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pres.author = 'Final Year MBBS';
pres.title = 'Carcinoma Breast - Surgical Management';

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// ═══════════════════════════════════════════════════════════════════════════════
//  SLIDE CREATION
// ═══════════════════════════════════════════════════════════════════════════════

// 1. TITLE SLIDE
titleSlide(pres, "CARCINOMA BREAST", "Surgical Management — Essay Discussion");

// 2. OUTLINE
contentSlide(pres, "Outline", [
  { text: "Epidemiology & Incidence", bold: true, color: C.teal },
  { text: "Aetiology & Risk Factors", bold: true, color: C.teal },
  { text: "Surgical Anatomy of the Breast", bold: true, color: C.teal },
  { text: "Pathology & Molecular Subtypes", bold: true, color: C.teal },
  { text: "Clinical Features & Spread", bold: true, color: C.teal },
  { text: "Investigations & Triple Assessment", bold: true, color: C.teal },
  { text: "TNM Staging", bold: true, color: C.teal },
  { text: "Surgical Treatment — Mastectomy Types", bold: true, color: C.teal },
  { text: "Breast Conservation Surgery (BCS)", bold: true, color: C.teal },
  { text: "Axillary Management (SLNB & ALND)", bold: true, color: C.teal },
  { text: "Adjuvant Therapy (Chemo / Hormonal / Radiation / Targeted)", bold: true, color: C.teal },
  { text: "Prognosis & Follow-up", bold: true, color: C.teal },
]);

// 3. SECTION — EPIDEMIOLOGY
sectionDivider(pres, "Epidemiology & Incidence");

// 4.
contentSlide(pres, "Epidemiology", [
  "Most common cancer in women worldwide; >2 million cases/year globally",
  "2nd leading cause of cancer deaths in females (after lung cancer)",
  "~297,790 new invasive cases & 55,720 in situ cases/year in the USA (2023)",
  "~43,700 estimated deaths/year in the USA",
  "India: Incidence rising — now the most common female cancer in urban India",
  "5-year survival: 63% (1960s) → 75% (1975–77) → 87% (1995–97) → 91% (2012–18)",
  "Higher incidence (>80/100,000): Australia, W. Europe, N. America",
  "Lower incidence (<40/100,000): Central America, E. Africa, S-Central Asia",
  "Black females: 40% higher mortality than White females (higher TNBC incidence, later diagnosis)",
]);

// 5. SECTION — AETIOLOGY
sectionDivider(pres, "Aetiology & Risk Factors");

// 6.
twoColSlide(pres, "Risk Factors for Breast Cancer",
  "Non-Modifiable", [
    "Female sex (100x > males)",
    "Age (risk increases after 40 yrs)",
    "Family history (1st-degree relatives)",
    "BRCA1 / BRCA2 gene mutations",
    "Previous breast cancer / DCIS / LCIS",
    "Dense breast tissue",
    "Early menarche (<12 yrs)",
    "Late menopause (>55 yrs)",
    "Nulliparity",
    "Radiation exposure (chest)",
  ],
  "Modifiable / Hormonal", [
    "HRT (oestrogen + progesterone)",
    "Oral contraceptive pill (slight risk)",
    "Late first pregnancy (>30 yrs)",
    "No or short breastfeeding",
    "Obesity (post-menopausal)",
    "Alcohol consumption",
    "Sedentary lifestyle",
    "Western diet / high fat diet",
    "Atypical ductal or lobular hyperplasia",
  ]
);

// 7. SECTION — ANATOMY
sectionDivider(pres, "Surgical Anatomy");

