const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE';
pres.title = 'BREAST SURGERY - NEET PG / INICET Rapid Revision Notes';
pres.author = 'Orris Medical AI';

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navyDark:  "0D1B2A",   // primary bg (dark slides)
  navy:      "1A2F4B",   // secondary bg
  teal:      "00B4D8",   // accent
  gold:      "FFD166",   // highlights / mnemonics
  green:     "06D6A0",   // correct / good prognosis
  red:       "EF233C",   // danger / warnings
  white:     "FFFFFF",
  lightGray: "E8EEF4",
  medGray:   "8DAEC9",
  orange:    "F4A261",
  purple:    "9B5DE5",
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function titleSlide(pres, title, subtitle) {
  let s = pres.addSlide();
  s.background = { color: C.navyDark };
  // Decorative top bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.08, fill: { color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: 13.3, h: 0.04, fill: { color: C.gold } });
  // Title
  s.addText(title, {
    x: 0.5, y: 1.5, w: 12.3, h: 2,
    fontSize: 44, bold: true, color: C.white,
    align: "center", fontFace: "Calibri"
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 0.5, y: 3.7, w: 12.3, h: 0.7,
      fontSize: 22, color: C.teal,
      align: "center", fontFace: "Calibri"
    });
  }
  s.addText("Source: Bailey & Love 28e | Schwartz 11e | S Das 13e", {
    x: 0.5, y: 6.8, w: 12.3, h: 0.4,
    fontSize: 13, color: C.medGray, align: "center"
  });
  return s;
}

function sectionHeader(pres, num, title, subtitle) {
  let s = pres.addSlide();
  s.background = { color: C.navy };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 7.5, fill: { color: C.teal } });
  s.addText(num, {
    x: 0.4, y: 1.5, w: 2, h: 1.5,
    fontSize: 72, bold: true, color: C.teal, fontFace: "Calibri"
  });
  s.addText(title, {
    x: 0.4, y: 3.2, w: 12, h: 1.2,
    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri"
  });
  if (subtitle) {
    s.addText(subtitle, {
      x: 0.4, y: 4.5, w: 12, h: 0.8,
      fontSize: 20, color: C.gold, fontFace: "Calibri"
    });
  }
  return s;
}

function contentSlide(pres, title, bullets, opts = {}) {
  let s = pres.addSlide();
  s.background = { color: opts.bg || C.white };
  // Header bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: opts.hdrColor || C.navyDark } });
  s.addText(title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 18, bold: true, color: C.white, valign: "middle", fontFace: "Calibri"
  });
  // Bottom accent line
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.06, fill: { color: C.teal } });

  let items = bullets.map((b, i) => {
    if (typeof b === "string") {
      return { text: b, options: { bullet: { code: "2022" }, fontSize: 14, color: opts.textColor || C.navyDark, breakLine: i < bullets.length - 1, paraSpaceBefore: 4 } };
    }
    return b;
  });
  s.addText(items, {
    x: 0.35, y: 0.85, w: opts.w || 12.6, h: opts.h || 6.3,
    valign: "top", fontFace: "Calibri"
  });
  return s;
}

function mnemonicSlide(pres, title, mnemonic, expansions, color) {
  let s = pres.addSlide();
  s.background = { color: C.navyDark };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: color || C.gold } });
  s.addText("🧠  " + title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 18, bold: true, color: C.navyDark, valign: "middle"
  });
  s.addText(mnemonic, {
    x: 0.4, y: 0.9, w: 12.5, h: 1.1,
    fontSize: 36, bold: true, color: color || C.gold, align: "center", fontFace: "Calibri"
  });
  let items = expansions.map((e, i) => ({
    text: e, options: { bullet: false, fontSize: 16, color: C.white, breakLine: i < expansions.length - 1, paraSpaceBefore: 6 }
  }));
  s.addText(items, {
    x: 0.4, y: 2.1, w: 12.5, h: 5.0, valign: "top", fontFace: "Calibri"
  });
  return s;
}

function twoColSlide(pres, title, leftItems, rightItems, opts = {}) {
  let s = pres.addSlide();
  s.background = { color: C.white };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: opts.hdrColor || C.navyDark } });
  s.addText(title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 18, bold: true, color: C.white, valign: "middle"
  });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.06, fill: { color: C.teal } });

  // Left col
  if (opts.leftLabel) {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.75, w: 5.9, h: 0.35, fill: { color: opts.leftColor || C.teal } });
    s.addText(opts.leftLabel, { x: 0.3, y: 0.75, w: 5.9, h: 0.35, margin: 0, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });
  }
  let lItems = leftItems.map((b, i) => ({
    text: b, options: { bullet: { code: "2022" }, fontSize: 13, color: C.navyDark, breakLine: i < leftItems.length - 1, paraSpaceBefore: 4 }
  }));
  s.addText(lItems, { x: 0.3, y: opts.leftLabel ? 1.15 : 0.85, w: 5.9, h: 5.8, valign: "top", fontFace: "Calibri" });

  // Divider
  s.addShape(pres.ShapeType.line, { x: 6.55, y: 0.8, w: 0, h: 6.3, line: { color: C.medGray, width: 0.5, dashType: "dash" } });

  // Right col
  if (opts.rightLabel) {
    s.addShape(pres.ShapeType.rect, { x: 6.8, y: 0.75, w: 6.2, h: 0.35, fill: { color: opts.rightColor || C.orange } });
    s.addText(opts.rightLabel, { x: 6.8, y: 0.75, w: 6.2, h: 0.35, margin: 0, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle" });
  }
  let rItems = rightItems.map((b, i) => ({
    text: b, options: { bullet: { code: "2022" }, fontSize: 13, color: C.navyDark, breakLine: i < rightItems.length - 1, paraSpaceBefore: 4 }
  }));
  s.addText(rItems, { x: 6.8, y: opts.rightLabel ? 1.15 : 0.85, w: 6.2, h: 5.8, valign: "top", fontFace: "Calibri" });
  return s;
}

function tableSlide(pres, title, headers, rows, opts = {}) {
  let s = pres.addSlide();
  s.background = { color: C.white };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: opts.hdrColor || C.navyDark } });
  s.addText(title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 18, bold: true, color: C.white, valign: "middle"
  });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.06, fill: { color: C.teal } });

  let tableData = [
    headers.map(h => ({ text: h, options: { bold: true, fill: { color: opts.headerFill || C.navy }, color: C.white, fontSize: 13, align: "center" } })),
    ...rows.map((row, ri) => row.map(cell => ({
      text: cell,
      options: { fill: { color: ri % 2 === 0 ? C.lightGray : C.white }, fontSize: 12, color: C.navyDark }
    })))
  ];

  s.addTable(tableData, {
    x: 0.3, y: 0.85, w: 12.7,
    border: { type: "solid", color: C.medGray, pt: 0.5 },
    fontFace: "Calibri"
  });
  return s;
}

function flowSlide(pres, title, steps, opts = {}) {
  let s = pres.addSlide();
  s.background = { color: opts.bg || C.lightGray };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: opts.hdrColor || C.navyDark } });
  s.addText(title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 18, bold: true, color: C.white, valign: "middle"
  });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.06, fill: { color: C.teal } });

  const colors = opts.colors || [C.navy, C.teal, C.green, C.orange, C.purple, C.red, C.gold, C.navyDark];
  const totalSteps = steps.length;
  const boxW = 11.5 / totalSteps;
  const arrowW = 0.2;
  const startX = 0.5;
  const y = 1.8;
  const boxH = opts.boxH || 1.2;

  steps.forEach((step, i) => {
    const x = startX + i * (boxW + arrowW);
    const col = colors[i % colors.length];
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: boxW, h: boxH,
      fill: { color: col },
      line: { color: C.white, width: 1 }
    });
    s.addText(step.label || step, {
      x, y, w: boxW, h: boxH,
      fontSize: opts.labelSize || 11, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri"
    });
    if (i < totalSteps - 1) {
      s.addShape(pres.ShapeType.line, {
        x: x + boxW, y: y + boxH / 2, w: arrowW, h: 0,
        line: { color: C.navyDark, width: 1.5, endArrowType: "triangle" }
      });
    }
    if (step.sub) {
      s.addText(step.sub, {
        x: x, y: y + boxH + 0.1, w: boxW, h: 1.0,
        fontSize: 10, color: C.navyDark, align: "center", valign: "top", fontFace: "Calibri"
      });
    }
  });
  return s;
}

