molecular classification).",
], size=11, space=4)

prs.save("/tmp/workspace/endometrial-ppt/Endometrial_Carcinoma.pptx")
print("saved", state["n"], "slides")