// 8.
contentSlide(pres, "Surgical Anatomy of the Breast", [
  { text: "Extent: 2nd–6th rib (vertically), sternum–mid-axillary line (horizontally)", bold: true, color: C.navy },
  "Axillary tail of Spence: projects through cribiform fascia into axilla",
  "Lymph drainage (clinically most important):",
  { text: "Axillary nodes (75%): Level I (lateral to pec minor), Level II (behind), Level III (medial)", sub: true },
  { text: "Internal mammary nodes (20–25%): medially located tumours", sub: true },
  { text: "Interpectoral (Rotter's) nodes: between pec major & minor", sub: true },
  { text: "Blood supply: Internal thoracic a., lateral thoracic a., thoracoacromial a., intercostal perforators", bold: false },
  "Nerves at risk in axillary dissection:",
  { text: "Long thoracic nerve (of Bell): serratus anterior — damage → winged scapula", sub: true, color: C.red },
  { text: "Thoracodorsal nerve: latissimus dorsi — damage → weakness of arm adduction", sub: true, color: C.red },
  { text: "Medial pectoral nerve: pec major — damage → muscle atrophy", sub: true, color: C.red },
  { text: "Intercostobrachial nerve: skin of medial arm — damage → numbness", sub: true },
]);

// 9. SECTION — PATHOLOGY
sectionDivider(pres, "Pathology & Molecular Subtypes");

// 10.
contentSlide(pres, "Pathological Classification", [
  { text: "Origin: 90% ductal, 10% lobular", bold: true, color: C.navy },
  { text: "In Situ (Non-Invasive):", bold: true, color: C.teal },
  { text: "DCIS (Ductal Carcinoma In Situ): no basement membrane breach; pre-invasive", sub: true },
  { text: "LCIS (Lobular Carcinoma In Situ): risk indicator, not true malignancy (8th AJCC)", sub: true },
  { text: "Invasive / Infiltrative (most common):", bold: true, color: C.teal },
  { text: "IDC (No Special Type / NST): 50–70% — cohesive mass, discrete lump", sub: true },
  { text: "ILC (Invasive Lobular): 5–15% — single-file infiltration, CDH1/E-cadherin loss, hard to detect", sub: true },
  { text: "Special types (better prognosis): Mucinous/Colloid, Tubular, Papillary, Cribriform", sub: true },
  { text: "Medullary: high grade, ER–/PR–/HER2–, lymphocytic infiltrate", sub: true },
  { text: "Inflammatory carcinoma: dermal lymphatic invasion, peau d'orange, ~2% of cases", sub: true, color: C.red },
  { text: "Histological Grading — Modified Bloom-Richardson / Nottingham Score:", bold: true, color: C.teal },
  { text: "Tubule formation + Nuclear pleomorphism + Mitoses → Score 3–9", sub: true },
  { text: "Grade I (3–5): well diff | Grade II (6–7): moderate | Grade III (8–9): poor", sub: true },
]);

// 11. MOLECULAR SUBTYPES TABLE
tableSlide(pres, "Molecular Subtypes of Breast Cancer (Gene Array / IHC)",
  ["Subtype", "ER", "PR", "HER2", "Ki-67", "Prognosis / Notes"],
  [
    ["Luminal A", "Pos", "Pos", "Neg", "Low", "Best prognosis; hormone therapy"],
    ["Luminal B", "Pos", "±", "±", "High", "Intermediate; chemo + hormone Rx"],
    ["HER2-Enriched", "Neg", "Neg", "Pos", "High", "Targeted therapy (Trastuzumab)"],
    ["Triple-Negative (TNBC)", "Neg", "Neg", "Neg", "High", "Worst prognosis; only chemo"],
    ["Luminal B HER2+", "Pos", "±", "Pos", "High", "Chemo + hormone + targeted Rx"],
    ["Normal-like", "Pos", "Pos", "Neg", "Low", "Similar to Luminal A"],
  ]
);

// 12. SECTION — CLINICAL FEATURES
sectionDivider(pres, "Clinical Features & Spread");