function examAlertSlide(pres, title, points, color) {
  let s = pres.addSlide();
  s.background = { color: C.navyDark };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color: color || C.red } });
  s.addText("⚡  NEET PG / INICET HIGH-YIELD: " + title, {
    x: 0.3, y: 0, w: 12.7, h: 0.7, margin: 0,
    fontSize: 16, bold: true, color: C.white, valign: "middle"
  });
  let items = points.map((p, i) => ({
    text: (i + 1) + ". " + p,
    options: { bullet: false, fontSize: 14, color: i % 2 === 0 ? C.gold : C.white, breakLine: i < points.length - 1, paraSpaceBefore: 8 }
  }));
  s.addText(items, {
    x: 0.4, y: 0.85, w: 12.5, h: 6.3, valign: "top", fontFace: "Calibri"
  });
  return s;
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE CREATION
// ─────────────────────────────────────────────────────────────────────────────

// SLIDE 1: TITLE
titleSlide(pres,
  "BREAST SURGERY",
  "NEET PG & INICET Rapid Revision Notes 2025-26\nBailey & Love 28e | Schwartz 11e | S Das 13e | Robbins Pathology"
);

// ─── SECTION 1: ANATOMY ─────────────────────────────────────────────────────
sectionHeader(pres, "01", "SURGICAL ANATOMY OF BREAST", "Lymphatics • Blood Supply • Axillary Levels • Cooper's Ligaments");

contentSlide(pres, "Breast Anatomy — Key Facts for NEET PG", [
  "Location: Overlies 2nd–6th rib, between sternum & mid-axillary line; lies on pectoralis major, serratus anterior, and external oblique",
  "Tail of Spence: axillary tail penetrating deep fascia — only part outside superficial fascia",
  "Structure: 15–20 lobes, each drained by a lactiferous duct → opens at nipple; lactiferous sinus = ampulla just beneath nipple",
  "TDLU (Terminal Ducto-Lobular Unit) = functional unit of the breast; site of origin of most breast cancers",
  "Cooper's ligaments: suspensory ligaments from skin to deep fascia; dimpling in Ca breast due to infiltration",
  "Retromammary space: between deep fascia of breast & pectoral fascia — pathway for spread of carcinoma",
  "Subareolar plexus (Sappey's plexus): rich network responsible for lymphatic drainage",
  "Blood supply: lateral thoracic artery (main), internal mammary perforators (medial), thoracoacromial artery",
  "Nerve supply: medial & lateral cutaneous branches of 2nd–6th intercostal nerves; nipple = T4 dermatome"
], { hdrColor: C.navy });

tableSlide(pres,
  "Axillary Lymph Node Levels (CRITICAL for NEET PG)",
  ["Level", "Location", "Landmark", "Clinical Significance"],
  [
    ["Level I (Low axilla)", "Lateral to lateral border of pectoralis minor", "Most lateral group", "First draining level; sampled in SLND"],
    ["Level II (Mid axilla)", "Posterior to pectoralis minor", "Central axillary nodes", "Included in ALND"],
    ["Level III (Apex)", "Medial to medial border of pectoralis minor", "Infraclavicular nodes", "Rotter's nodes between pectoralis major & minor = interpectoral nodes"],
    ["Rotter's nodes", "Between pectoralis major & minor", "Interpectoral", "Skips axilla → direct spread; preserved in modified radical mastectomy"],
    ["Internal mammary nodes", "Along internal mammary vessels", "Parasternal", "Medial quadrant tumors drain here; prognostically important"],
  ],
  { hdrColor: C.navy, headerFill: C.navy }
);

mnemonicSlide(pres,
  "Lymphatic Drainage — Mnemonic",
  "\"ALL Surgeons CLIP Carefully\"",
  [
    "A = Anterior / Pectoral nodes (most common group receiving breast lymphatics)",
    "L = Lateral (brachial) nodes — drain arm",
    "L = Level I → II → III (direction of lymph flow)",
    "S = Subscapular (posterior) nodes",
    "C = Central nodes (receive from all others)",
    "L = Level III → Subclavian trunk → junction of internal jugular & subclavian",
    "I = Internal mammary nodes (important for medial/central quadrant drainage)",
    "P = Parasternal / 75% of lymph drains to axilla; 25% to internal mammary",
    "★ 97% of breast lymph drains to ipsilateral axilla (Level I first)"
  ],
  C.teal
);

contentSlide(pres, "Nipple & Areola — High-Yield Points", [
  "Nipple: projects at level of 4th intercostal space (T4 dermatome)",
  "Areola: circular pigmented area; contains Montgomery glands (modified sebaceous glands) — lubricates nipple during lactation",
  "Inversion of nipple: congenital (bilateral, since puberty) vs acquired (unilateral, recent onset — MALIGNANT until proved otherwise)",
  "Accessory nipples (polythelia): along milk ridge from axilla to groin; most common supernumerary structures",
  "Galactorrhea: milk secretion outside pregnancy/lactation; causes: prolactinoma, hypothyroidism, drugs (metoclopramide, domperidone, antipsychotics)",
  "Paget's disease of nipple: eczematoid destruction of nipple from in situ carcinoma tracking along ducts — always associated with underlying DCIS/invasive Ca",
  "NEET TIP: Paget's disease = epidermotropism of malignant cells; Toker cells (clear cells of nipple) are its benign counterpart"
], { hdrColor: C.navy });

// ─── SECTION 2: BENIGN BREAST DISEASE ──────────────────────────────────────
sectionHeader(pres, "02", "BENIGN BREAST DISEASE (ANDI)", "Aberrations of Normal Development & Involution — Cardiff Concept");

tableSlide(pres,
  "ANDI Classification (Bailey & Love 28e)",
  ["Phase", "Age", "Normal Process", "Aberration (ANDI)", "Disease"],
  [
    ["Early reproductive\n(15–25 yr)", "Lobule development", "Fibroadenoma (small)", "Giant fibroadenoma; Multiple fibroadenomata"],
    ["", "Stroma development", "Juvenile hypertrophy", "Gigantomastia"],
    ["Reproductive\n(15–50 yr)", "Cyclical changes\n(epithelium)", "Cyclical mastalgia\nNodularity", "Severe mastalgia\nPersistent nodularity"],
    ["", "Cyclical changes\n(stroma)", "Cyclical nodularity\n(ANDI)", "Diffuse lumpy breast"],
    ["Involution\n(35–55 yr)", "Lobular involution", "Macrocysts, microcysts", "Symptomatic cysts"],
    ["", "Ductal involution", "Nipple retraction\nPeriductal fibrosis", "Mammary duct ectasia"],
    ["", "Epithelial turnover", "Mild hyperplasia", "Moderate/florid hyperplasia,\nADH → risk lesion"],
  ],
  { hdrColor: C.teal, headerFill: C.teal }
);

contentSlide(pres, "Fibroadenoma — NEET PG Favorite", [
  "MOST COMMON benign tumor of breast in young women (15–35 yrs)",
  "Pathology: fibroepithelial tumor; 2 types — intracanalicular (stroma compresses ducts → slit-like appearance) and pericanalicular (stroma surrounds round/oval ducts)",
  "Clinical: smooth, firm, mobile, non-tender, rubbery lump — 'breast mouse' due to high mobility",
  "Size: typically <3 cm; Giant FA = >5 cm (or >10 cm); Juvenile FA = rapidly growing in adolescents",
  "Phyllodes tumor (cystosarcoma phyllodes): fibroepithelial tumor, OLDER women (>40 yr), leaf-like projections on cut section; locally aggressive",
  "Phyllodes: benign (50%), borderline (25%), malignant (25%); stroma is the malignant component; treat with wide excision (1 cm margin); recurrence common",
  "Management of FA: observe if <35 yr + classic clinical features; FNAC/core biopsy + excision if >35 yr, rapid growth, size >3 cm, or patient anxiety",
  "NEET TIP: Phyllodes is NOT a sarcoma; it has epithelial lining; stromal sarcomatous change makes it malignant"
], { hdrColor: C.teal });

twoColSlide(pres,
  "Breast Cysts vs Breast Abscess",
  [
    "Most common in 40–55 yr (perimenopausal)",
    "ANDI — cystic involution of TDLU",
    "Types: macrocyst (palpable >3 mm), microcyst",
    "Smooth, well-defined, fluctuant",
    "Diagnosis: USS (anechoic, round, posterior enhancement)",
    "Treatment: aspiration (send fluid only if blood-stained or residual lump)",
    "Blue-domed cyst (Bloodgood's cyst) = old straw-colored fluid appears blue through thinned-out wall",
    "Risk: simple cysts — NO increased risk; complex cysts — slight ↑ risk",
    "Recurrent cysts after aspiration → excision biopsy"
  ],
  [
    "Acute: usually lactational; S. aureus most common organism",
    "Periareolar (non-lactational): young women, smokers; anaerobes + S. aureus; associated with periductal mastitis",
    "Treatment: ANTIBIOTICS first (flucloxacillin); if fluctuant → aspirate or incise & drain",
    "I&D: radial incision to avoid injury to lactiferous ducts",
    "Mammary duct ectasia: inspissated secretions → periductal mastitis → cheesy/green discharge → nipple retraction (slit-like) → plasma cell mastitis",
    "Tuberculous mastitis: secondary to pulmonary TB; cold abscess; sinus formation; diagnose by ZN stain / culture",
    "Mondor's disease: superficial thrombophlebitis of thoracoepigastric vein; tender cord on breast; self-limiting; Tx: NSAIDs",
    "Granulomatous mastitis: idiopathic; mimics Ca; treat with steroids/methotrexate"
  ],
  { leftLabel: "BREAST CYSTS", rightLabel: "BREAST ABSCESS / INFECTIONS", leftColor: C.teal, rightColor: C.orange }
);

// Nipple Discharge
contentSlide(pres, "Nipple Discharge — Classification & Management", [
  "Physiological: bilateral, multiple ducts, non-spontaneous, milky/green/yellow — REASSURE",
  "Pathological: unilateral, single duct, spontaneous, blood-stained — INVESTIGATE",
  "Causes of pathological discharge:",
  "  - Bloody: ductal papilloma (MC cause), DCIS, Paget's, Ca",
  "  - Clear/serous: duct ectasia, fibrocystic change",
  "  - Milky bilateral (galactorrhea): prolactinoma, drugs, hypothyroidism",
  "  - Purulent: abscess/mastitis",
  "Investigation: cytology of discharge, mammogram + ultrasound, ductogram (galactography), MRI",
  "Microdochectomy: single duct excision for solitary papilloma",
  "Hadfield's operation (total duct excision / Adair-Patey): all major ducts excised for duct ectasia, recurrent discharge",
  "NEET TIP: Solitary intraductal papilloma = MC cause of blood-stained nipple discharge; subareolar location"
], { hdrColor: C.orange });

// Risk assessment
contentSlide(pres, "Benign Breast Lesions — Cancer Risk Classification", [
  "No increased risk (1×): adenosis, apocrine metaplasia, cysts, mild hyperplasia, fibroadenoma, mastitis, fat necrosis, duct ectasia",
  "Slightly increased risk (1.5–2×): moderate/florid hyperplasia without atypia, sclerosing adenosis, solitary papilloma",
  "Moderately increased risk (4–5×): atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH)",
  "★ Lobular carcinoma in situ (LCIS): risk marker (not a cancer); 1–2% per year risk of subsequent invasive Ca; bilateral risk",
  "DCIS vs LCIS: DCIS = pre-cancer (unicentric, calcifications on mammo); LCIS = risk marker (multicentric, bilateral, no calcifications)",
  "High risk: LCIS + family history → RR 10×",
  "NEET TIP: ADH + 1st-degree family history = RELATIVE RISK 10× (Dupont & Page)",
  "Radial scar (complex sclerosing lesion): stellate lesion mimicking Ca on mammogram; requires excision to exclude Ca"
], { hdrColor: C.purple });

// ─── SECTION 3: CARCINOMA BREAST ─────────────────────────────────────────────
sectionHeader(pres, "03", "CARCINOMA OF THE BREAST", "Epidemiology • Risk Factors • Pathology • Molecular Subtypes");

contentSlide(pres, "Epidemiology & Risk Factors", [
  "Most common cancer in women worldwide; accounts for 25% of all female cancers",
  "In India: median age ~48 yr (vs ~60 yr in West); incidence rising in urban areas",
  "BRCA1 (chromosome 17q21): 50–85% lifetime risk; associated with triple-negative Ca, ovarian Ca",
  "BRCA2 (chromosome 13q12): 50–85% lifetime risk; associated with male breast Ca, pancreatic Ca",
  "BRCA1/2 mutations account for only 5–10% of all breast cancers",
  "Gail Model: estimates 5-year and lifetime risk; uses age, menarche, nulliparity, FHx, prior biopsies, atypical hyperplasia",
  "High-risk threshold: >1.7% in 5 years or >20% lifetime risk → chemoprevention (tamoxifen/raloxifene)",
  "Radiation exposure: RR = 6 (highest modifiable risk); atomic bomb survivors, prior chest RT",
  "Protective factors: early first full-term pregnancy (<20 yr), prolonged breastfeeding, oophorectomy"
], { hdrColor: C.red });

mnemonicSlide(pres,
  "Risk Factors for Breast Cancer — 'OESTROGENIC EXPOSURE'",
  "\"EARLY MENARCHE, LATE MENOPAUSE = MORE EXPOSURE\"",
  [
    "E = Early menarche (<12 yr) → ↑ risk",
    "L = Late menopause (>55 yr) → ↑ risk",
    "N = Nulliparity or late first pregnancy (>35 yr) → ↑ risk",
    "H = HRT use (>10 yr combined OCP) → ↑ risk",
    "R = Radiation exposure → RR 6",
    "A = Alcohol (>3 drinks/day → RR 1.46)",
    "O = Obesity / BMI >30 (postmenopausal) → ↑ risk",
    "F = Family history + BRCA1/2 → HIGHEST non-modifiable risk",
    "PROTECTIVE: Breastfeeding >12 months, early first childbirth, exercise, aspirin"
  ],
  C.red
);

// Molecular subtypes table
tableSlide(pres,
  "Molecular Classification of Breast Cancer (PAM-50 / IHC Surrogates)",
  ["Subtype", "ER/PR", "HER2", "Ki-67", "Grade", "Prognosis", "Treatment"],
  [
    ["Luminal A", "+", "-", "Low (<14%)", "I/II", "BEST", "Endocrine therapy alone"],
    ["Luminal B (HER2-)", "+", "-", "High (≥14%)", "II/III", "Intermediate", "Endocrine + Chemo"],
    ["Luminal B (HER2+)", "+", "+", "Any", "II/III", "Intermediate", "Endocrine + Anti-HER2 + Chemo"],
    ["HER2-enriched", "-", "+", "High", "III", "Poor (improving)", "Anti-HER2 + Chemo"],
    ["Triple Negative (Basal)", "-", "-", "High", "III", "WORST", "Chemo only (PARP inhibitors if BRCA+)"],
  ],
  { hdrColor: C.red, headerFill: C.red }
);