// 13.
twoColSlide(pres, "Clinical Features of Breast Carcinoma",
  "Local Symptoms", [
    "Hard, painless, irregular lump (most common)",
    "Skin changes: dimpling, peau d'orange, ulceration",
    "Nipple changes: retraction, discharge (blood-stained), eczema (Paget's disease)",
    "Fixity: skin or deep to chest wall",
    "Inflammatory: erythema, warmth, oedema (≥1/3 breast)",
    "Most common site: Upper Outer Quadrant (40–50%)",
  ],
  "Spread & Distant Metastases", [
    "Lymphatic: axillary (most common), internal mammary, supraclavicular",
    "Haematogenous spread (BOLS mnemonic):",
    "  Bone (most common — lytic / sclerotic)",
    "  Ovary / Organs (liver)",
    "  Lung",
    "  Skin / Brain",
    "Bone metastases: pain, pathological fracture, hypercalcaemia",
    "Virchow's node: left supraclavicular LN — late sign",
  ]
);

// 14. SECTION — INVESTIGATIONS
sectionDivider(pres, "Investigations — Triple Assessment");

// 15.
contentSlide(pres, "Triple Assessment (Gold Standard Diagnostic Approach)", [
  { text: "1. Clinical Examination", bold: true, color: C.teal },
  { text: "History + systematic breast examination (inspection + palpation)", sub: true },
  { text: "2. Imaging", bold: true, color: C.teal },
  { text: "Mammography: first-line imaging; microcalcifications suggest DCIS; 2-view (CC + MLO)", sub: true },
  { text: "Ultrasound: best for young / dense breasts; cystic vs solid; guides biopsy", sub: true },
  { text: "MRI Breast: highest sensitivity; for BRCA+, dense breasts, neoadjuvant response assessment", sub: true },
  { text: "3. Pathological (Tissue Diagnosis)", bold: true, color: C.teal },
  { text: "FNAC: cytology (C1–C5 scale); quick but no architecture assessment", sub: true },
  { text: "Core Needle Biopsy (CNB): preferred — histology, ER/PR/HER2 status, grade", sub: true },
  { text: "Excision biopsy: diagnostic + therapeutic", sub: true },
  { text: "Metastatic Work-up (for Stage III/IV or symptomatic):", bold: true, color: C.teal },
  { text: "CT chest/abdomen/pelvis + Isotope bone scan", sub: true },
  { text: "PET-CT (18F-FDG): sensitive for distant disease", sub: true },
  { text: "Blood: LFTs, bone profile (ALP), FBC, tumour markers (CA 15-3)", sub: true },
]);

// 16. SECTION — STAGING
sectionDivider(pres, "TNM Staging");

// 17. T STAGE
tableSlide(pres, "TNM Staging — Tumour (T) & Node (N) Classification (AJCC 8th Ed.)",
  ["Stage", "T Description", "N Description"],
  [
    ["Tis", "DCIS / Paget's (no invasive)", "Nx — cannot assess"],
    ["T1 (≤2cm)", "T1mi ≤1mm | T1a 1–5mm | T1b 5–10mm | T1c 10–20mm", "N0 — No nodal mets"],
    ["T2", "Tumour >2 cm to ≤5 cm", "N1 — Mobile ipsilateral axillary LN"],
    ["T3", "Tumour >5 cm", "N2 — Fixed axillary LN OR internal mammary"],
    ["T4a", "Extension to chest wall", "N3 — Infra/supraclavicular OR IM+axillary"],
    ["T4b", "Skin involvement (peau d'orange / ulcer)", ""],
    ["T4c", "Both T4a + T4b", ""],
    ["T4d", "Inflammatory breast cancer", "M1 — Distant metastases"],
  ]
);