contentSlide(pres, "Histopathological Types of Breast Carcinoma", [
  "Origin: 90% ductal, 10% lobular (from lobules)",
  "IN SITU CARCINOMAS:",
  "  DCIS: No basement membrane breach; comedo (central necrosis + calcification, high grade) vs non-comedo types; unicentric; ER+; treat with lumpectomy ± RT ± tamoxifen",
  "  LCIS: Lobular, multicentric, bilateral; no calcifications; risk marker NOT pre-cancer; treat with surveillance ± chemoprevention",
  "INVASIVE (INFILTRATING) CARCINOMAS:",
  "  NST (No Special Type, formerly IDC): MC type; 70–80%; hard, scirrhous consistency",
  "  ILC (Invasive Lobular): 10–15%; bilateral; 'Indian file' pattern; may not form mass; ER+ almost always",
  "  Mucinous (colloid): large mucin pools; better prognosis; ER+",
  "  Medullary: syncytial growth, heavy lymphocytic infiltrate; better prognosis; often BRCA1 / triple negative",
  "  Tubular: best prognosis of invasive; well-formed tubules; ER+; rarely spreads to nodes",
  "  Inflammatory Ca: T4d; peau d'orange; erythema >1/3 breast; NO palpable mass usually; WORST prognosis; Dx = dermal lymphatic emboli on skin biopsy"
], { hdrColor: C.red });

mnemonicSlide(pres,
  "Bloom-Richardson Grading System — Mnemonic",
  "\"TNM for Grading\" → Tubules, Nuclear Pleomorphism, Mitoses",
  [
    "T = Tubule formation: Score 1 (>75% tubules) to Score 3 (<10% tubules)",
    "N = Nuclear pleomorphism: Score 1 (small, regular) to Score 3 (marked variation)",
    "M = Mitoses per HPF: Score 1 (low) to Score 3 (high)",
    "Total Score:",
    "  Grade I (Well differentiated): 3–5",
    "  Grade II (Moderately differentiated): 6–7",
    "  Grade III (Poorly differentiated): 8–9",
    "★ Used in modified Scarff-Bloom-Richardson (Nottingham) grading system",
    "★ NEET TIP: Higher grade = worse prognosis; Grade III = triple negative or HER2-enriched often"
  ],
  C.orange
);

// ─── SECTION 4: CLINICAL FEATURES & INVESTIGATIONS ──────────────────────────
sectionHeader(pres, "04", "CLINICAL FEATURES & INVESTIGATIONS", "Triple Assessment • Mammography • USS • FNAC • Core Biopsy");

contentSlide(pres, "Clinical Features of Breast Carcinoma", [
  "PAINLESS lump (MC presentation) — hard, irregular, ill-defined, fixed",
  "Skin changes: peau d'orange (lymphatic obstruction → dimpling between hair follicles), dimpling (Cooper's ligament tethering), ulceration, erythema",
  "Nipple changes: retraction (recent onset!), Paget's disease (eczematoid, unilateral, starts at nipple tip), bloody discharge",
  "Axillary lymphadenopathy: hard, matted nodes → think N2 disease",
  "Arm edema: from axillary nodal block (N3 disease or post-treatment)",
  "Peau d'orange ≠ inflammatory Ca: PdO is skin sign; inflammatory Ca requires >1/3 breast involvement + erythema",
  "Signs of locally advanced disease (LABC): skin involvement, chest wall fixity, N2-N3 nodes, >5 cm tumor",
  "Clinical breast examination: compare both breasts systematically; examine supine + sitting; all 4 quadrants + central + axillary tail",
  "Upper outer quadrant (UOQ) most common site: 50% of all breast cancers (largest volume of breast tissue)"
], { hdrColor: C.purple });

// Triple Assessment
flowSlide(pres,
  "TRIPLE ASSESSMENT — Gold Standard for Breast Lump Evaluation",
  [
    { label: "1. CLINICAL\nEXAMINATION", sub: "History + Inspection\n+ Palpation" },
    { label: "2. IMAGING\n(Mammogram\n+ USS)", sub: "Mammo <35yr\nUSS preferred\nBI-RADS 1–6" },
    { label: "3. PATHOLOGY\n(FNAC or Core\nBiopsy)", sub: "FNAC: C1–C5\nCore biopsy:\npreferably" },
    { label: "CONCORDANT\nBENIGN → DISCHARGE\nor FOLLOW-UP", sub: "All 3 benign\n= safe" },
    { label: "ANY DISCORDANT\n→ EXCISION\nBIOPSY", sub: "One suspicious\n= proceed" },
  ],
  { colors: [C.navy, C.teal, C.purple, C.green, C.red] }
);

tableSlide(pres,
  "BI-RADS Classification (ACR) — Must Know for NEET PG",
  ["BI-RADS", "Assessment", "Malignancy Risk", "Action"],
  [
    ["0", "Incomplete — needs additional imaging", "N/A", "Call back for more imaging"],
    ["1", "Negative (normal)", "0%", "Routine annual screening"],
    ["2", "Benign finding", "0%", "Routine annual screening"],
    ["3", "Probably benign", ">0% to ≤2%", "Short-term follow-up (6 months)"],
    ["4A", "Low suspicion", ">2% to ≤10%", "Tissue diagnosis (biopsy)"],
    ["4B", "Intermediate suspicion", ">10% to ≤50%", "Tissue diagnosis"],
    ["4C", "High suspicion", ">50% to <95%", "Tissue diagnosis"],
    ["5", "Highly suggestive of malignancy", "≥95%", "Biopsy + treatment"],
    ["6", "Known biopsy-proven malignancy", "N/A", "Awaiting definitive treatment"],
  ],
  { hdrColor: C.purple, headerFill: C.purple }
);

contentSlide(pres, "FNAC vs Core Needle Biopsy — NEET PG Comparison", [
  "FNAC (Fine Needle Aspiration Cytology): 23G needle; aspirates cells; CYTOLOGY report (C1–C5)",
  "  C1 = Inadequate/unsatisfactory",
  "  C2 = Benign",
  "  C3 = Atypia, probably benign",
  "  C4 = Suspicious of malignancy",
  "  C5 = Malignant",
  "FNAC Advantage: quick, cheap, OPD procedure; Disadvantage: cannot distinguish in situ from invasive; no ER/PR/HER2",
  "Core Needle Biopsy (Tru-cut / 14G): provides HISTOLOGY; can grade tumor, assess ER/PR/HER2/Ki-67",
  "Vacuum-assisted biopsy (Mammotome): for impalpable / calcifications; US or stereotactic guidance",
  "Excision biopsy (open): if all other methods fail or discordant results",
  "NEET TIP: Core biopsy preferred in current practice — gives receptor status for neoadjuvant planning",
  "★ SENTINEL LYMPH NODE BIOPSY: Vital Blue dye (isosulfan blue) + Tc-99m sulfur colloid; first draining node in axilla"
], { hdrColor: C.purple });

// Mammography & Imaging
contentSlide(pres, "Imaging in Breast Disease — High-Yield Summary", [
  "MAMMOGRAPHY: bilateral, 2 views (CC + MLO); detects microcalcifications, masses, architectural distortion",
  "  Best screening tool for women >40 yr; not ideal for dense breasts (young women)",
  "  Malignant features: irregular, spiculated mass; clustered microcalcifications; architectural distortion; skin/nipple retraction",
  "  Benign features: smooth, round, well-defined with halo sign; coarse calcifications (fibroadenoma)",
  "ULTRASOUND: first line <35 yr and in pregnant/lactating women; distinguishes solid vs cystic; guides biopsy",
  "  Malignant features: hypoechoic, irregular margins, taller-than-wide, posterior acoustic shadowing",
  "MRI BREAST: highest sensitivity (90–95%); indications — BRCA carriers, dense breasts, discordant triple assessment, post-lumpectomy scar vs recurrence, multifocal/multicentric evaluation, implant integrity",
  "PET-CT: metastatic workup (LABC, Stage III); not for early disease",
  "Bone scan: bone mets (most common distant metastasis site); alkaline phosphatase ↑",
  "NEET TIP: First imaging in <35 yr = Ultrasound; >35 yr = Mammogram ± USS"
], { hdrColor: C.teal });

// ─── SECTION 5: STAGING ─────────────────────────────────────────────────────
sectionHeader(pres, "05", "STAGING OF BREAST CANCER", "AJCC/UICC 8th Edition TNM System");

tableSlide(pres,
  "TNM Staging — T Category (Tumor Size)",
  ["T Category", "Criteria"],
  [
    ["Tx", "Primary tumor cannot be assessed"],
    ["T0", "No evidence of primary tumor"],
    ["Tis (DCIS)", "Ductal carcinoma in situ"],
    ["Tis (Paget's)", "Paget's disease of nipple NOT associated with underlying Ca"],
    ["T1mi", "Microinvasion ≤1 mm"],
    ["T1a", ">1 mm to ≤5 mm"],
    ["T1b", ">5 mm to ≤10 mm"],
    ["T1c", ">10 mm to ≤20 mm"],
    ["T2", ">20 mm to ≤50 mm"],
    ["T3", ">50 mm"],
    ["T4a", "Extension to chest wall (NOT pectoral muscle alone)"],
    ["T4b", "Ulceration / satellite nodules / peau d'orange (not inflammatory)"],
    ["T4c", "T4a + T4b"],
    ["T4d", "Inflammatory carcinoma"],
  ],
  { hdrColor: C.navyDark, headerFill: C.navyDark }
);

tableSlide(pres,
  "TNM Staging — N & M Categories",
  ["Category", "Criteria"],
  [
    ["cN0", "No regional LN metastasis"],
    ["cN1", "Movable ipsilateral Level I/II axillary LN"],
    ["cN1mi", "Micrometastasis >0.2 mm but none >2 mm"],
    ["cN2a", "Fixed/matted Level I/II axillary LN"],
    ["cN2b", "Internal mammary LN (no axillary)"],
    ["cN3a", "Infraclavicular (Level III) LN"],
    ["cN3b", "Internal mammary + axillary LN"],
    ["cN3c", "Supraclavicular LN"],
    ["M0", "No distant metastasis"],
    ["M1", "Distant metastasis present"],
    ["Common Mets Sites", "BONE (MC) > Lung > Liver > Brain; 'BL-LB' mnemonic"],
  ],
  { hdrColor: C.navyDark, headerFill: C.navyDark }
);

tableSlide(pres,
  "Stage Grouping — Anatomical (Must Memorize for NEET PG)",
  ["Stage", "T", "N", "M", "5-yr Survival"],
  [
    ["0", "Tis", "N0", "M0", "~99%"],
    ["IA", "T1", "N0", "M0", "~99%"],
    ["IB", "T0/T1", "N1mi", "M0", "~99%"],
    ["IIA", "T0/T1, T2", "N1, N0", "M0", "~93%"],
    ["IIB", "T2, T3", "N1, N0", "M0", "~75%"],
    ["IIIA", "T0–T3, T3", "N2, N1", "M0", "~66%"],
    ["IIIB", "T4", "N0–N2", "M0", "~41%"],
    ["IIIC", "Any T", "N3", "M0", "~41%"],
    ["IV", "Any T", "Any N", "M1", "~26%"],
  ],
  { hdrColor: C.navyDark, headerFill: C.navyDark }
);

mnemonicSlide(pres,
  "Metastatic Workup — When to Order?",
  "\"LABC gets FULL workup; Early Ca only if SYMPTOMATIC\"",
  [
    "LOCALLY ADVANCED (T3, T4, N2, N3) → FULL WORKUP:",
    "  • CT chest + abdomen + pelvis (contrast enhanced)",
    "  • Isotope bone scan",
    "  • PET-CT (alternative to CT + bone scan)",
    "EARLY BREAST CANCER (T1/T2, N0/N1) → ONLY IF SYMPTOMATIC:",
    "  • Raised ALP → bone scan",
    "  • Neurological symptoms → CT/MRI brain",
    "  • Cough, dyspnea → CT chest",
    "★ Routine CT/bone scan NOT recommended for asymptomatic early breast cancer",
    "★ Most common distant site: BONE (sclerotic mets in breast Ca, unlike osteolytic in most)"
  ],
  C.gold
);

// ─── SECTION 6: SURGICAL TREATMENT ─────────────────────────────────────────
sectionHeader(pres, "06", "SURGICAL TREATMENT", "Mastectomy Types • Breast Conservation • Axillary Surgery");

tableSlide(pres,
  "Types of Mastectomy — Complete Comparison",
  ["Procedure", "Breast Removed", "Muscles Removed", "LN Dissection", "Key Notes"],
  [
    ["Radical mastectomy\n(Halsted 1882)", "Yes", "Pect. major + minor", "Levels I+II+III", "Historic; rarely done now; chestwall deformity"],
    ["Extended radical\n(Urban's)", "Yes", "Pect. major + minor", "Levels I–III + Internal mammary", "For medial tumors; high morbidity"],
    ["Modified Radical\nMastectomy (Patey)", "Yes", "Only pect. minor", "Levels I+II", "Standard; preserves pect. major"],
    ["Modified Radical\nMastectomy (Auchincloss/\nMadden)", "Yes", "Neither muscle", "Level I+II only", "Most common; best functional outcome"],
    ["Simple/Total mastectomy", "Yes", "None", "None", "Prophylactic/DCIS; ± SLNB"],
    ["Skin-sparing mastectomy", "Gland only (skin preserved)", "None", "SLNB or ALND", "For immediate reconstruction"],
    ["Nipple-sparing mastectomy", "Gland (nipple-areola preserved)", "None", "SLNB or ALND", "Cosmesis; risk of occult nipple Ca ~5%"],
    ["BCS (Wide local excision)", "Lump + 1 cm margin", "None", "SLNB ± ALND", "Followed by whole-breast RT"],
  ],
  { hdrColor: C.green, headerFill: C.green }
);

contentSlide(pres, "Breast Conserving Surgery (BCS) — Indications & Contraindications", [
  "INDICATIONS: Stage I and IIA (T1-T2, N0-N1); patient preference; adequate breast volume for cosmesis",
  "BCS = Wide local excision / Lumpectomy / Quadrantectomy (removes more tissue with overlying skin)",
  "Quadrantectomy (Veronesi): 2–3 cm margin; removes entire quadrant; better oncological but worse cosmesis",
  "ABSOLUTE CONTRAINDICATIONS to BCS:",
  "  - Multicentric disease (>1 quadrant)",
  "  - Inability to achieve negative margins after re-excision",
  "  - Prior breast radiation",
  "  - Pregnancy (relative — if RT can wait for delivery)",
  "  - Inflammatory carcinoma",
  "RELATIVE CONTRAINDICATIONS: Large tumor relative to breast size; collagen vascular disease; patient refusal of RT",
  "BCS outcomes: EQUIVALENT to mastectomy in Stage I/II (proven by multiple RCTs — Fisher NSABP B-06 trial)",
  "NEET TIP: BCS MUST be followed by whole-breast radiotherapy to reduce local recurrence from 30% to <10%"
], { hdrColor: C.green });

contentSlide(pres, "Axillary Surgery — SLNB vs ALND", [
  "SENTINEL LYMPH NODE BIOPSY (SLNB): Standard of care for clinically node-negative (cN0) patients",
  "Technique: dual mapping = isosulfan blue dye (1%) + Tc-99m sulfur colloid (99mTc); identify 'hot' and 'blue' node",
  "★ First hot or blue node = sentinel node; if negative → no further axillary surgery needed",
  "SLNB is now STANDARD even in 1-2 positive axillary nodes (Z0011 trial) — avoids full ALND",
  "ALND (Axillary Lymph Node Dissection): Level I + II nodes; ≥10 nodes retrieved for staging",
  "ALND complications: lymphedema (MC long-term), nerve injuries (intercostobrachial nerve → medial arm numbness), seroma, shoulder stiffness",
  "Long thoracic nerve injury → winging of scapula (serratus anterior palsy)",
  "Thoracodorsal nerve injury → weakness of latissimus dorsi (↓ medial rotation + adduction of arm)",
  "Medial pectoral nerve → pectoralis minor; Lateral pectoral nerve → pectoralis major (proximal)",
  "NEET TIP: ACOSOG Z0011 trial — if ≤2 positive SLNs in patients undergoing lumpectomy + whole-breast RT → ALND can be safely omitted"
], { hdrColor: C.green });