// 18. STAGE GROUPING
tableSlide(pres, "Stage Grouping & Approximate 5-Year Survival",
  ["Overall Stage", "T", "N", "M", "5-yr Survival"],
  [
    ["Stage 0", "Tis", "N0", "M0", "~99%"],
    ["Stage I", "T1", "N0", "M0", "~99%"],
    ["Stage IIA", "T0–T2", "N0–N1", "M0", "~86%"],
    ["Stage IIB", "T2–T3", "N1–N0", "M0", "~73%"],
    ["Stage IIIA", "T3", "N1–N2", "M0", "~57%"],
    ["Stage IIIB", "T4", "N0–N2", "M0", "~49%"],
    ["Stage IIIC", "Any T", "N3", "M0", "~40%"],
    ["Stage IV", "Any T", "Any N", "M1", "~27%"],
  ]
);

// 19. SECTION — SURGERY
sectionDivider(pres, "Surgical Treatment");

// 20. MASTECTOMY TYPES
contentSlide(pres, "Types of Mastectomy", [
  { text: "1. Radical Mastectomy (Halsted — HISTORICAL)", bold: true, color: C.red },
  { text: "Breast + skin + pec major + pec minor + all axillary LN (levels I–III)", sub: true },
  { text: "Abandoned: causes shoulder deformity, lymphoedema, no survival benefit over MRM", sub: true },
  { text: "2. Extended Radical Mastectomy", bold: true, color: C.red },
  { text: "Halsted + internal mammary LN dissection — rarely used", sub: true },
  { text: "3. Modified Radical Mastectomy (MRM) — PATEY's / Scanlon's", bold: true, color: C.teal },
  { text: "Entire breast + skin + NAC + axillary LN (levels I–III) — BOTH pectorals preserved (Patey preserves pec major, removes pec minor)", sub: true },
  { text: "STANDARD operation for operable breast cancer requiring mastectomy", sub: true },
  { text: "4. Simple / Total Mastectomy", bold: true, color: C.teal },
  { text: "Entire breast only — no axillary dissection; used for DCIS, prophylactic mastectomy", sub: true },
  { text: "5. Skin-Sparing Mastectomy (SSM)", bold: true, color: C.navy },
  { text: "Breast + NAC removed, skin envelope preserved; for immediate reconstruction", sub: true },
  { text: "6. Nipple-Sparing Mastectomy (NSM)", bold: true, color: C.navy },
  { text: "Entire breast removed, skin + NAC preserved; tumour >1 cm from skin, >2 cm from nipple", sub: true },
]);

// 21. BCS
contentSlide(pres, "Breast Conservation Surgery (BCS / Lumpectomy / Wide Local Excision)", [
  { text: "Definition: Removal of tumour with 1-cm clear margin of normal breast tissue", bold: true, color: C.teal },
  { text: "BCS + Radiotherapy = Breast Conservation Therapy (BCT)", bold: true, color: C.navy },
  "SSO-ASTRO-ASCO guidelines (2014): 'No ink on tumour' is sufficient margin for early invasive cancer",
  { text: "Indications:", bold: true, color: C.teal },
  { text: "T1 / T2 tumours (<4 cm, suitable breast size), unicentric, no diffuse microcalcifications", sub: true },
  { text: "Patient preference and motivated for RT", sub: true },
  { text: "Contraindications:", bold: true, color: C.red },
  { text: "Multicentric tumour | Diffuse microcalcifications on mammogram", sub: true, color: C.red },
  { text: "Large tumour-to-breast ratio | Positive margins after 2 re-excisions", sub: true, color: C.red },
  { text: "Prior breast/chest wall radiation | SLE or other collagen vascular disease", sub: true, color: C.red },
  { text: "Pregnancy (relative — radiation contraindicated)", sub: true, color: C.red },
  { text: "BRCA1/2 (relative — high risk of second primary)", sub: true, color: C.red },
  "Specimen orientation: Long suture = Lateral; Short suture = Superior (important for margin assessment)",
  "ALL BCS patients MUST receive adjuvant whole-breast radiotherapy",
]);