// ─── SECTION 7: ADJUVANT THERAPY ────────────────────────────────────────────
sectionHeader(pres, "07", "ADJUVANT & SYSTEMIC THERAPY", "Chemotherapy • Radiotherapy • Hormone Therapy • Targeted Therapy");

contentSlide(pres, "Adjuvant Chemotherapy — Key Regimens", [
  "Indications: node-positive, triple-negative, HER2+, high Ki-67, grade III tumors, young patients",
  "CMF (historic): Cyclophosphamide + Methotrexate + 5-FU — largely replaced",
  "AC → T (current standard): Anthracycline (Adriamycin/Cyclophosphamide) × 4 cycles → Taxane (Paclitaxel/Docetaxel) × 4 cycles",
  "Anthracyclines: doxorubicin (Adriamycin); cardiotoxicity — dilated cardiomyopathy (dose-dependent); monitor ECHO",
  "Taxanes (paclitaxel, docetaxel): peripheral neuropathy; alopecia; neutropenia",
  "Carboplatin: added in BRCA1/2-associated triple-negative Ca",
  "NEOADJUVANT CHEMO (NACT): given BEFORE surgery; aims to downstage; achieve pCR (pathological complete response)",
  "pCR (ypT0ypN0) = complete disappearance of tumor; best prognosis after NACT",
  "NACT advantage: allows BCS in locally advanced tumors; gives in vivo chemosensitivity data",
  "Response assessment: clinical exam + imaging (MRI best); ypN status guides further treatment"
], { hdrColor: C.orange });

tableSlide(pres,
  "Hormone Therapy — Key Drugs & Indications",
  ["Drug", "Class", "Indication", "Key Side Effects"],
  [
    ["Tamoxifen (20 mg/day × 5-10 yr)", "SERM (Selective ER Modulator)", "Premenopausal ER+ (all stages); DCIS", "DVT/PE, endometrial Ca (agonist effect), hot flashes, cataracts"],
    ["Aromatase Inhibitors\n(Anastrozole, Letrozole, Exemestane)", "AI — blocks peripheral estrogen synthesis", "Postmenopausal ER+ (preferred over Tamoxifen)", "Osteoporosis, arthralgia, hot flashes (NO uterine Ca)"],
    ["Fulvestrant (Faslodex)", "SERD — degrades ER", "Postmenopausal; AI-resistant advanced Ca", "Injection site reactions"],
    ["Ovarian suppression\n(GnRH agonists: Goserelin)", "Medical oophorectomy", "Premenopausal high-risk ER+ Ca", "Menopausal symptoms, osteoporosis"],
    ["Raloxifene", "SERM", "Chemoprevention in high-risk postmenopausal", "DVT/PE risk (less than tamoxifen)"],
  ],
  { hdrColor: C.orange, headerFill: C.orange }
);

contentSlide(pres, "Targeted Therapy & Immunotherapy — HER2 & BRCA", [
  "HER2+ BREAST CANCER (≈20% of all cases): HER2 overexpression by IHC (3+) or FISH amplification",
  "TRASTUZUMAB (Herceptin): first anti-HER2 mAb; given with chemo + continued adjuvant × 1 yr",
  "  Cardiotoxicity (reversible heart failure — different from anthracycline); monitor ECHO every 3 months",
  "PERTUZUMAB: blocks HER2-HER3 dimerization; used with trastuzumab (dual blockade) for high-risk HER2+",
  "T-DM1 (Trastuzumab emtansine / Kadcyla): antibody-drug conjugate; for residual HER2+ disease post-NACT",
  "NERATINIB: irreversible HER2 inhibitor; extended adjuvant (after trastuzumab) for high-risk HER2+",
  "TRIPLE NEGATIVE BREAST CANCER (TNBC) — ER-/PR-/HER2-:",
  "  PARP inhibitors (Olaparib, Talazoparib): BRCA1/2-mutated TNBC; exploit synthetic lethality",
  "  Pembrolizumab (anti-PD1): added to NACT for high-risk TNBC; immunotherapy",
  "  Sacituzumab govitecan: ADC for metastatic TNBC",
  "CDK4/6 inhibitors (Palbociclib, Ribociclib, Abemaciclib): ER+/HER2- metastatic Ca with fulvestrant/AI"
], { hdrColor: C.orange });

contentSlide(pres, "Radiotherapy in Breast Cancer", [
  "ADJUVANT RT AFTER BCS: Mandatory; reduces local recurrence from ~30% to <10%; whole-breast RT (40-50 Gy in 15-25 fractions)",
  "ADJUVANT RT AFTER MASTECTOMY (PMRT): indicated if T3/T4, ≥4 positive nodes, positive margins, skin/muscle involvement",
  "PMRT indications in 1-3 positive nodes: controversial; recommended by most guidelines especially with adverse features",
  "RT BOOST: Additional dose to tumor bed (10-16 Gy) in high-risk patients (young, close margins)",
  "INTRAOPERATIVE RT (IORT): single fraction at time of surgery; for low-risk BCS patients",
  "RT FIELDS: Chest wall + draining nodal basins (axillary, supraclavicular, internal mammary)",
  "COMPLICATIONS: Radiation pneumonitis (early), radiation fibrosis (late), lymphedema, rib fractures, secondary malignancy (angiosarcoma), cardiac toxicity (left-sided RT)",
  "NEET TIP: RT is CONTRAINDICATED in pregnancy; prior RT to chest is absolute contraindication to BCS + RT",
  "Angiosarcoma of breast: rare late complication of RT; Stewart-Treves syndrome = angiosarcoma in lymphedematous arm"
], { hdrColor: C.orange });

// ─── SECTION 8: SPECIAL SITUATIONS ─────────────────────────────────────────
sectionHeader(pres, "08", "SPECIAL SITUATIONS", "Inflammatory Ca • Male Breast Ca • Ca in Pregnancy • Screening");

twoColSlide(pres,
  "Inflammatory Carcinoma vs Male Breast Cancer",
  [
    "INFLAMMATORY CARCINOMA (T4d):",
    "Diffuse erythema + edema (peau d'orange) involving >1/3 of breast skin",
    "No discrete palpable mass usually",
    "Diagnosis: clinical + skin punch biopsy (dermal lymphatic emboli)",
    "Highly aggressive; WORST prognosis (5-yr ~40%)",
    "Stage IIIB automatically",
    "Treatment: NACT → mastectomy (NOT BCS) → RT",
    "Even after pCR with NACT → still classified as inflammatory Ca",
    "IHC: often HER2+ or triple negative",
    "Mistaken for mastitis in young women → crucial to biopsy"
  ],
  [
    "MALE BREAST CANCER:",
    "Only 0.5–1% of all breast cancers; RR higher with BRCA2 (vs BRCA1)",
    "Risk factors: Klinefelter syndrome (XXY), gynecomastia, exogenous estrogen, liver cirrhosis, radiation",
    "Usually ER+ (90%), HER2- ; treated like female breast Ca",
    "Presents late — often Stage III/IV at diagnosis",
    "MC type: IDC-NST",
    "Harder to do BCS (less tissue); modified radical mastectomy preferred",
    "GYNECOMASTIA: benign; unilateral > bilateral; causes — physiological (puberty, old age), drugs (spironolactone, digoxin, cimetidine, cannabis, anti-androgens), liver disease, hypogonadism",
    "NEET TIP: All male breast lumps need FNAC/biopsy (Ca vs gynecomastia)"
  ],
  { leftLabel: "INFLAMMATORY CARCINOMA", rightLabel: "MALE BREAST CANCER", leftColor: C.red, rightColor: C.navy }
);

contentSlide(pres, "Breast Cancer in Pregnancy & Hereditary Breast Cancer", [
  "PREGNANCY-ASSOCIATED BREAST CA (PABC): during pregnancy or within 1 yr postpartum; typically advanced stage at diagnosis",
  "Imaging: USS first (no radiation); MRI without gadolinium (safe); mammogram with shielding if needed",
  "FNAC / Core biopsy: safe in pregnancy",
  "Treatment: 1st trimester → terminate pregnancy + treat; 2nd/3rd trimester → surgery first, chemo from 2nd trimester (taxanes + AC safe after organogenesis)",
  "RT deferred until after delivery; tamoxifen contraindicated in pregnancy",
  "HEREDITARY BREAST CANCER (BRCA1/2):",
  "Refer for genetic counseling if: <40 yr at diagnosis, bilateral, male breast Ca, FHx of ovarian Ca, 2 FDR with breast Ca, Ashkenazi Jewish",
  "BRCA1: Chromosome 17q; Triple negative often; ↑ ovarian Ca risk (40–50%)",
  "BRCA2: Chromosome 13q; ER+ usually; ↑ male breast Ca, pancreatic Ca, prostate Ca",
  "Risk reduction: prophylactic bilateral mastectomy (reduces risk by 95%); bilateral salpingo-oophorectomy; surveillance with MRI ± mammo from age 25"
], { hdrColor: C.navy });

contentSlide(pres, "Breast Cancer Screening — NEET PG Essentials", [
  "AIMS: Detect cancer at an earlier (more curable) stage in asymptomatic population",
  "MAMMOGRAPHIC SCREENING:",
  "  - UK NHS: every 3 years for women 50–70 yr",
  "  - ACS/USPSTF: annual mammo from 40–45 yr (optional); 45–54 yr annually; ≥55 yr every 2 yr",
  "  - India: No formal national program; awareness campaigns (NACO)",
  "SCREENING REDUCES MORTALITY by ~20–30% (RCTs); lead time bias and overdiagnosis must be considered",
  "MRI SCREENING: BRCA1/2 carriers, Li-Fraumeni syndrome, prior chest RT (age 10–30); start 25 yr or 10 yr before youngest family case",
  "BREAST SELF-EXAMINATION (BSE): not proven to reduce mortality (Thomas 2002 RCT); AWARENESS valued",
  "CLINICAL BREAST EXAM (CBE): annual by clinician >40 yr; detects interval cancers between mammograms",
  "NEET TIP: Most important screening tool = MAMMOGRAPHY; MRI most sensitive but not used for mass screening (cost, resources)"
], { hdrColor: C.teal });

// ─── SECTION 9: RECONSTRUCTION & PROGNOSIS ──────────────────────────────────
sectionHeader(pres, "09", "RECONSTRUCTION & PROGNOSIS", "Breast Reconstruction • Prognostic Factors • Oncotype DX");

twoColSlide(pres,
  "Breast Reconstruction Methods",
  [
    "TIMING:",
    "Immediate: at time of mastectomy; better psych outcome; no delay in treatment",
    "Delayed: after completion of all treatment; safer if PMRT planned",
    "IMPLANT-BASED:",
    "Tissue expander → permanent implant (2-stage)",
    "Direct-to-implant (1-stage)",
    "Ideal for small-medium breasts; easier; but risk of capsular contracture + poor RT tolerance",
    "ACELLULAR DERMAL MATRIX (ADM): supports implant; reduces contracture",
    "NEET TIP: RT + implant = higher complication rate; autologous preferred if PMRT planned"
  ],
  [
    "AUTOLOGOUS FLAPS:",
    "TRAM flap (Transverse Rectus Abdominis Myocutaneous): pedicled or free; MC used flap globally; donor site: anterior abdominal wall weakness",
    "DIEP flap (Deep Inferior Epigastric Perforator): free flap; spares rectus muscle; best abdominal donor site morbidity profile",
    "LD flap (Latissimus Dorsi): pedicled flap; may need implant; good for partial defects",
    "SGAP / IGAP (gluteal artery perforator): alternative donor sites",
    "NIPPLE-AREOLA RECONSTRUCTION: last stage; tattooing + local flap techniques",
    "ONCOPLASTIC SURGERY: combines oncological resection with plastic surgical techniques; allows larger excisions with better cosmesis"
  ],
  { leftLabel: "IMPLANT-BASED", rightLabel: "AUTOLOGOUS FLAPS", leftColor: C.teal, rightColor: C.green }
);

tableSlide(pres,
  "Prognostic Factors in Breast Cancer — NEET PG Priority",
  ["Factor", "Good Prognosis", "Poor Prognosis"],
  [
    ["Axillary LN status", "Node negative (N0)", "4+ nodes (N2) — MOST IMPORTANT prognostic factor"],
    ["Tumor size", "T1 (<20 mm)", "T3/T4 (>50 mm)"],
    ["Histological grade", "Grade I (well differentiated)", "Grade III (poorly diff)"],
    ["ER/PR status", "ER+ PR+ (Luminal A)", "ER- PR- (triple negative)"],
    ["HER2 status", "HER2- (better natural hx)", "HER2+ (worse without therapy)"],
    ["Ki-67", "Low (<14%)", "High (>30%)"],
    ["Molecular subtype", "Luminal A", "Triple negative / HER2-enriched"],
    ["Lymphovascular invasion", "Absent", "Present (↑ metastasis risk)"],
    ["Response to NACT", "pCR (ypT0N0)", "Residual disease"],
    ["Oncotype DX score", "Low recurrence score (<18)", "High recurrence score (≥31)"],
  ],
  { hdrColor: C.teal, headerFill: C.teal }
);

contentSlide(pres, "Genomic Tests & Molecular Markers", [
  "ONCOTYPE DX (21-gene recurrence score): ER+ HER2- N0 or N1mi patients; predicts benefit from chemotherapy",
  "  Low score (<18): endocrine therapy alone sufficient",
  "  Intermediate (18–30): uncertain benefit; TAILORx trial — most intermediate can skip chemo",
  "  High score (≥31): chemotherapy + endocrine therapy",
  "MAMMAPRINT (70-gene signature / MammaPrint): low-risk vs high-risk; guides chemo decision (MINDACT trial)",
  "PAM50 / PROSIGNA: molecular subtyping (Luminal A/B, HER2-enriched, basal); gives ROR score",
  "BRCA1/2 testing: guides PARP inhibitor use (olaparib) in metastatic setting",
  "PIK3CA mutation: targetable with alpelisib (PI3K inhibitor) in ER+ HER2- advanced Ca",
  "NEET TIP: Oncotype DX is the most commonly tested genomic assay in exams; know the score thresholds (18 and 31)"
], { hdrColor: C.teal });

// ─── SECTION 10: HIGH-YIELD EXAM ALERTS ─────────────────────────────────────
sectionHeader(pres, "10", "NEET PG / INICET HIGH-YIELD FACTS", "Exam-Pattern Questions & One-Liners");

examAlertSlide(pres,
  "TOP 20 ONE-LINERS (Most Frequently Tested)",
  [
    "MC benign breast tumor: Fibroadenoma (15–35 yr) — 'breast mouse'",
    "MC malignant breast tumor: Invasive Ductal Carcinoma NST (70–80%)",
    "MC site: Upper outer quadrant (50%)",
    "MC cause of blood-stained nipple discharge: Ductal (intraductal) papilloma",
    "Best screening tool: Mammography (women >40 yr); MRI = most sensitive",
    "MC lymph node group involved: Anterior (pectoral) axillary nodes (Level I)",
    "First investigation in <35 yr breast lump: Ultrasound",
    "DCIS treatment: Lumpectomy + RT ± Tamoxifen (ER+); NOT mastectomy as default",
    "LCIS: NOT a cancer; risk marker; bilateral; treat with surveillance ± tamoxifen",
    "Paget's disease of nipple: always associated with underlying DCIS/invasive Ca; eczematoid lesion starting at nipple tip",
    "Triple negative Ca: ER-/PR-/HER2-; worst prognosis; only chemotherapy option (± immunotherapy)",
    "HER2+ treatment: Trastuzumab (Herceptin) + chemotherapy; cardiotoxicity (reversible)",
    "Tamoxifen side effect: ENDOMETRIAL CARCINOMA (agonist on uterus); DVT; NOT osteoporosis",
    "Aromatase inhibitors: cause OSTEOPOROSIS; safe from uterine Ca; only in postmenopausal",
    "Halsted mastectomy: removes breast + pect. major + pect. minor + axillary LNs",
    "ALND nerve injury → winging of scapula: Long thoracic nerve (serratus anterior)",
    "ALND nerve injury → medial arm numbness: Intercostobrachial nerve (T2)",
    "Lymphedema MC cause post-mastectomy: ALND; Stewart-Treves = angiosarcoma in lymphedematous arm",
    "Inflammatory Ca: T4d; NOT same as mastitis; skin biopsy shows dermal lymphatic emboli",
    "BRCA1 = Chr 17q; BRCA2 = Chr 13q; BRCA2 more common in MALE breast Ca"
  ],
  C.red
);