// 22. AXILLARY MANAGEMENT
contentSlide(pres, "Axillary Management", [
  { text: "Sentinel Lymph Node Biopsy (SLNB) — Standard of Care for Clinically Node-Negative", bold: true, color: C.teal },
  { text: "Technique: Inject 99mTc-labelled nanocolloid + Patent Blue V dye periareolar/peritumoral", sub: true },
  { text: "Identify first draining (sentinel) node — frozen section / touch imprint cytology intraoperatively", sub: true },
  { text: "If SLN negative: no further axillary surgery (avoids ALND and its morbidity)", sub: true },
  { text: "If SLN positive (1–2 nodes): ACOSOG Z0011 trial — ALND may be omitted if BCT planned", sub: true },
  { text: "Axillary Lymph Node Dissection (ALND) — Indications:", bold: true, color: C.teal },
  { text: "Clinically positive axilla (confirmed by FNA/core biopsy)", sub: true },
  { text: "SLN positive with >2 macro-metastases or mastectomy patient", sub: true },
  { text: "Inflammatory breast cancer; locally advanced disease", sub: true },
  { text: "Standard: Level I + II dissection; Level III if grossly positive", sub: true },
  { text: "Complications of ALND:", bold: true, color: C.red },
  { text: "Lymphoedema (most common long-term complication): compression garments, physio, MLD", sub: true, color: C.red },
  { text: "Seroma | Nerve injury (long thoracic, thoracodorsal, ICBN) | Shoulder stiffness", sub: true, color: C.red },
]);

// 23. NEOADJUVANT / ADJUVANT
sectionDivider(pres, "Adjuvant & Neoadjuvant Therapy");

// 24.
contentSlide(pres, "Neoadjuvant & Adjuvant Systemic Therapy", [
  { text: "Neoadjuvant (Pre-operative) Chemotherapy — Indications:", bold: true, color: C.teal },
  { text: "Locally advanced / inflammatory breast cancer (Stage III, T4)", sub: true },
  { text: "Large tumour where BCS is desired — to downstage for conservation", sub: true },
  { text: "HER2+ and TNBC (most responsive to NACT)", sub: true },
  { text: "Pathological Complete Response (pCR): absence of invasive tumour in breast + nodes after NACT", sub: true },
  { text: "Regimens: Anthracycline + Taxane-based (AC-T); Add Trastuzumab/Pertuzumab for HER2+", sub: true },
  { text: "Adjuvant Chemotherapy:", bold: true, color: C.teal },
  { text: "Given post-surgery; reduces systemic micrometastases", sub: true },
  { text: "Indications: node-positive, TNBC, HER2+, high-grade tumours", sub: true },
  { text: "Hormonal (Endocrine) Therapy:", bold: true, color: C.teal },
  { text: "ER/PR positive tumours", sub: true },
  { text: "Tamoxifen (SERM): pre- and post-menopausal women — 5–10 years", sub: true },
  { text: "Aromatase Inhibitors (Letrozole, Anastrozole, Exemestane): post-menopausal only", sub: true },
  { text: "Targeted Therapy:", bold: true, color: C.teal },
  { text: "Trastuzumab (Herceptin): monoclonal Ab against HER2 — HER2+ cancers — 1 year", sub: true },
  { text: "Pertuzumab: added to Trastuzumab for HER2+ metastatic / neoadjuvant", sub: true },
  { text: "Olaparib / Niraparib (PARP inhibitors): BRCA1/2-mutated metastatic breast cancer", sub: true },
]);