examAlertSlide(pres,
  "INICET / NEET PG PREVIOUS YEAR PATTERN QUESTIONS",
  [
    "Q: Triple assessment in breast: Clinical exam + Imaging (Mammo/USS) + Pathology (FNAC/Core biopsy) — ALL THREE must agree",
    "Q: Bloom-Richardson scoring: Tubules + Nuclear pleomorphism + Mitoses; Grade I = 3-5, Grade II = 6-7, Grade III = 8-9",
    "Q: Nerve at risk in ALND causing winging of scapula → Long thoracic nerve of Bell (serratus anterior)",
    "Q: Ductal papilloma vs papillomatosis: Papilloma = single duct, lower risk; Papillomatosis = multiple ducts, higher risk",
    "Q: Sentinel lymph node identification: Vital blue dye (isosulfan/patent blue) + Tc-99m sulfur colloid",
    "Q: Mondor's disease = thrombophlebitis of thoracoepigastric vein; lateral breast; tender cord; self-limiting",
    "Q: Phyllodes tumor = Fibroepithelial; STROMA is malignant component; treat with WIDE LOCAL EXCISION (1 cm clear margins)",
    "Q: TRAM flap donor site = anterior abdominal wall; risk = hernia; DIEP = no muscle sacrifice",
    "Q: Inflammatory Ca treatment = NACT → mastectomy (NOT BCS) → RT; pCR still called inflammatory",
    "Q: Li-Fraumeni syndrome = p53 mutation; breast Ca + sarcoma + brain tumor + adrenocortical Ca",
    "Q: Cowden syndrome = PTEN mutation; breast + thyroid + endometrial Ca; mucocutaneous lesions",
    "Q: Stewart-Treves syndrome = angiosarcoma in chronic lymphedema (post-mastectomy arm)",
    "Q: Peau d'orange mechanism = lymphatic obstruction of dermal lymphatics tethering hair follicles",
    "Q: NACT response marker = Ki-67 reduction on Day 14 biopsy predicts pCR"
  ],
  C.gold
);

// Flowchart: Management of breast lump
flowSlide(pres,
  "Management Algorithm: Breast Lump",
  [
    { label: "BREAST LUMP\nDetected", sub: "History + exam" },
    { label: "AGE <35 yr\n→ ULTRASOUND\nfirst", sub: "Cystic vs Solid" },
    { label: "AGE >35 yr\n→ MAMMO +\nULTRASS", sub: "BI-RADS score" },
    { label: "TRIPLE\nASSESSMENT\nComplete", sub: "Exam+Imaging\n+FNAC/Core Bx" },
    { label: "All BENIGN\n→ Follow up\n(3–6 months)", sub: "Or excise if\npatient anxious" },
    { label: "ANY MALIGNANT\n→ Staging + MDT\n→ Surgery ±\nNACT ± RT", sub: "Onco referral" },
  ],
  { colors: [C.navy, C.teal, C.purple, C.orange, C.green, C.red] }
);

// Flowchart: Treatment of breast cancer
flowSlide(pres,
  "Treatment Algorithm: Early Breast Cancer (Stage I/II)",
  [
    { label: "EARLY\nBREAST Ca\n(Stage I/II)", sub: "T1-T2, N0-N1" },
    { label: "SURGERY\nBCS or\nMastectomy\n+ SLNB/ALND", sub: "If BCS→RT\nmandatory" },
    { label: "RECEPTOR\nASSESSMENT\nER/PR/HER2/\nKi-67", sub: "IHC on core bx" },
    { label: "ER+/HER2-\n→ Endocrine\n± Chemo\n(Oncotype DX)", sub: "Tamoxifen or AI" },
    { label: "HER2+\n→ Trastuzumab\n+ Chemo\n± Pertuzumab", sub: "1 year Herceptin" },
    { label: "Triple -ve\n→ Chemo\n(AC-T)\n± Pembrolizumab", sub: "BRCA→Olaparib" },
  ],
  { colors: [C.navyDark, C.teal, C.purple, C.orange, C.red, C.navy] }
);

examAlertSlide(pres,
  "COMPARISON TABLE — Often Confused in NEET PG",
  [
    "Fibroadenoma vs Phyllodes: FA = young women; Phyllodes = older (>40); Phyllodes = leaf-like cut surface; STROMA malignant",
    "DCIS vs LCIS: DCIS = unicentric, calcifications, pre-cancer; LCIS = multicentric, bilateral, no calcifications, RISK MARKER",
    "Paget's vs Eczema of nipple: Paget's = starts at nipple TIP, unilateral, associated with Ca; Eczema = bilateral, starts at areola",
    "Tamoxifen vs Aromatase Inhibitors: Tamoxifen = premenopausal (↑ uterine Ca); AI = postmenopausal (↑ osteoporosis)",
    "Halsted vs Patey: Halsted = both muscles removed; Patey MRM = only pect. minor removed; Madden MRM = neither muscle",
    "Long thoracic nerve vs Thoracodorsal nerve: LTN injury = winged scapula; TDN injury = weak latissimus dorsi",
    "SLNB vs ALND: SLNB = cN0 patients; ALND = cN1+ (or positive SLNB >2 nodes — but Z0011 shows ALND avoidable in selected)",
    "Trastuzumab vs Anthracycline cardiotoxicity: Trastuzumab = REVERSIBLE cardiomyopathy; Anthracyclines = dose-dependent IRREVERSIBLE"
  ],
  C.purple
);

// ─── FINAL SLIDE ─────────────────────────────────────────────────────────────
let finalSlide = pres.addSlide();
finalSlide.background = { color: C.navyDark };
finalSlide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.08, fill: { color: C.teal } });
finalSlide.addShape(pres.ShapeType.rect, { x: 0, y: 0.08, w: 13.3, h: 0.04, fill: { color: C.gold } });
finalSlide.addText("ALL THE BEST FOR NEET PG & INICET!", {
  x: 0.5, y: 1.5, w: 12.3, h: 1.5,
  fontSize: 38, bold: true, color: C.gold, align: "center", fontFace: "Calibri"
});
finalSlide.addText([
  { text: "Remember:\n", options: { bold: true, color: C.teal, fontSize: 20, breakLine: true } },
  { text: "TRIPLE ASSESSMENT for every breast lump\n", options: { color: C.white, fontSize: 16, breakLine: true } },
  { text: "BCS = mastectomy in outcome (Stage I/II) BUT must add RT\n", options: { color: C.white, fontSize: 16, breakLine: true } },
  { text: "AXILLARY LN STATUS = most important prognostic factor\n", options: { color: C.white, fontSize: 16, breakLine: true } },
  { text: "BRCA1 = Chr 17q (Triple negative); BRCA2 = Chr 13q (Male Ca)\n", options: { color: C.gold, fontSize: 16, breakLine: true } },
  { text: "NEET PG Pattern: Always think molecular subtypes + staging + operative choice + adjuvant therapy\n", options: { color: C.white, fontSize: 16, breakLine: true } },
], {
  x: 0.5, y: 3.2, w: 12.3, h: 3.5, valign: "top", fontFace: "Calibri"
});
finalSlide.addText("Source: Bailey & Love 28e | Schwartz 11e | S Das 13e | Robbins Pathology | AJCC 8th Edition", {
  x: 0.5, y: 6.8, w: 12.3, h: 0.4, fontSize: 12, color: C.medGray, align: "center"
});

// Write the file
pres.writeFile({ fileName: "/home/daytona/workspace/breast-surgery-neet/BREAST_SURGERY_NEET_PG_Revision.pptx" })
  .then(() => console.log("DONE: BREAST_SURGERY_NEET_PG_Revision.pptx written successfully"))
  .catch(err => console.error("Error:", err));