// 25. RADIOTHERAPY
contentSlide(pres, "Radiotherapy in Breast Cancer", [
  { text: "Post-BCS Whole Breast RT (MANDATORY after all BCS):", bold: true, color: C.teal },
  { text: "50 Gy in 25 fractions (conventional) OR 40 Gy in 15 fractions (hypofractionation)", sub: true },
  { text: "Reduces local recurrence rate by ~50–70%", sub: true },
  { text: "Post-Mastectomy RT (PMRT) — Indications:", bold: true, color: C.teal },
  { text: "T3/T4 tumours (>5 cm)", sub: true },
  { text: ">4 positive axillary nodes OR extranodal extension", sub: true },
  { text: "Inflammatory breast cancer (ALWAYS after MRM + NACT)", sub: true },
  { text: "Close or positive surgical margins after mastectomy", sub: true },
  { text: "Intraoperative RT (IORT) / Partial Breast Irradiation:", bold: true, color: C.navy },
  { text: "Selected low-risk patients; single dose at time of surgery", sub: true },
  { text: "Regional Nodal Irradiation:", bold: true, color: C.navy },
  { text: "Supraclavicular and internal mammary nodes for high-risk nodal disease", sub: true },
  { text: "Radiation Complications:", bold: true, color: C.red },
  { text: "Skin reaction, pneumonitis, rib fracture, lymphoedema, cardiac toxicity (left-sided)", sub: true, color: C.red },
]);

// 26. SECTION — PROGNOSIS
sectionDivider(pres, "Prognosis & Follow-up");

// 27.
twoColSlide(pres, "Prognostic Factors & Follow-up",
  "Prognostic Factors", [
    "POSITIVE (good): Small tumour size (T1), Node-negative (N0), Grade I, ER/PR+, HER2- (Luminal A), Low Ki-67, No LVI",
    "NEGATIVE (poor): Large tumour, Node-positive, Grade III, TNBC, HER2+ (untreated), High Ki-67, Lymphovascular invasion",
    "Multigene assays: Oncotype DX (21-gene), MammaPrint (70-gene) — guide chemo decision in N0 ER+",
    "pCR after NACT = excellent prognosis predictor",
    "Overall 5-yr survival: Stage I ~99%, Stage IV ~27%",
  ],
  "Follow-up Schedule", [
    "1st 2 years: Every 3–4 months",
    "Years 3–5: Every 6 months",
    "After 5 years: Annually",
    "Annual mammogram (bilateral or contralateral)",
    "Check for local recurrence, contralateral breast",
    "Monitor for tamoxifen / AI side effects",
    "Monitor for lymphoedema — physio referral",
    "BRCA positive: consider prophylactic contralateral mastectomy discussion",
    "Bone density monitoring (on AI therapy)",
  ]
);

// 28. SPECIAL SITUATIONS
contentSlide(pres, "Special Situations in Breast Cancer", [
  { text: "Inflammatory Breast Cancer:", bold: true, color: C.red },
  { text: "Acute onset erythema + oedema (peau d'orange) ≥1/3 breast; dermal lymphatic invasion", sub: true },
  { text: "Treatment: NACT → MRM + ALND → PMRT (NO BCS; NO immediate reconstruction)", sub: true },
  { text: "Breast Cancer in Pregnancy (PABC):", bold: true, color: C.teal },
  { text: "MRM preferred; BCS after 1st trimester; RT deferred until after delivery", sub: true },
  { text: "Chemo safe after 1st trimester (avoid methotrexate, avoid trastuzumab)", sub: true },
  { text: "Male Breast Cancer:", bold: true, color: C.teal },
  { text: "~1% of all breast cancers; usually ER/PR positive; presents later", sub: true },
  { text: "MRM is standard; tamoxifen for adjuvant hormone therapy", sub: true },
  { text: "Paget's Disease of Nipple:", bold: true, color: C.navy },
  { text: "Eczematous change of nipple-areola complex; 90% associated with underlying DCIS or invasive Ca", sub: true },
  { text: "Biopsy: Paget cells (large pale vacuolated cells) on histology", sub: true },
  { text: "Locally Advanced Breast Cancer (LABC) / Stage III:", bold: true, color: C.navy },
  { text: "NACT → surgery (MRM preferred) → PMRT; multidisciplinary team essential", sub: true },
]);

// 29. KEY MNEMONICS
contentSlide(pres, "Key Mnemonics & Exam Points", [
  { text: "Sites of haematogenous metastasis — 'BOLS':", bold: true, color: C.teal },
  { text: "Bone | Ovary/Organs (liver) | Lung | Skin/Brain", sub: true },
  { text: "Nerves at risk in axillary dissection:", bold: true, color: C.teal },
  { text: "Long thoracic n. (Bell) → winged scapula; Thoracodorsal n. → weak adduction; ICBN → arm numbness", sub: true },
  { text: "Contraindications to BCS — 'SLIM Dr.':", bold: true, color: C.teal },
  { text: "SLE | Large tumour-breast ratio | Irradiated before | Multicentric | Diffuse DCIS | Recurrence post-BCS", sub: true },
  { text: "Triple Assessment = Clinical + Imaging + Pathology (all 3 must agree!)", bold: true, color: C.navy },
  { text: "Margin Rule (SSO-ASTRO 2014): 'No ink on tumour' = adequate for invasive cancer + WBI", bold: true, color: C.navy },
  { text: "MRM = Modified Radical Mastectomy — preserves BOTH pectorals (Patey: removes pec minor)", bold: true, color: C.navy },
  { text: "SLNB technique: Blue dye (Patent Blue V) + Radioisotope (99mTc nanocolloid)", bold: true, color: C.navy },
  { text: "Tumour markers: CA 15-3 (monitoring), CEA (metastatic disease) — NOT for screening", bold: true, color: C.red },
  { text: "DCIS margin: 2 mm required; Invasive cancer: 'no ink on tumour' sufficient (with WBI)", bold: true, color: C.red },
]);

// 30. CONCLUSION
const s30 = pres.addSlide();
s30.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
s30.addShape(pres.ShapeType.rect, { x: 0, y: 0.85, w: 10, h: 0.1, fill: { color: C.gold } });
s30.addShape(pres.ShapeType.rect, { x: 0, y: 4.85, w: 10, h: 0.1, fill: { color: C.teal } });
s30.addText("Summary & Key Takeaways", {
  x: 0.3, y: 0.1, w: 9.4, h: 0.7, fontSize: 24, bold: true, color: C.gold, fontFace: "Calibri", align: "center"
});
const summaryPoints = [
  { text: "Most common cancer in women; multimodal treatment is the standard", options: { bullet: true, fontSize: 15, color: C.white, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "Triple assessment (Clinical + Imaging + Pathology) is the gold standard workup", options: { bullet: true, fontSize: 15, color: C.white, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "TNM staging (AJCC 8th Ed.) guides treatment planning", options: { bullet: true, fontSize: 15, color: C.white, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "MRM is standard surgery; BCS + RT = BCT for early disease — equivalent survival", options: { bullet: true, fontSize: 15, color: C.gold, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "SLNB has replaced routine ALND in clinically node-negative patients", options: { bullet: true, fontSize: 15, color: C.gold, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "Adjuvant therapy determined by ER/PR/HER2 status and molecular subtype", options: { bullet: true, fontSize: 15, color: C.light, fontFace: "Calibri", breakLine: true, paraSpaceAfter: 5 } },
  { text: "MDT approach essential for all patients with breast cancer", options: { bullet: true, fontSize: 15, color: C.light, fontFace: "Calibri", breakLine: false, paraSpaceAfter: 5 } },
];
s30.addText(summaryPoints, { x: 0.5, y: 1.1, w: 9, h: 3.6, valign: "top", margin: 6 });
s30.addText("Sources: Bailey & Love's Surgery 28e | Sabiston Textbook of Surgery | Schwartz's Principles of Surgery 11e", {
  x: 0.3, y: 5.0, w: 9.4, h: 0.45, fontSize: 11, color: C.gray, fontFace: "Calibri", align: "center", italic: true
});

// ─── WRITE FILE ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/breast-cancer-ppt/Carcinoma_Breast_Surgery_MBBS.pptx" })
  .then(() => console.log("SUCCESS: PPT saved"))
  .catch(e => console.error("ERROR:", e));